Saturday, December 19, 2015

How to Choose a Nursing Home for a Loved One

Choosing a nursing home to place a family member or friend can be very difficult.  You are placing a vulnerable person in the hands of strangers.  Will they treat her with kindness?  Will they make sure she is bathed, fed, and clothed?  Will they care for her medical needs, prevent conditions from worsening, and recognize when an emergency attention is needed?

The nursing home industry is a business.  The more that a company spends on attracting quality employees and providing good care, the less profit it makes.  People who run nursing homes are there to increase profits and while containing costs.  The goal is not to provide the best care, but rather to make the most money.

The quick explanation of how you will select a nursing home:
You start with the nursing homes in the geographical area that is most convenient for you to visit your loved one often.  You then visit all of these nursing homes and return several times to the ones you liked to take in the atmosphere and get a feeling for what the facilities are like on a regular basis.  You ask friends and neighbors what their experiences were in these nursing homes.  If you know any healthcare workers from the area, ask them for their experiences with these facilities or in dealing with patients who resided there.

If your neighbor who is a paramedic tells you that a certain nursing home has more fractured hip calls than any other, and the staff never seems to know what is going on, this is a Red Flag.

On your tours, you need to look at the staff- are they running around, frantic, understaffed?  Are they nowhere to be found?  Are they sitting around, talking on their phoens, ignoring patients?  Do not assume that every worker is a nurse.  Most are not.  Nursing homes schedule as few Registered Nurses as possible to save money.

Look at the patients.  Are they clean?  Do they look content, or are they yelling for assistance or attention?  Do they have something to do, or are they crammed into a little room to watch a television?

Look at the environment.  Is it clean?  Welcoming?  Conducive to the flow of people with wheelchairs and walkers?  Remember that a "Secure Unit" for Alzheimer's cannot have all the decorations and colors of other floors for safety and cognitive reasons.  (For example, a pattern on a floor or rug may be mistaken for a pit or splatter of dirt by someone with Alzheimer's, so the floors and walls on these units are usually bare.)

In the United States, most people look online to review official ratings from Medicare.gov, which are based on inspections.  [For clarification, Medicare does not cover long-term nursing home placement.  It covers short-term rehabilitation in a nursing home setting, such as recovery from a stroke, open-heart surgery, or a fractured hip.]

As someone who has worked for years during such inspections, let me clarify the implications of the ratings.

During a survey, the inspectors look in the different areas of the nursing home to see that the physical building and the staff are presenting a "good show."  That is, someone in charge knows what needs to be demonstrated, and a bunch of other people have agreed to participate in the show during the inspection.  Extra staff is standard during an inspection.  Chart reviews can't be faked during the actual inspection, but a facility that is survey-minded will have someone reviewing charts year-round and making corrections before the chart is seen by an inspector.

So a high rating from an official inspection does not automatically translate into great patient care, and a low rating does not indicate poor care.  It means that the company that owns the nursing home had the wherewithal to pull things together in that facility in time for the inspection.

Don't be impressed by the furniture.  Google "nursing home furniture" and you can see that the plastic mauve sofas and coordinating curtains are standard issue.  Be bothered if the furniture is falling apart.  The budget for the appearance of the nursing home is the last thing slashed.  If the place is in disrepair, the budget for patient supplies was slashed long ago.

Ideally, you will decide on a nursing home before placement is needed.  You need time to make your inspections and become comfortable with your decision.  Waiting until your mother fractures her hip or has a stroke is a really bad time to try to evaluate nursing homes.

If your loved one ends up in the hospital from home and needs a discharge to a nursing home, let the healthcare team at the hospital know right away which nursing home you want.  Sometimes the case manager or social worker sends a patient to a nursing home without telling the family about the pending discharge or without letting the family know that you have a choice of nursing homes.


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