My loved one needs nursing home care. What do I do now?

By: S.Francesconi, editor | Last Updated: 07/27/2010 14:23

When it becomes apparent that nursing home care is something to consider for your loved one, many families become overwhelmed with the task of nursing home selection. Nursing home placement is often one of the most difficult decisions a family must make. Many factors should be considered, particularly the needs and preferences of the individual needing care as well as the health and well being of the primary caregiver. Nursing homes are able to provide 24 hour nursing care, certified nurses’ aides to assist with activities of daily living, consistent nutritious meals, medication monitoring, and regular medical care.

1. Sit down with the key people involved. The person who requires the placement, family members who regularly visit or provide care, and others who are vital to the daily wellbeing of your loved one.

2. Ask each person to identify their priorities for selecting a nursing home. Things that may come up are:

● Distance–
How far is it from home? Can friends easily visit?

● Quality of care–
What is the Medicare rating? What types of public health citations have been given?

● Private room vs. having a roommate/s –
How important is this to the potential resident? How many roommates would the person be comfortable with? Some facilities have up to three or four people in a room.

● Size of facility–
Smaller facilities may be more comfortable for some while larger facilities may be able to provide a broader range of activities.

● Recreation opportunities–
What type of programs are available and do they match the person’s interests?

● Cost–
What type of financial commitment are you comfortable with? If finances are limited, a facility that accepts Medicaid would be best.

● Transportation for visitors who don’t drive–
Is the facility accessible by public transportation? How will someone who doesn’t drive visit?

● Reputation in the community–
Have you heard positives or negatives regarding a facility from friends and other community members?

● Cleanliness of facility–
How is the odor, cleanliness and maintenance of the facility?

● Staff ratio–
Nursing homes do not provide 1 to 1 care, often a C.N.A. cares for 10-20 patients.

● Consistent Staff–
How important is it that staff are consistent, that the same C.N.A. or Nurse will be providing care most (5 of 7) days?

● Types of residents–
Ages, sex, diagnosis. It is important to some people that they will have others at their level to interact with.

● Food–
selection and variety of meal options.

3. Look for similarities between the lists and come up with the top priorities as a group.

4. Obtain a list of local nursing homes. DuPage County Senior Services has a long term care directory, contact 630-407-6500 to request. The Long Term Care Directory is also posted on the DuPage County website (www.dupageco.org) under Senior Services (Human Services). If you are comfortable on the internet, go to www.Medicare.gov and click on Nursing Home Compare. There you will be able to give your Zip code and a radius for a list of nursing homes in your area. Identify 4 nursing homes to start researching, selecting them based on the group criteria.

5. www.Medicare.gov has a Nursing Home Compare section where each facility has a Star Rating between 1 star and 5 stars, with 5 stars being the highest rating available. It also provides detailed information on each facility including size, if they take Medicaid, and results of past Public Health Survery.

6. Contact the identified nursing homes and ask:
● Are you currently accepting residents?
● What is the admission process?
● Do you accept Medicaid? (if finances are an issue)
● When are tours available?

7. Create a list of questions to ask at each facility that highlight the top priorities. Examples of questions are:
● May I see your last public health report? (quality of care)
● How many residents are in a room? Are private rooms available? If yes, is there a cost factor? How do you match roommates? (Private room and roommate issues)
● Do you limit the number of Medicaid residents you allow? (Cost – if finances are an issue)
● How many residents does 1 C.N.A. care for on first and second shifts? (Staff ratio)
● What is your staff turnover? (Consistent Staff)
● What types of residents do you provide care for? (Types of residents)

8. Visit each facility with someone, if possible. It is often recommended that you do not schedule a tour, however, please be prepared to wait a bit until someone is available to speak with you. You may want to schedule a tour so you can save time. Look around when you are touring and ask the questions on your list. Also make notes regarding:
● Is there an overall odor? Incidental odors are expected – however a facility should not smell the minute your walk in.
● Does it look clean and well kept?
● Is it noisy? If yes, why? Are residents yelling and upset?
● Do residents look well cared for? Are they dressed in regular clothing? Is hair combed? Do ladies have make up on?
● What types of activities do you see residents engaged in? Watching TV? Talking in a group? Sleeping?
● Does the staff call residents by their names? Does staff appear happy?

9. After your visits, determine if any of the facilities meet your requirements. If yes, proceed with their application process. If not, go back to the list and pick a few more to evaluate. You may want to have repeated visits to a facility you are considering. If possible, and appropriate, have the individual needing placement tour, as well as other key people.

The decision to place a loved one in a nursing home should not be taken lightly and requires thoughtfulness and an understanding of that individual’s needs and preferences, financial impact, and caregiver support.

Source: Mona Hunter, MSW, LSW

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