A Complete Guide for Selecting a Nursing Home

Nursing Home

Selecting a nursing home for a loved one can be an emotionally wrenching and intimidating process. Touring facilities and wading through the marketing pitches and materials to identify the facility that will provide the best care can be overwhelming.

Because so much is riding on this decision, we cannot skip one step in this process. Fortunately there are standards to which all U.S. nursing homes must adhere, and through elder law attorneys, geriatric care managers and other services that support seniors, there is plenty of help available for the selection process. Getting this decision right requires knowledge of the laws designed to protect nursing home residents, awareness of supportive resources available in the community, repeated visits to nursing homes, and asking pointed questions.

The internet may be the first tool to invoke in the selection process. The Medicare.gov website, for instance, contains many tools for seniors. The Nursing Home Compare page provides lists of Medicare and Medicaid nursing homes that are closest to the zip code entered by the user. The lists include a star rating system for each facility.

Since 1987, in response to a large number of reported cases of elder abuse, the Nursing Home Reform Act was established to set the standard for the homes across the country to provide dignity, respect and freedom to their residents.

The Act gives nursing home residents the right to be fully informed of their care and to participate in their care decisions. Residents also have a right to the security of their possessions and to complain without fear of reprisal. States have offices of the ombudsman for the institutionalized elderly that inspect and sanction facilities and investigate grievances.

Elder law attorneys often work closely with geriatric care managers in helping clients identify suitable facilities, review residency contracts, learn the Medicare, Medicaid and Veterans Administration rules that may help obtain additional funding for care and advocate for clients throughout the process. Care managers not only tour facilities on behalf of or with a family, but they often monitor the quality of care.

Choosing a nursing home generally requires a few visits beforehand. The cleanliness of the hallways and residential areas can only be determined by walking beyond the lobby, which is typically tidy and well appointed. Interactions among the residents during mealtime can also be telling. Also, because a nursing home that will be easy for family and friends to visit can make a difference in the resident’s attitude and the attention she gets, it is important to find a facility where the visitors feel comfortable as well.

We ask many questions when visiting nursing homes for both our loved one’s well-being and our own peace of mind. Facilities may differ in the services they offer, whether they accept Medicaid benefits, the demographics of the residents, the physical therapy they provide, etc. The following sample questions can help direct the decision toward the most suitable nursing home for a loved one.

Admissions and Charges

  • Is the facility licensed by the state? Does it accept Medicare and Medicaid?
  • Is there a benevolent fund that can subsidize the resident in the event she runs out of money?
  • How many beds does it have and how many are occupied; is there a waiting time for admission?
  • Are the rooms private; semi-private? What is the basic monthly rate for each?
  • Are there any additional charges, optional charges, fees, etc.?

Physical Environment

  • Are the buildings and grounds kept clean?
  • Are there sidewalks and outdoor relaxing areas?
  • Is there a convenient parking facility?
  • Is the facility free of loud noises and unpleasant odors?
  • Is smoking permitted on the premises?
  • Are all floors air-conditioned?
  • Is the home equipped with sprinklers and fire extinguishers?
  • Are there ample windows throughout the facility and in the dining area?
  • Are there private dining areas and conference rooms that can be reserved by the residents to use with their families?

Rooms

  • Are the rooms attractive, clean and comfortable?
  • Does each room have a kitchen with sink and disposal and a bathroom?
  • Is there adequate closet space in each?
  • Are the rooms furnished? What type rooms are presently available?
  • Do residents have a private phone? Television?
  • Do bathrooms have grab bars and non-slip floors?
  • Does each room have its own thermostat?
  • Is there a raised ledge on the floor between the living area and the bathroom? (Residents have been known to trip.)

Staff and Services

  • How many administrators are there? What are their hours? What are their duties?
  • How many staff are on the premises? What are their hours?
  • To what extent do they interface with the residents?
  • Are there doctors, nurses on duty? What are their hours?
  • Are other specialists available: dentists, podiatrists, pharmacy services, etc.?
  • How often is there a social worker available? What are his/her duties? Does the social worker run support groups for families?
  • Is the staff respectful of the residents; are they aware of any special needs and how do they attend to that?
  • Is physical therapy provided and is there a separate facility for that?
  • What equipment is available in the physical therapy room?
  • Is there a high turnover rate? (Usually the answer is yes.)
  • Is there a separate unit for dementia patients?
  • What do they do to prevent skin ulcers on residents, dehydration, and resident falls? Do they track these incidents?

Resident Life

  • Are there visiting hours or are visitors free to visit at any time?
  • Are three meals served daily? What are some typical menus?
  • Are mealtimes long enough to accommodate residents on different schedules?
  • Are between meal snacks available?
  • Are there multiple choices for residents at mealtime?
  • Are special diets accommodated, such as diabetic, gluten-free, kosher, or vegetarian?
  • Do most residents take their meals in the dining room or their private room? What is the policy about that?
  • Are visitors invited to join residents for meals?
  • What percentage of the residents need assistance at meal time? Is it readily provided?
  • Are there daily activities and is a schedule posted? Is there an activities director?
  • What percentage of the residents participate in the activities?
  • Is there a barber shop/beauty salon available?
  • Are field trips planned? How often? How long duration?
  • Do residents spend substantial time outside of their rooms?
  • Is there a walking path outside or a garden for residents to work in?

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About Dana Bookbinder

DANA E. BOOKBINDER, ESQ. is the Founder of Bookbinder Law, LLC and has been advising families throughout South Jersey for nearly two decades on legal issues concerning asset protection for long term care expenses, public benefits eligibility rules, disability planning, and estate planning. Ms. Bookbinder has been certified as an Elder Law Attorney by the ABA accredited National Elder Law Foundation. www.bookbinderlaw.com

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