Screening and Selecting Nursing Homes

The selection of nursing home care for a family member is often an overwhelming and difficult task. Your goal is to find a nursing home that will provide care and treatment to restore or maintain the patient's highest level of physical, mental, and social well-being.

Types of Facilities

A Skilled Nursing Facility (SNF) is a facility that is required to provide continuous (24-hour) nursing supervision by registered or licensed nurses. SNF's provide medical, nursing, dietary, pharmacy, and activity services. These facilities care for the incapacitated person in need of long- or short-term care and assistance with many aspects of daily living, including walking, bathing, dressing, eating. An Intermediate Care Facility (ICF) generally serves patients who are ambulatory and need less supervision and care. ICF's provide medical, intermittent nursing, dietary, pharmacy, and activity services. Licensed nurses are not always immediately available in an ICF. A Residential or Assisted Living Facility provides shelter, board, some protective oversight and the assistance in administering medications.

Licensing and Certification

All state governments require that nursing homes be licensed. The licensing requirements establish acceptable practices for care and services. State inspectors visit nursing homes at least once a year to determine their compliance with state standards and their qualifications to receive Medicare and Medicaid reimbursement.

Who Operates Nursing Homes?

Some nursing homes are operated as nonprofit corporations. They are sponsored by religious, charitable, fraternal, and other groups or run by government agencies at the federal, state, or local levels. But many nursing homes are businesses operated for profit. They may be owned by individuals or corporations. Sometimes they are part of a chain of nursing homes.

Unfortunately, the choice of a nursing home is often made in a crisis moment when you are rushed to find a safe and secure home for a family member. Selecting a home is an important decision—one that deserves foresight and careful clear-headed consideration.

There are several ways you can help in advance to select a quality home for your loved one.

Find out what nursing homes are located in your community and learn what you can about them. If you have friends or relatives who are familiar with the homes, ask for their opinions. If you know people who live in nursing homes, pay them a visit and gather some firsthand impressions.

The United States Department of Health and Human Services operates a website addressing long term care facilities. By visiting www.medicare.com you can search for facilities in your area. After narrowing your scope, familiarize yourself with each facility's history. The comprehensive surveys or statements of deficiency include a brief summary of the federal regulations the facility failed to follow. Be sure to check for noncompliance pertaining to patient care, staff adequacy, and facility cleanliness and maintenance. You can compare the overall number of deficiencies to the state and national average.

Each county has an ombudsman program that provides assistance for patients in nursing homes. The ombudsman program, federally mandated, is designed to provide information to the public about nursing homes in a particular area and to resolve complaints on behalf of the nursing home residents. The ombudsman should be listed in the local government section of your telephone book. Talk with your physicians. Your physician also may be able to suggest some nursing homes you might consider.

Selection of a Nursing Home

When you have compiled a list of the facilities that seem most appropriate, you should make a personal visit to each one. When you do visit a home, there are a number of services to observe and evaluate:

Location – consider the home's location. Accountability is the most important tool you have to ensure quality care. It is not always possible, but it is preferable that the home be convenient for friends, relatives, and your doctor, as well as appealing to you. Additionally, the home should be reasonably close to a hospital in care of a medical emergency.

Visiting Hours – Find out whether the visiting hours are convenient. Often the best arrangement is one that allows visitors to come anytime.

Facility Size – A large home may have more activities while a smaller home might be more personal. Decide which is best for your needs. You should also consider the quality—not just the quantity—of services and activities offered.

Financing – it is very important to check with the facility regarding what services Medicaid or Medicare covers. Make sure you find out what extra costs are involved in addition to the basic daily room rate. Often extra charges are made for professional services beyond basic nursing care (also for things such as television and toiletries). Some homes only provide the bare minimum in the way of services.

Room Selection – find out whether attention is paid to roommate and room selection – two factors that can be very important to your happiness.

Bedhold – ask if they reserve a bed if you need to be transferred to a hospital. Medicaid will pay for 7 days of bedhold. Medicare and private-pay residents will have to pay for each day the bed is held but not more than the regular daily rate. Sometimes if hospital stay is extended you can make an agreement with the nursing home.

Valuables – find out how valuables are protected. Theft is sometimes a problem in nursing homes. If at all possible, you should leave valuable items with friends and relatives.

Grievance Procedure—ask whether patients have some sort of grievance procedure. Find out if there is a patient's council and a way that patients can be involved in decision making.

Volunteers – find out if community volunteers are used at the home. Active community involvement by individuals and groups of volunteers can greatly extend the amount of patient services available and help reduce the isolation and loneliness that many nursing home patients feel.

Morale – see how the patient's morale appears to be. Do they have privacy and respect? Do they have access to things like television and radio? Be sure you take into consideration what you are comfortable with when making your selection.

Food – check the food being served. Make a visit at the time of the midday meal which is often the main meal. Ask the other patients about the quality of the food. If the dining room atmosphere attractive, pleasant, and clean, the cold food cold? Is some food available at times other than mealtimes? Do they supply food for special diets?

Nursing Home Admission Agreements

Once you have made a selection of a nursing home, you will want to review and be sure you thoroughly understand the home's contract or financial agreement. If you have questions, ask a lawyer or the local long-term-care ombudsman in your area (check in phone book). Since this agreement constitutes a legal contract, it is advisable to have a lawyer review the agreement before signing it. NEVER SIGN A LEGAL DOCUMENT THAT YOU DO NOT UNDERSTAND.

Assuring Good Care

You, your family, and friends play a vital role in assuring your family member continues to receive quality care. Visit regularly and at different times. Watch for signs and symptoms of abuse or neglect. Consider whether there is sufficient staff to meet the residents' needs. Ask whether they appear clean, hungry or thirsty. Communicate your concerns to the charge nurse. If you do not see improvements ask to speak with the Director of Nursing or Administrator. If you suspect someone has been the victim of abuse or neglect report it to your states Department of Senior Services. In Missouri, call 1-800-392-0210. In addition, contact our office. You and your family member have rights. We can help.

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