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In an environment where more and more elderly are entering into nursing home situations, family members should look closely at their choices of which home and which company to pick. Many articles have been written about what criteria family members should use. Some of the suggestions that I have read have included touring the facilities, to look on walls for accreditdations and awards, to review recent government survey results (which are required to be available for public review), to ask questions about what insurance cover what services, and of course to pay attention to your own initial gut impressions. What I have not read too much about is how the actual residents feel about living there. What concerns and what complaints do they have about a particular home?
I have worked directly in the nursing-home industry for more than ten years. Usually about once a month I attend meetings conducted by the facility's Resident Counsel. These are meetings where nursing home administration and staff get to announce new programs and news concerning residents and where residents themselves get to address problems, concerns, or make requests for some changes.
Listed below by departments are some more common complaints presented by residents to administration. In Italics, I suggest some ways that family members can discover these issues while still researching their choices and as they tour each candidate facility.
Related To Nursing Care:
Shower rooms and bathrooms are not kept clean by staff. Briefs, gloves, soiled towels, and dirty clothes are left behind on the floor. This makes the bathroom experience very uncomfortable for the next user.
Ask to see a Central Shower Room and a Resident's bathroom. Step inside and look around.
During resident showers and baths, privacy curtains may be pulled, but the main door to the hallway is sometimes left open. This tends to create a draft that makes residents very cold.
Try to tour facilities early morning as residents are being dressed and made ready for the day. Nine or ten o'clock are good times for this example.
When changing beds, nursing assistants often leave soiled linens on floors or overbed tables instead of depositing them into their proper containers.
Early morning tours also tend to show these discrepancies as well.
Beds are sometimes made to tight which makes it difficult for the elderly to get in bed.
Look at a freshly made up room, feel the beds.
Sheets on beds don't always get changed daily, sometimes leaving residents sleeping with unpleasant odors or in wet beds.
Some of this may be noticeable as you to tour. Look into all of rooms as you pass by them.
Call bells are not answered promptly. Or, residents are occasionally told, " That's not my job ", instead of, " I'll try to find someone that can help you."
Chances are that no matter when you tour, a call bell will be lit and ringing. How are the nurses and other facility staff behaving?
Residents whom wear briefs are not always changed on a regular basis, leaving them uncomfortable for several hours.
Hard to tell, but if you tend to notice several smelly residents, or several that look uncomfortable, then that may be a sign that something is not right.
Some types of disposable briefs are not very effective.
Again, odors and level of comfort are good indicators.
Soiled briefs sometimes get thrown into trashcans rather than the proper containers with lids. This leads to real bad odors in their rooms.
This can be easily observed as you peak into resident's rooms on the way down main hallways. Slow the tour guide down if they walk too fast for you.
When serving meals in dining rooms, if music is available, many times it is not the variety that older folks appreciate. This can tend to make a meal very unpleasant.
When you visit the dining room, what do you hear? If a radio is visible, try to notice where the tuning dial appears to be set. Is that about right for the type of music that an older person might listen?
During meal service residents who choose to eat in their rooms, but require assistance don't always get that assistance due to shortages of available staff. Often too many aides are assigned to the central dining rooms leaving only a skeleton crew to care for individuals left behind.
If visiting at a meal hour, how many aides do you count attending to residents in rooms? How many aides appear to be in dining rooms?
When residents do eat in dining rooms, many times the servers are not very accommodating. Some may even get to be a little rude.
If possible say, "Hello" to staff as you pass them by. Do they acknowledge and return your jester, or just keep moving like they don't hear you?
Residents prefer fresh ice and water every few hours. Some facilities may only distribute water once a day.
Look inside rooms, water cups and pitchers should be out in the open and very obvious, especially if they were recently placed there. If present, is ice fresh or melted?
Nurses are not always careful about distribution of medications. Residents may not remember every name of every medicine, but they do remember things like eye drops, creams, colors of pills, how many pills, and the order in which they should be given.
Sometimes this shows up as a State Deficiency, especially if it happens frequently. Check the state reports for indications of this sort of problem.
When residents are involved with room changes, many residents prefer to move during daytime hours. Some facilities tend to move people around at night or at odd times. This tends to be inconvenient for the residents.
Ask your tour guide about the facility's policy and procedures regarding room changes.
Evening care and weekend care is not always as good as week day care. This means that not enough assistance is provided during those hours. Residents are left to fend for themselves and sometimes don't get what they need.
If possible, try to visit on the weekend. Take a second look during evening hours. Ask your guide about the different shifts and their staff to resident ratios.
Related To Dietary Services:
In the mornings, for breakfast, coffee tends to be cold.
Breakfast meals tend to be soggy or watery.
Bacon tends to be too fatty or frequently burned.
Bread tends to be hard or stale.
Lunch and dinner vegetables are not always cooked enough.
If you get the opportunity to speak to one or more of the residents, ask about the food that they eat. If visiting during meal hours try to notice the quality of the food. Ask your tour guide to walk you past the kitchen. Try to observe the workers preparing the food.
Silverware is not always appropriate for the meal served such as no soup spoons for soup, no salad forks or salad, and so on.
Frequently, silverware shows residue form last meal eaten.
Condiments are not always available.
When touring one or more dining rooms, ask your tour guide the specific way that food is served, i.e. restaurant style or assisted feeding. Look around the room. Pick up and look at silverware. Ask about how condiments are served. What do you notice?
Dietary staff doesn't always follow tray card information. This means that residents don't always get proper food for their individual diets.
Ask your guide about diet accuracy. If possible ask that resident that you spoke to about whether his / her food gets served the way that they like it to be. More serious problems in this area are noted on the official state reports.
Food presentations are not always appetizing.
Look at the food. What do you think?
Alternative requests take too long to arrive at the resident's room.
Ask your representative about what happens when something is wrong with the meal service? Ask how long does it normally takes for a replacement meal to be sent to a resident's room?
Meal service scheduled for specific times are frequently late.
Ask about the meal service time schedule.
Dining room tablecloths tend to be soiled or not wiped thoroughly between meals.
This is an easy thing to pay attention to when you tour a dining room. Do not just look at the top surfaces, look for dirt down the sides and on chairs where people actually sit.
Some facilities do not provide residents with menus or even post menus so residents can be aware of what meal choices are available. Last minute changes are also not posted or announced. Residents are aware that they may not wish to eat everything served, so they prefer to pick and chose their individual preferences.
When touring the nursing home ask to see that day's meal plan. Ask about where it is posted. If you ask for a copy of the day's menu and your guide hands you one to take with you, then that facility probably has a good policy in place so that interested parties can easily get the information that they need to plan their meals.
Relating To Activity Programs:
Residents enjoy activities that are held in outside courtyards. This is not done too often in some places.
Is the courtyard easily accessible? Are tables, chairs, and umbrellas ready for resident's use? Ask to visit the courtyard and step outside into it.
Some facilities do not provide sufficient activities in the evenings and on weekends.
If touring a facility during "off business" hours, you can see first hand the level of activity. Always ask for a copy of the "Activities Schedule" to take home with you. Look it over to determine if their level and frequency will satisfy your loved one's social routine.
Residents sometimes feel that they don't get enough small group discussions that focus on current events. They feel a bit lost from what's going on the outside.
What level of small groups (clicks) did you notice as you toured the facility? Look over the "Activities Schedule" to see if there are discussion groups scheduled.
Relating To Environmental Services And Conditions:
Residents sometimes experience little fruit flies in their rooms. This is usually an indication that garbage and trash are not being addressed in a timely fashion.
Do you notice any little flies? How about food or trash just lying on the floor waiting to be picked up?
Holes in window screens also allow flies to enter, especially on warmer days.
Walk over to the windows in whatever rooms you visit. Look at windows and screens. Big holes may mean that a pest control problem is possible. Do you notice any ant traps on floors or windowsills? Ask questions if you are skeptical about what you see.
Maintenance staff or housekeeping staffs are not always available in evenings and on weekends.
Ask your tour guide about company policy regarding those departments and staff. How do you feel that those schedules will affect your loved ones needs and concerns?
Housekeeping staff does not always sweep behind doors, under beds, or dust all areas inside the resident's room. This tends to be a bigger problem on weekends when staffing may be extremely short handed.
Look all around the rooms visited for effective housekeeping. Look behind doors, under beds, and check dusting on high areas to see what is getting missed. Dirt tends to become obvious when not tended too properly.
Umbrellas for outside courtyard tables tend to be missing or not available for warmer days when residents wish to sit for a while outdoors. Most elders do prefer shade to direct sunlight.
This gets back to review of the courtyard and other outside areas. What areas were ready for residents to use?
Inside the building, handrails tend to be loose, dirty, or have trash on them (between wall and handrail). Residents use handrails frequently to get up and down hallways. No one likes to touch dirt or someone else's trash.
Touch and pay attention to handrails as you initially tour each candidate facility.
Relating To Laundry Services:
Personal clothes are not picked up and washed frequently enough leading to overflowing hampers, odors in rooms, and occasionally residents looking for a piece of clothing that is still at the bottom of the hamper.
Did you notice overflowing bins of laundry inside resident's rooms waiting to be picked up for cleaning?
Towels, washcloths, and sheets may be too rough for resident's skin. This is usually caused by the choice of chemical agents utilized by laundry supervisors or nursing home administration.
Ask to look inside a clean linen closet or linen cart. Touch the towels, washcloths, and sheets. Do they feel rough?
Residents don't always have sufficient amounts of towels, washcloths, sheets, or blankets. This can pose a real inconvenience or even chills to a resident. This is frequently connected to poor inventory control policies by the facility.
Your look inside a closet or cart would have revealed the abundance of supplies. What types of linens were available if you were giving care to your loved one and you needed something?
Other More Generalized Concerns:
Sometimes aggressive wanderers (Dementia Residents) wander into resident rooms causing scare or inconvenience to the more quiet residents.
Ask your guide about facility policy and how your nurses handle such situations.
Residents don't appreciate when staff displays rudeness or arrogance when asked for help. This demonstrates a lack of respect.
How do facility staff members, other than your tour guide, treat you as a visitor as you pass them by in the hall or on your way in and out of the building? If they seem friendly, then maybe that's a good sign that they care about their job, duties, and responsibilities.
Money or personal items sometimes disappear from resident rooms.
Ask your tour guide about facility responsibility when items disappear. What is the company's policy regarding replacement? Are locks and keys made available to residents and their families?
Frequently, residents experience long delays when staff have been presented with a problem and promise to respond.
Ask your tour guide about problem resolution techniques, procedures, and time frames. What is the routine "chain of command"? Who will be responsible for contacting responsible family members before the complaint gets out of control?
Residents prefer when staff wears nametags to identify whom they are. Residents realize that they don' know all the staff members, and even if they remember a face, they can't always remember names. Also they do get embarrassed when they go up to someone asking for help, then that stranger replies, " I don't work here, I'm just visiting."
Do staff usually wear name badges and are they easily identified by a first time visitor such as yourself. For many residents, with their impairments on short-term memory, every day, looking for help is a new experience.
While this article does not address every possible concern, I felt that I could present a nice cross section of more common problems and complaints in order to make suggestions as to what to look for before your loved one gets stuck in a bad situation. I hope that this information has been helpful.
Copyright 1998, 2001, By Bob Singer, BS, NHA, PCHA, Author.
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