Choosing a Nursing Facility: Key Considerations

Choosing a nursing facility for a loved one is never an easy process! This is something that should be done slowly if possible and with a great of thought and consideration. Does your loved one need assisted living due to convalescent care needs, memory care due to cognitive impairments, or skilled nursing home care? No matter what area is needed, in preparation start by making a basic list of items that are essential in terms of care. Then think about what will be the most important to you and your loved one when looking at a new home. Think about what you value and what will make them the happiest! Is it restaurant style dining? Is ongoing PT a consideration? Are activities and day trips important? Be true to yourself and your loved one by listing all the basics elements that will be essential for their care needs and happiness! It is best to speak with a financial planner and Elder Care Attorney for guidance before moving forward. A Care Advisor can also provide guidance and resources as needed.

The following questions below can serve as a guide for your process. Do not be shy, ask questions, lots of questions, and take time to gather and consider all information before moving forward! This is along list, so highlight areas that are important prior to your facility visits. You can also cut and paste questions and put them into a customized checklist to bring with you... the important thing is to ask questions, be informed, and move forward in positive way!

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• How will you get to know my family member and help them to settle in? • What will their first day be like? What will most days be like? • How will the resident be greeted upon arrival? • How are cultural preferences addressed? • How is patient centered care coordinated? • How are activities planned? Do they ask for resident input? How often? Are they grouped based on resident cognitive level and functionality? • What happens if a resident needs to stay in their room due to illness; how is socialization addressed? • If asking about memory care inquire about staff training and daily resident programming. Look for visual cueing throughout areas, frustration free ability to move throughout, access to outside, etc. • Ask if memory care residents are grouped by stage of disease process. How are difficult behaviors managed? • How are private duty nurses obtained if wanted by resident? Does your facility provide them and can outside companies be used? How do you ensure quality of these staff? Will level of care be lower if having private duty performing aspects of care? How will staff roles be clarified for this? • Can my family member stay there long term and age in place? Are there any care restrictions, etc? • How are the levels of care defined? How often are they reassessed? • What will be done to help the resident adjust if having difficulties? • Continuity of care: do the CNA's / nursing assistants take care of the same group of residents each time they work, or do you rotate the assignments after a period of time? How is the schedule and resident assignments made? • How is information regarding residents communicated from shift to shift, on weekends? • What services can be provided on site? (Beauty, MD/ NP, podiatry, psychiatric, eye, dental, social worker?) • Who makes staff assignments? • What is the ratio of staff to residents? How is staffing adjusted to accommodate high acuity? What is the staffing and supervision during busier times / weekends? • Will my loved one be awakened at a set time in the morning or will they have a choice regarding their schedule? • Where are medications given and treatments done? • What if my family member wants to dine in their room or sleep in? Is there and additional charge for in room dining? • What is your policy regarding food choices and alternatives? Do they have to come to the dining room? • What type of recreational activities are offered here? • How do you build a sense of community, and give those who live here a voice in the decisions about how things are done? • How do you meet the special needs of people who have some type of dementia? What is the staff training?
 • If hospice or palliative care is needed does your facility refer to a specific group? How are staff roles coordinated / defined between outside agencies and the facility staff? • Are their any restrictions on visitation? • What is the role of family members? Do you have a Family Council, or support group meetings? How are concerns to be voice and through what mechanism? • Do you have a rehabilitation team and access to therapists such as speech pathologists, physical therapists, and occupational therapists? • Do you measure the turnover of your staff (defined as the average percentage of staff who stop working at the home each year)? • If so, what is the turnover rate for your direct care workers (CNAs, nurse assistants)? Shoot for any number under 40 percent. (The national average is 66 percent.) Licensed nursing staff? Aim for any number under 30 percent. (The national average is 41 percent for RNs and 50 percent for LPNs.) • Do you measure staff satisfaction, family, resident satisfaction? • Do you have general resident meetings, how often? • How often do you measure the satisfaction of these groups? • If yes, what do you do with the satisfaction survey results? • How is quality of care measured? Do you have any current deficiencies cited? How are these areas being addressed and corrected? • What is your mission statement? Are staff able to share the mission in their own words and indicate that it is meaningful to their work? Is it posted? • Are pets allowed? Which type? • What is the visitor policy? • What is the security at night? Are doors locked, supervision, night time checks?? During the day? • What is the policy for checking on residents at night? • Are their cameras in the facility? Can you add cameras in your family members room? • Who do I contact if there is a quality of care issue? How will this be handed and resolved? • What quality control mechanisms are in place to ensure that staff are doing resident care and checks? How is this documented and evaluated? • Is there a social worker on staff? • What happens if my family member has less than three years of funds? Will the facility help me in planning and moving forward with care? Does the facility take medicaid? • To get an overall Impression of the facility observe the following: • What is the culture? Happy, relaxed, busy stressful, clinical? • What are the staff education programs? Family support and education programs? • Are staff and residents interacting with what looks like interest and kindness? • Are resident behaviors ever ignored by staff when repetitive or are they acknowledged? Are they appropriately and kindly redirected? • Do staff come across genuine or like sales people? What is your gut feeling? • Look at the furnishings, condition of facility, colors, furniture, walls, floors, lighting, real or artificial plants, bird cages, fish tanks, pets, smells, lighting, signs, postings, elements of privacy, options for sitting alone, activity areas, transportation vehicles, conversation areas, private dining rooms, and resident facial expressions. • Are there decor items and a flow that helps with cueing residents to appropriate aspects of their day, surroundings, etc. • Can the facility accommodate medicaid if needed down the road? What happens if we run out of funds? Does the facility have auxillary grant beds? What is the internal process? Is there a social worker on site to assist with planning? • Look at the types of resources and activities that are posted. Are cultural elements present? • Check to see if Resident Council and Family Council materials, and ombudsman contact information, are posted in clear, obvious places and at a level where a person in a wheelchair could read them. • Look for the most report of the state survey. You can ask to have a copy of this also as it should be made available for you to review. • Talk to residents and families when you are visiting. Do not rush. Try to comeback without an appointment...pop in! See the facility as it really is!!! Ask residents how they feel about their home and if they would recommend it to others? • Try not to ask this in the presence of a staff person as residents may fear sharing negative comments. • You want to ensure that you get an inaccurate impression!

Finally, if it does not feel like the right fit, it probably is not!!!

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