What questions should you ask a nursing home?

It's unfortunate that some areas of the country have consistently good nursing homes and others not so good (or even terrible). However, doing your homework is still a good idea.

The staff matters much more than the surroundings. I always watch to see if the interaction between staff and residents seems genuine. Taking into consideration issues that can't be changed (such as paranoia with dementia) how does the staff handle difficult residents? How do residents look when a staff member approaches? Is there a level of trust and comfort overall?

In the end much of this is about the "vibes" that you get when you visit. As has been mentioned, look for official reports such as the one that Medicare puts out and try to talk to other family members if you can.



Beautiful surroundings are nice but people are what matter. You're smart to start asking questions early. Good luck.
Carol

Canard note is so right! DONT BE FOOLED BY HOW BEAUTIFUL THE SURROUNDINGS ARE! Ask questions primarily about the patient to "nurse" ratio. How often is medication distributed? Does the facility have the ability to get ALL of your grandma's medications? If not can you provide it so that doses are not missed? Don't let them tell you that something is "the about same as that medicine". If it's not what her Dr. prescribed, it's not the same. The time each medicine is taken may also make a difference. If it is 3 times a day and the NH only does med rounds 2X a day, that makes a big difference! Does an RN distribute meds or is that delegated to an LVN a or God forbid a CNA. I have seen this more than once and I believe it is illegal.
Ask also, what happens if the patient doesn't make it to the dining room for a meal? Does the staff come to get them so they don't go hungry?
Can your grandma keep her own Drs.? Most NHs require the patient to become the patient of the NH's Dr. They assume the responsibility for all medical care of your loved one. I my experience, 90% of the time this new Dr. doesn't even bother to come and meet and examine your loved one for 48hrs or so. They simply "rubber stamp" the incoming notes and meds. at admission. At that point, medicines should be ordered. There may be delays in getting them so be prepared with backup meds. You will be asked to turn those over to the nurse at the facility but at the very least they should be labeled with grandma's name, etc and help prevent a delay in getting her the medicine she is supposed to get. Nursing homes order their own supply for economic reasons and there is almost always delays and substitutions. Be aware of those and what she is being given. It can make a difference in her health! Not all medicines are equal in terms of efficacy.
I don't want to scare you but DONT BECOME COMPLACENT!!! Quality facilities are out there but there are MANY more bad ones. A lot of which are camouflaged by pretty furniture and a slick brochure. Don't be fooled. What really matters is ratio of staff to patients and cleanliness of the facility as well as general level of contentment of other residents. Don't hesitate to stop and ask residents and their families how they feel about the place and staff etc. the time to ask and investigate is BEFOREHAND not after you admit your grandma.
Best of luck. This is a difficult decision for most families. Nothing is perfect but just know that you are going to make the most educated and compassionate choice you can. Good luck. Keep posting!

As a former ombudsman (go-between residents and management) for the State of CT, there's not one question for the nursing home. There are many. Don't judge the home by the number of chandeliers! One suggestion from my 2003 handbook, published as "Conrad Notes - Home Health Care Assisted Living and Long-Term Nursing", is start by downloading the checklist provided for nursing homes by the U.S. Centers for Medicare and Medicaid Services. This website has tons of information...all free and reliable. Good luck!

Schedule your first visit and take note of how you feel when you first enter the facility. First impressions should not be ignored, if it does not pass the smell test than look elsewhere. Plan on at least two more unannounced visits, in the evening and on the weekend. Does there appear to be adequate staffing, talk with other family members of residents, eat a meal with the residents. There are many checklists available, I have a free booklet available at TexasElderLawAttorney, "Consumers Guide to Nursing Homes and Assisted Living Facilities". This oversight does not end when your your loved one becomes a resident, but rather, it becomes more important to visit on a regular basis and if that is not possible, hire a qualified individual to do so for you. If something does not seem right, then go to the head nurse or administrator and voice your concerns as soon as possible.

If you can, talk to patients and families and watch, watch, watch. The checklists are great also. Get a list of the activities provided, talk with the social worker, find out who the docs are and how often they come in. there is a lot of research to do.
but it seems that you have time to do it and make a good decision. good luck

Might you also want to look at Memory Care? If Grandma has dementia but is physically okay, she probably wouldn't need the skilled nursing that a NH provides. Take a look at continuing care communities (those that have a single campus with many options, usually ranging from Independent Living to Hospice and everything in between. Get familiar with what is available in your area and assess (or have a social worker assess) what Grandma's needs are now. It's very hard to predict with any accuracy what an elder is going to need in the future, because there are so many variables such as stroke, falls, fractures and the like. But in retrospect, as a family, we had NO idea what Assisted Living meant, or even that there was an option called Independent Living.

Also, make sure that if you are looking at definitions of levels of care that you are looking at a site that is specific to Connecticut, as regulations vary. For example, in NYS, where Mom lived, being a "two person assist" (meaning that it takes two staff members to get you out of bed, to the toilet, etc) is only available in a NH, while in the State of Connecticut, this is allowed in Assisted Living.

You guys are SO smart to look ahead! Better to do this kind of looking when NOT in emergency mode.

I agree with Babalou. If dementia is her primary ailment and she doesn't need skilled nursing care, then I would explore Memory Care facilities. And depending on how mobile she is, I would explore one that has a secure unit. I never thought my loved one with dementia would wander, due to her limited mobility, but it happened. I had to move her to a Secure Memory Care facility, due to her trying to get into cars in the parking lot of the assisted care facility.

The first thing I would do if you haven't already is to study dementia and what it brings to a person. I would read a lot about the phases and progression of the disease so you know what phases your grandmother will be facing. Once you know this, you will know what features the facility needs to have to care for your mom.

Don't be turned off to a facility because the residents in the memory care seem severely affected by dementia. That is the normal progression of the disease. My loved one will eventually be that way too. That was something I had to process. Being with those patients does not disturb my loved one, but seems to make her comfortable.

What impressed me with the Memory Care facilities that I toured were the ability of the place to care for her for the rest of her life. They are trained to work with the patient, even after the patient loses their ability to function on many ways. They understand why it's happening and they handle it. Some places don't seem to know how to handle dementia very well and it shows.

I would have a good discussion with the director of the place and let them share with you what options there are for those with dementia and what their experience has been in caring for dementia patients. They should share their philosophy and goals. See if you think it's a good match. They know a lot about dementia. I would make sure I was well read on it too when you meet. Also make sure you have a realistic description of your grandmother's abilities and needs, understanding that those will change over time.

I agree about not getting distracted with fancy furniture. With dementia patients, I've learned all the fancy stuff is for the family and visitors. The patients aren't impressed with that stuff They need compassion, time, care and attention.

I actually ran into a couple of family members in the parking lots of the places I visited. I asked them what they though of the place. I think I got candid responses. Still, your experience is very individual. Your loved one may need a different level of care than their loved one needs.

I would have a backup facility in mind in case the first place doesn't work out. If she gets settled into one place and it isn't working out, I would relocate her. I had to do that and it was the right decision. Even places that are highly rated are not for all patients.

Also, note that most Memory care facilities have a mandated staff/patient ratio that is lower than most other facilities, but you would need to check with your state regulations on that.

Do you research early. Don't wait until your grandmother is in crisis and you desperately need to place her immediately. Most of the places encourage you to place the resident while she is still able to communicate and get used to her surroundings. That way they get a chance to know her likes, personality, etc., before it is very affected by dementia.

I worked in many nursing home and things to do are check them out early in the morning about 7 am or weekends early. If you smell poop and pee walk out there are no need for q&a. look to see if the clients are drugged if everyone is in wheelchair and falling asleep walk away. ask how many clients an aide has. when was the last abuse like a bed sores or fall in their home was and how often does it happen with in the month then year. make sure you are able to came at all times. when you take the walk through make sure you look at the aide do they look over work are they nice to the clients and does the client interact well with them. ask the nurse question if he/she is to busy and rude most likely they will be to busy later when your loved one is there. Also if you see a client or two out side before coming in ask them how they like the place they know how it is when family is not there. good luck with this. just watch and go with your gut

I haven't read any of the answers but I looked on the Medicare website for the ratings which in the end didn't really mean all that much. You can see the complaints, the remedies, etc.

And remember, a nursing home is a business, so you can ask all the questions you wish, you'll get canned answers because they are selling a product.

The rehab where my mother is also serves as a 'nursing home' (I say this because very few nursing homes have nurses anymore). This particular one got a three star rating by Medicare but I think it's great, the CNA's are wonderful, helpful, and my mother loves the place. Lots of activities, clean, etc.

Quite frankly, I think it's a crap shoot, no pun intended.

I can't remember all the questions I asked but I am sure some of the sites the people listed on here are good. But I don't know about asking the "residents/patients" what they think. They are there due to dementia/alzheimers do if they say they hate it, doesn't mean its not good. I see a lady each time I visit my dad, she says the nurses are mean, she hates but honestly I haven't seen one bad situation, so in this persons mind she just don't like it..........so don't base your findings on what the patients say. NOW not unless you actually see or hear one of the patients being treated badly.