Proper Screening and Selection
of Nursing Homes
The selection of nursing home care for a family member can be a difficult task and sometimes overwhelming. Your goal should be 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.
Different Types of Facilities
The term “nursing home” is not always used these days, and there are different care levels. A skilled nursing facility (SNF) is a facility that’s required to provide continuous (24-hour) nursing supervision by registered or licensed nurses. SNFs also 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 and eating. An intermediate care facility (ICF) generally serves patients who are not as ill and who are ambulatory, needing less supervision and care. ICFs 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 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 are required to 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’re normally sponsored by religious, charitable, fraternal and other groups. They can also be run by government agencies at the federal, state, or local levels. However, many nursing homes are businesses operated for profit. These types of facilities are usually owned by individuals or corporations. A few larger corporations operate several nursing homes in one area or even in several states.
Unfortunately, the choice of a nursing home is often made in a crisis moment when you are rushing to find a safe and secure facility for a family member. Selecting the right place is an important decision – one that deserves a lot of planning and careful, clearheaded consideration.
Educate Yourself as to What’s Available in Your Community
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 everything 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 presently live in nursing homes, pay them a visit and gather some firsthand impressions.
- The U.S. 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 or online resource. 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’s not always possible, but it’s preferable that the home be convenient for friends, relatives and your doctor, as well as you. Additionally, the home should be reasonably close to a hospital in case of a medical emergency.
- Visiting Hours – Find out whether the visiting hours are convenient for you and others. Often the best arrangement is one that allows visitors to come any time.
- 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’s 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 there are extra charges 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.
- Bed-hold – Ask if the facility reserves a bed if the patient needs to be transferred to a hospital. Medicaid will pay for seven days of bed-hold. 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 and where valuables are protected. Theft is sometimes a problem in nursing homes and can be attributable to staff, other patients or visitors. If at all possible, you should leave valuable items with friends and relatives and not at the nursing home.
- Grievance Procedure – Ask whether patients have some sort of grievance procedure. Find out if there is a patients’ council or some 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 number of patient services available and help reduce the isolation and loneliness that many nursing home patients feel.
- Morale – Check on the current patients’ morale. 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 – If you can, check what sort of food being served. Make a visit at the time of the midday meal, which is often the main meal in a nursing home. Ask the other patients about the quality of the food. Is the dining room atmosphere attractive, pleasant, and clean? Is the cold food cold? Is food available at times other than mealtimes? Do they cater to special diets?
Nursing Home Admission Agreements
Once you’ve selected a nursing home, you’ll want to review and be sure you thoroughly understand the home's contract or financial agreement. If you have questions, ask your attorney or the local long-term-care ombudsman in your area (check the phone book or online). Since this agreement constitutes a legal contract, it’s advisable to have a lawyer review the agreement before signing it. NEVER SIGN A LEGAL DOCUMENT THAT YOU DO NOT UNDERSTAND OR AGREE WITH.
Once Admitted, Ensuring Good Care for the Long Term
Family and friends play a vital role in ensuring your loved one continues to receive quality care. Visit regularly and, if you can, at different times. Watch for signs and symptoms of abuse or neglect. Consider whether there is sufficient staff to meet the residents' needs. Ask the resident if they are clean, hungry or thirsty and well cared for.
Communicate any concerns you may have to the charge nurse immediately. If there are safety issues and 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, call us immediately. You and your family member have rights. We can help.You can also report it to your state’s Department of Senior Services. In Missouri, call 1-800-392-0210.
For a Free Consultation Contact Us Toll-Free: 1-877-816-2600
It’s important to contact us immediately if you or a loved one has been the victim of negligence or abuse in a nursing home. Initial consultations are free of charge and all of our work is done on a contingency basis.