The nursing home visit is probably the most important step in selecting the right nursing home. A visit provides you with an opportunity to talk to nursing home staff, and more importantly, with the people who live and receive care at the nursing home.
When you visit the nursing home, you will probably be given a formal tour. While this may be a very useful introduction to the home, it is important that you are not overly influenced by a guided tour. When the tour is over, return to some of the places where staff members are caring for residents. Be ready to ask the staff members questions about their jobs and how they feel about their jobs and how they feel about caring for people with so many different needs. The Facility Evaluation Checklist gives you some more ideas on questions to ask.
Near the beginning of your visit, spend time examining the nursing home’s most recent survey inspection report. By law, this report must be posted in the nursing home in an area that is accessible to visitors and residents. Surveyors compile a survey report that lists areas in which the nursing home has been cited for deficient practices. Keep these deficiencies in mind as you visit the nursing home, and see whether the home has corrected them. Over the last decade, different laws and regulations have been enacted to raise the standards of nursing home care, particularly with respect to quality of life. The law requires that residents receive the necessary care and services that will enable them to reach and maintain their highest practicable level of physical, mental and social well-being. In addition, civil rights law ensures equal access in all nursing homes regardless of race, color or national origin. Ask residents questions about the nursing home. Learn what they like and what their complaints are. Ask visitors or volunteers similar questions.
All nursing homes that are certified to participate in the Medicare or Medicaid programs are visited by a team of trained state surveyors approximately once a year. These surveyors (like inspectors) examine the home over several days and inspect the performance of the nursing home in numerous areas – including quality of life and quality of care. At the conclusion of the survey, the team reports its findings. Nursing homes with deficiencies may be subject to fines and other penalties if they are not corrected. Spend some time at Medicare's Nursing Home Compare website. The tool has detailed information about every Medicare and Medicaid-certified nursing home in the country.
When visiting nursing homes, pay special attention to quality of life issues. People who are admitted into nursing homes do not leave their personalities at the door. Nor do they lose their basic human needs for respect, encouragement and friendliness. All individuals need to retain as much control over the events in their daily lives as possible.
Nursing home residents should have the freedom and privacy to attend their personal needs—from managing their own finances (if mentally able) to decorating their room with favorite items. They should also be able to participate in their care planning and retain the right to examine their medical records. Residents may only be restrained when medically necessary. Most importantly, staff must always respect the dignity of each individual resident.
To check to see if the nursing home respects the dignity of each individual, look into these questions:
- Are staff members courteous to residents and is the home’s management responsive to concerns raised by residents?
- Does the nursing home provide a variety of activities and allow residents to choose the activities they want to attend?
- Does the nursing home provide menu choices or prepare special meals at the request of residents? (Sample the food if possible.)
- Are family members encouraged to visit, and are they allowed to visit in privacy when requested?
The Facility Evaluation Checklist lists other topics you should consider when assessing whether the nursing home is sensitive to quality of life.
Unless you have a medical or social work background, it might be difficult to assess how well the nursing home provides high quality health care to its residents. However, there are still a number of actions you can take to evaluate whether the home is providing high quality health care.
- Check the survey report and see if the home was cited for deficient practices in any quality of care areas.
- Ask about the home’s staffing, and ask residents if the staff are available when needed. Make sure that you are comfortable with the number of residents assigned to each nurse and nurse aide. Be aware that there might be less staff at night or on weekends.
- If you have any special care needs (e.g. dementia, ventilator dependency), it is generally a good idea to make sure the home has experience working with people who have the same condition.
- Even if you have a trusted doctor, ask about the nursing home’s physician and how often he or she visits the home. Since the home’s doctor maybe called in emergencies, you should be confident that the home’s doctor can take care of resident needs.
By law, nursing homes must complete a comprehensive assessment for every new resident within two weeks of admission. The home also must complete a care plan designed to help each resident reach or maintain his/her highest level of well-being. Ask the home about its care planning process and make sure you agree with the home’s philosophy. Remember that residents who have meaningful activities and are as independent as possible are generally better able to maintain health.
The Facility Evaluation Checklist is available for downloading. Make copies of this checklist so you can fill out a separate checklist for each nursing home you visit. As you visit several homes, it might become difficult to keep all your observations straight, so fill out the checklist shortly after each visit. Blank spaces have been left at the bottom of the page for you to add your own concerns. If you have any gut feelings or additional observations, write them down also. After visiting several homes and filling out the checklist, you should be ready to decide on a short list of homes that might be a good choice for you or your relative.
You should visit the nursing homes on your short list at least one more time (or as many additional times as you think necessary). Make sure you see the home at least once in the evening and/or on a weekend because staffing is frequently different at these times. Also, your follow-up visit should include attending a meeting of the nursing home’s resident council and/or family council. These meetings will give a unique look at the concerns of the residents and/or their families. If the nursing home does not have resident or family councils, that might tell you something about the philosophy of the home’s management.
Follow-up visits should be conducted at different times of the day than your first visit. Be sure at least one of your visits was during the late morning or midday, so you can observe residents when they are out of bed, eating, and attending activities. Continue to ask questions, and take special note of the differences between the nursing homes on your short list.
After your follow-up visits, you should be able to narrow your short list down to a few nursing homes. At this point, it still may be difficult to pick one. If you have additional questions, do not hesitate to contact or visit the nursing home again.
You should now be ready to select the nursing home that is best able to meet your needs. The final decision may still be difficult, and it is possible that more than one nursing home will be a good choice. However, you should now have enough information to be confident you are making the wisest possible choice.
The above is adapted from information provided by the US Centers for Medicare & Medicaid Services.