To Evaluate a Nursing Home
By KL Winston Ph.D
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Is it conveniently located?
Your loved one may live in a nursing home for several years. If it's too far away, visiting may be a problem. A good facility 10 miles away might be better in the long run than a great facility 105 miles away.
Is it licensed and accredited?
Check the facility's record with local and state regulatory agencies. A stellar record is great, of course, but a facility that has had a few black marks may still be quite good. Ask if the administration has changed since any problems were discovered. Ask how problems have been dealt with. Forget the lobby decor. A nice lobby with artwork, potted plants, and cut flowers is inviting and reassuring. So are gardens, and wood-paneled administrative offices. But residents don't live in the lobby or garden, or the administrative wing.
Focus your attention on the rooms, bathrooms, kitchen, and day rooms. Use your nose. In facilities where many residents are likely to be incontinent, bathroom odors are almost inevitable. However, they should not be overpowering. How does the staff deal with incontinence? Catheters should be a last resort. As you look around, only a few people should have catheter bags attached to their beds or wheelchairs.
Check the menu.
You know your loved one's tastes. Will they mesh with what the facility serves? If your relative has special dietary needs, can they be accommodated? Is food available only during mealtimes? Or is snacking possible?
Check the bathrooms.
Are they clean? Are they equipped with grab bars and other aids your loved one needs?
Ask if staff are trained to dealing with people who have Alzheimer's.
You know the problems your loved one has. Talk with some nurses and ask how they would deal with them. Ask what proportion of residents have Alzheimer's. You don't have to place your loved one in a facility devoted exclusively to Alzheimer's disease, but you want a facility whose staff are experienced in dealing with the condition.
Notice the resident-to-staff ratio.
The lower the ratio, the better the care (usually.) Of course, more staff also mean higher cost. Look for value for your money.
Pay attention to how staff interact with residents.
Number of staff is not the whole story. Do they just sit at the nurse's station? Or are they involved with the residents? Do staff have questions about your loved one? Staff who inquire about the person's likes and dislikes, abilities and problems will probably provide better, more individualized care than staff who treat everyone the same way.
Pay attention to how staff interact with each other.
Happy staff are a good sign of a well-run facility.
Who develops the care plan?
Federal law requires that nursing homes have individual care plans worked out for each resident. Who develops the plan? Can you participate? As your loved one's Alzheimer's disease progresses, how will the care plan change?
Check out the daytime program.
Do residents watch TV all day? Or does the facility have organized activities? People with Alzheimer's disease are generally less agitated--and require less medication and physical restraint--in facilities that have rich programs: music, exercise, bingo, dancing, games, etc.
Look at the room doors.
People with Alzheimer's disease often become hopelessly confused and quite agitated in long corridors with dozens of identical doors. Look for individualized doors with distinctive colors and personal touches. Look for community involvement.
Do clergy, students, and outside volunteers visit the facility?
People with Alzheimer's disease don't do well in crowds of unfamiliar people, but some variety keeps them interested and helps prevent behavior problems.
Ask about visiting policies.
When can you visit? Can you have any privacy with the resident? Can you take the resident off the grounds? The more "open" the facility, the better. In facilities that severely restrict visitation, you wonder what goes on when visiting is prohibited.
Ask how behavior problems are handled.
Has the administration developed written guidelines? If so, do they seem to be followed? Look around and see how many residents are restrained. Sometimes restraint is necessary, but only a small proportion of residents should be restrained.
Ask what proportion of residents get medicated.
What are the medication guidelines? Under what conditions might a particularly unruly resident be expelled? Ask about medical and dental care. How are routine medical and dental care handled?
Do health professionals visit the facility?
Or are residents taken to physicians and dentists? Can they be taken to their own providers?
Ask about medical emergencies.
Is there a physician on call? Which hospital(s) does the facility use?
Ask about end-of-life decisions.
If your loved one has a living will and does not wish to be kept alive with heroic, technological measures, will those wishes be respected?
Ask about smoke detectors, fire alarms, and the evacuation plan.
Facilities should have all three, along with periodic fire drills.
Ask about disaster planning.
In areas where tornadoes, hurricanes, flooding, or earthquakes might strike, facilities should have contingency plans. If there have been natural disasters recently, investigate how the facility and its residents fared.
Get all information about fees in writing.
What is included in the base fee? Are there any "extras"? Are fee increases possible? How does the facility work with Medicare? Medicaid? Long-term care insurers?
Go over the contract with a lawyer.
Even the most wonderful facility administrator is an advocate for the nursing home. You need an advocate for you and your loved one.
Keep asking questions.
Even after your loved one has moved in, continue to be observant, and raise any issues that come up for you.
Befriend the staff.
If you've taken care of a loved one with Alzheimer's disease, you know how difficult it is. Nursing home staff have a lot more people to care for. They deserve your respect and support. And if you're kind to and appreciative of them, they are likely to take more personal interest in your loved one.
(c) copyright 1995
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