The decision to place a loved one in a nursing home is one of the most difficult tasks a family member
Prospective residents and their families should have the best information possible to make
this decision. The purpose of this article is to help guide you in making an informed choice.
CONDUCT YOUR OWN INVESTIGATION
Once it is certain that nursing home care is necessary, determine which qualities of a nursing home are most important for meeting the needs and expectations of the resident. Each nursing home in your area will have unique strengths and weaknesses. Some issues to consider when evaluating your choices include quality of care, bed availability, provision of services that the resident will need, cost, quality, and location in an area where friends and family of the resident can visit often. It is critically important that you visit any facility on your list. Speak with other residents and families. Take a look at staffing levels on weekends or evenings – all of these first-hand observations are critically important. We have attached to this article a rating guide or checklist for your use as you survey each nursing home facility.
Look to the Experts:
Long Term Care Ombudsmen and Citizen Advocacy Groups
A state or local Ombudsman and/or citizen advocacy group can assist you in piecing together the different sources of information to make an informed decision about nursing home care. To find your Long-Term Care Ombudsman, go to the National Citizens Coalition for Nursing Home Reform (NCCNHR) website at www.nursinghomeaction.org and click on the button labeled “Ombudsmen.”
- Educates consumers and long term care providers about residents’ rights and good care practices
- Provides information to the public on nursing homes and other long term care facilities and services, residents’ rights, and legislative and policy issues
- Investigates complaints and advocates for residents’ rights and quality care in nursing homes, personal care, residential care and other long term care facilities
- Will be familiar with the homes in your area and often with the staff and residents who reside in them.
- The Ombudsman can help you find and interpret information from state inspection reports (discussed below) and the resident characteristics or quality measures.
- Many states and/or communities have active Citizen Advocacy Groups that are knowledgeable about nursing homes and can be very helpful in evaluating advice and information you receive. To find a local citizen advocacy group go to the NCCNHR website at www.nursinghomeaction.org and click on the button labeled “Citizen Groups.”
NURSING HOME COMPARE WEBSITE
Nursing home data is provided by the federal government through the Nursing Home Compare web site found at: www.medicare.gov/NHCompare/home.asp. On this site, you can search for nursing homes by state, county, city, or zip code, and as of Jan. 2009, you can sort nursing homes by a 5 star rating system, 5 being the best, 1 the worst.
Once you have selected the nursing facility or facilities, you are given the option of viewing several different types of information including facility inspection, staffing level, and quality measure information. Below are consumer tips on how – and how not – to use each of these sources of information.
The Nursing Home Compare web site also provides information about the hours of nursing care provided at each facility. Staffing levels are a critically important factor to consider in evaluating the quality of care given at a facility. The information provided on nurse staffing levels includes national and state staffing averages, and the daily average for individual nursing homes.
- Pay attention to the number of Certified Nursing Assistant (CNA) staffing hours. CNAs provide 90% of the hands-on resident care.
- Visit the facility and ask staff and families about the actual numbers of staff available to directly care for residents on each shift.
STATE NURSING HOME INSPECTION REPORTS
Every state has an agency responsible for the regular inspection of its nursing homes. State inspection or “survey” reports contain information about any deficiencies found when inspectors complete their annual inspection of the facility. Inspections take place at least every 9 to 15 months. You can also obtain state inspection reports from the state survey agency, the facility itself, or the long-term care ombudsman. Each facility is required by law to make the latest state inspection report available for examination in a place readily accessible to residents. To look at a summary of state inspection information on ‘Nursing Home Compare’, click on the tab labeled “Inspections.” You may obtain a copy of the inspection reports in Virginia by contacting the Center for Quality Health Care Services and Consumer Protection, 3600 West Broad Street, Suite 216, Richmond, VA 23230-4920.
- Beware of choosing a facility with a very high number of deficiencies compared to other facilities in the area and the state average.
- Don’t assume that a “deficiency free” rating necessarily means that there are no problems with care at a particular facility.
Once your loved one is living in a facility, your continued care, support, love, and involvement in his or her life are absolutely key to getting good care there. Make sure you:
- Visit frequently and encourage others to visit;
- Speak up to raise concerns and compliments;
- Participate in family council meetings if a family council exists, or seek out other family members to organize one;
- Attend quarterly care plan conferences and advocate for individualized care;
- Get to know the staff and help them get to know the resident. Share details about the resident’s likes, dislikes, and daily routines;
- Follow up on the agreed upon care plan. Make sure the resident’s doctor knows what is in the plan. Notice if the plan is not being followed and request another meeting if necessary;
- Make contact with your community’s long term care ombudsman, any local citizen advocacy groups and become familiar with the state and federal laws and regulations that apply to nursing homes and;
- Document (date, time, persons involved) any problems you might observe so that managers, the ombudsman, or state survey agency can investigate