Deciding How to Choose the Right Nursing Home in 21 Questions
If you have made the difficult decision to move a loved one into a nursing home, you want to be assured that it will be a comfortable place and one where they will not be exposed to abuse and neglect. You want to be assured that the home will respect your loved one’s legal rights as a nursing home resident.
Just as you would if you were buying a new house or considering a new apartment, you should do your research. You will want to visit a few – if not several – nursing homes before you make a choice. There are many questions to ask and concerns to address about medical care, personal care, security, financing and more.
The following are 21 questions you should ask (based on a checklist compiled by the Centers for Medicare & Medicaid Services):
1. Is the nursing home located close enough for friends and family to visit?
Seeing loved ones on a regular basis is important to a person who has moved to a nursing home. It should also be important for you. You will need to visit and make sure your family member’s treatment and care is proper. It should not be a chore to go to see someone in a nursing home. The Illinois Council on Long Term Care provides a nursing home directory that allows you to search by map, county or zip code.
2. Are hallways and rooms well lit, comfortably heated, clean and maintained?
Signs that the nursing home is well-maintained indicate that someone cares about residents’ comfort. The home should be free of unpleasant odors, especially bodily odors. Corridors should be free of clutter or other problems that could cause potentially deadly falls. Furniture should be sturdy, clean and comfortable. If there are TVs in common areas, check if they work properly and consider whether the volume is appropriate. Look at the age of furnishings. If they look old or outdated, ask about plans for replacing worn pieces.
3. Does the nursing home have a system for protecting residents’ possessions?
Like anyone making a move, your loved one will have many old and new personal effects. He or she will need these items to be comfortable in the home. Ask the home how it will keep track of these possessions. In addition to lockable cabinets and closets in residents’ rooms, the home should maintain descriptive lists of possessions and have a labeling system.
4. Does the nursing home have smoke detectors, sprinklers and emergency exits?
The answer to this question absolutely must be, “Yes.” Federal law requires nursing homes to meet the applicable provisions of the Life Safety Code of the National Fire Protection Association. You should be able to answer this question for yourself. Emergency exits, smoke detectors and fire sprinklers should be common enough that you spot them easily as you visit and tour the home. Make sure to ask how often the nursing home’s smoke detectors are tested. The answer should be at least once a month. (Also, batteries should be replaced at least twice a year.)
5. Does the nursing home have a security system?
Again, the answer to this question absolutely must be, “Yes.” If not, your tour should come to a quick conclusion. Security systems in nursing homes should be designed to keep some residents in and intruders out. Violence or assaults, in fact, is a growing problem in nursing homes. Individuals with Alzheimer’s disease and other forms of dementia tend to wander and must be kept safe from hurting themselves. A security system is more than locks on doors. It should include security cameras, alarms and people standing watch 24 hours a day. Ask about procedures for preventing wandering and elopement and about balancing security concerns with capable residents’ rights to go outside for fresh air and exercise.
6. Are all areas of the home accessible by wheelchair?
All common areas, residents’ rooms, bathrooms and doorways should be designed to accommodate wheelchairs. Even if your loved one is not in a wheelchair today, they may well be someday. Compliance with the Illinois accessibility code shows the nursing home is meeting its legal responsibilities. Use of universal or barrier-free design elements, which are functional, aesthetically pleasing and inclusive of everyone – regardless of disabilities – shows that a forward-looking company owns the nursing home.
7. Are residents clean, well-groomed and appropriately dressed?
Poor hygiene among nursing home residents is a sign of neglect. Many nursing home residents need daily assistance with bathing, grooming, dressing and more. Their bed sheets need to be changed, and many residents need to be turned to prevent bedsores. In addition to health factors, being able to present yourself as well-groomed and appropriately dressed is matter of dignity, which is one of the many rights and protections guaranteed nursing home residents. The home should be adequately staffed so that no one goes without this daily personal care.
8. Do residents have access to personal phones or the Internet?
Being able to maintain contact with friends and family and, indeed, the world through the Internet is a nursing home resident’s right and part of a healthy lifestyle. The nursing home’s policies and practices should encourage residents to be active and engaged and discourage withdrawal. Personal phones and access to postal mail and/or e-mail accounts also allow residents to exercise their rights to privacy in their personal communications.
9. Are residents provided with exercise and recreational activities?
Regular exercise and recreational activity is important to physical and mental health. Exercise and activity also helps the elderly to fight disease and infirmity. Nursing homes are required to have ongoing programs of activities designed to meet each resident’s interests and enhance their physical and mental well-being. The programs should include: Fitness, exercise and movement activities; sensory and cognitive stimulation programs; and activities that promote social interaction skills, self-expression and daily living and functioning in the community. See the Illinois Council on Long Term Care website for more information on this important topic.
10. How does staff monitor residents when they go outside?
Ask about policies for outdoor activities and residents’ access to the nursing home’s grounds and whether there are steps in place to prevent wandering and elopement. Are the grounds attractive? Do they include appropriate spaces for walking and places with benches for sitting? What is the staff-to-resident ratio when residents are on the grounds of the home? How are residents who spend time away from the nursing home able to visit family or friends during the day or overnight? Are they checked in and out of the nursing home?
11. Does the nursing home provide for residents’ special dietary needs?
Our dietary needs change as we age. At the same time, a diet may affect the development of heart disease, cardiovascular disease, diabetes, osteoporosis and some forms of cancer, which are among the most common diseases affecting elderly people. The elderly tend to eat less. Certain ailments common to the aged can diminish the desire and/or ability to eat. So, it becomes more important for meals to be nutritious as well as tailored to individual residents’ needs. Meals should reflect any illness, allergies and cultural or religious preferences the residents have. Does the nursing home also have strategies for assisting residents at risk of malnutrition?
12. Does the home conduct criminal background checks before hiring staff?
In the Health Care Worker Background Check Act, Illinois law specifically protects the state’s “most frail and disabled citizens … from possible harm through a criminal background check of certain health care workers and all employees of licensed and certified long-term care facilities [including nursing homes] who have or may have contact with residents or have access to the living quarters or the financial, medical or personal records of residents.” The Act makes it illegal to hire anyone as a health care worker who has been convicted of committing or attempting to commit any one of more than 80 enumerated crimes or as an employee of a nursing home who has been convicted of committing or attempting to commit any one of more than 20 crimes.
13. Has there been any major or repeated turnover in administrators and staff?
Stability in any organization is good for a number of reasons. Nursing homes provide hands-on, intimate care to individuals. Residents will fare better emotionally and psychologically if they know and trust the people who are caring for them. Repeated turnover in a nursing home staff is an indicator of poor working conditions and impacts how residents are treated. A single major change in staff may indicate an ownership change or a problem that was revealed and corrected – in part at least – by a change in leadership. A major change in a nursing home’s administration could be a good thing.
14. Are staff members warm, polite and respectful to residents?
If you are touring a prospective nursing home with the admissions counselor or another administrator, you should expect that the staff members you meet are polite, respectful and warm. But look at how residents react to staff members. Do they seem comfortable or do they withdraw from certain staff members? One of the signs of nursing home abuse is a resident who exhibits fear or apprehension around certain caregivers. Beyond an absence of abuse or neglect, nursing home residents have a right to be treated with respect and dignity. Ask yourself whether that’s how it feels at the nursing home you are visiting. On a tour, ask to meet and talk to some residents. See if they say they are being treated well and whether they feel like they can talk to you with candor.
15. What is the nursing home’s staff member-to-resident ratio?
Under federal and state law, nursing homes must have enough staff to meet the needs of their residents. In Illinois, the law requires a minimum number of nursing staff expressed as hours of total nursing time. According to the administrative rule applied by the Illinois Department of Health, “The number of staff [members] who provide direct care who are needed at any time in the facility shall be based on the needs of the residents and shall be determined by figuring the number of hours of direct care each resident needs on each shift of the day.” Since January 1, 2014, the minimum staffing ratios are 3.8 hours of nursing and personal care each day per resident needing skilled care, and 2.5 hours of nursing and personal care each day per each resident needing intermediate care. The Illinois Citizens for Better Care long-term care advocacy group provides a more detailed explanation.
16. Are registered nurses (RNs) licensed practical nurses (LPNs) and/or certified nursing assistants (CNAs) available at the nursing home 24 hours per day?
Direct care staff includes RNs, LPNs, CNAs, psychiatric services, rehabilitation aides, therapy aides and medical services coordinators and managers. Currently, federal law requires nursing homes to provide the services of at least one RN for a minimum of eight consecutive hours a day, seven days a week. However, a bill in the U.S. House in 2014 would have required at least one RN in each nursing home providing assessment, surveillance and direct care to residents 24 hours a day, seven days a week. In a report about that bill, the New York Times said that 13 states already require 24-hour registered nurse coverage in some cases. Four states – Tennessee, Rhode Island, Hawaii and Connecticut – require an RN 24/7 in all nursing homes that receive Medicare and Medicaid payments. How do the standards at the nursing home you are considering rank in comparison?
17. Does the nursing home have a policy for administering medication?
A federal government report released in 2014 said that 1-in-3 patients in 600 skilled nursing homes under review suffered a medication error, infection or some other type of harm related to their treatment. Elsewhere, the American Society of Consultant Pharmacists states that antipsychotic medications appropriate for psychotic disorders such as schizophrenia and for delusions and hallucinations are often used inappropriately in nursing homes to treat behavioral and psychological symptoms of dementia such as wandering and aggression. Any medication can be administered incorrectly or improperly, including in improper dosages or at improper intervals. A medication error can cause serious harm to the recipient. Nursing homes should have strict controls for ordering, receiving and administering medications as they are prescribed. You should also know how powerful medications like antipsychotics and narcotics are controlled and used at the facility.
18. Are residents given routine preventative care and hearing and vision tests?
Preventative medicine is crucial for keeping elderly patients well. Medicare payments, which most nursing homes accept and rely on, normally cover one flu shot per flu season. They also cover some preventive and diagnostic eye exams for diabetes sufferers, patients with age-related macular degeneration (AMD) and glaucoma in individuals age 65 or older. If requested by a medical professional, diagnostic hearing exams should be covered as well. These are more than perks. Preventative medicine can be essential to keeping an elderly nursing home resident healthy and active.
19. Does the nursing home help residents see their personal doctors?
One of the rights and protections nursing home residents have under federal law is the right to be informed about their medical condition and medications and to see their own doctor. In Illinois, the Nursing Home Care Act states that a nursing home resident has the right to see his or her own personal doctor (at the resident’s expense or through personal insurance coverage). A nursing home should protect and facilitate these rights. Ask about transportation services or other arrangements available to help residents of the nursing home attend medical appointments outside of the home.
20. Is there an arrangement with a nearby hospital for emergencies?
If a medical emergency occurs, who is called? As you consider the location of a nursing home for your loved one, think about where the closest hospital emergency room is and where the nearest rescue squad or ambulance service is based. Closer ties between a nursing home, nearby ambulance services and a hospital – particularly one with geriatric emergency / medication specialists on staff – means medical and emergency response personnel are likely to be familiar with the home and its nurses, residents and others. This should ensure a faster and more informed response in an emergency situation.
21. Does the nursing home have any reported deficiencies, and how were they corrected?
Every nursing home in Illinois is required to keep the most recent five years’ worth of annual surveys, complaint investigations, follow-up surveys, notices of fines and plans of correction. The home should make these materials available to anyone who asks to see them. Another resource is the Illinois Department of Health website, which provides Quarterly Reports of Nursing Home Violators. Read more about nursing home violations in this report by the long-term care advocacy group, Illinois Citizens for Better Care.
These 21 questions should be asked if your wondering how to choose the right nursing home. They can make the difference between your loved ones being properly taken care of and treated well or ending up on the bad end of things and becoming victims of neglect and abuse.
Patrick A. Salvi concentrates his legal practice in several limited areas primarily involving a trial practice in cases concerning serious personal injury, medical malpractice, wrongful death, and mass torts. Mr. Salvi has achieved record-breaking jury verdicts and settlements on behalf of his clients, including serving as lead counsel in obtaining an Illinois record-high $148 million jury verdict and a Lake County record $33 million jury verdict.