Finding a good nursing home: A primer

Sunday, December 4, 2011

Finding a nursing home or long-term care facility can be challenging.  

Read advice from advocates and nursing home administrators on what you should look for, recommended websites for comparison and questionnaires to use when looking for a nursing home.


Advocates and nursing home staff alike both advise that you tour facilities you are considering for long-term care.

“I would tour each facility I was considering to observe several factors (including) cleanliness, friendliness of staff, food quality, resident activities, services provided,” wrote Greg Wilson, vice president of quality management for Petersen Health Care in an email.

“I would also be sure talk to the residents, families and staff to get a feel for the environment and generally gauge their satisfaction with their home.”

Deb Reardanz, president and CEO, Clark-Lindsey Village, Urbana:

“The very best way is still the old-fashioned way of walking through the halls,” Reardanz advised. 

She suggests families see for themselves:

  • Is staff smiling?
  • Are residents out of their rooms?
  • Check the activity calendar to see if there’s enough going on to keep residents entertained and lively.
  • Come at a meal time and check out what’s being served, how the residents are being treated, etc.

“I think you have a pretty good sense after a walk-through of, is this a place where people like living and working or not?” Reardanz said. 

Rosanna McLain, director, Senior Resource Center, Family Service of Champaign County:

“Families need to ask lots of questions and talk to a lot of people,” McLain said.

Ask around if you know anyone who has a family member in a facility you’re considering, she said.

“There may be some places that you would mark off your list right away by looking at (investigation reports), by seeing repeated complaints or repeated problems of a dangerous nature,” McLain said.

When looking at complaints:

“You’re looking for trends; you’re looking for things that haven’t been fixed.”

You also need to be aware of the differences between short-term and long-term care, McLain said.

For long-term, look at quality of life issues, how long people live after moving in, how they do on staff measures, she said.

Also, ask if they use a lot of temp agency staffing.

“Which is a fine practice, but if you constantly have agency staff on, they don’t know the residents, they don’t know the procedures, and I would be curious about why their staffing patterns are so minimal or so open so many times that they have to have that many agency staff in,” McLain said.

She also advised:

  • Watch how CNAs interact with residents
  • Watch out for infection control problems, repeated cases of Staph or MRSA outbreaks.
  • For more physically active, mentally alert relatives, walk around and check out what people are doing. Are they just parked in front of the TV or in their room all day?
  • Check out the activity calendar and see if they have age-appropriate recreation planned.
  • How often are they able to get out of the building?

“Is there any place where they can get out and have some fresh air and watch leaves blow? And how often are there opportunities for them to go someplace else?” McLain suggested.

If McLain were going to place her own father in a nursing home, one major thing she would watch out for are repeated problems with falls.

“That can indicate staffing patterns to me, it could indicate a lack of hydration, it could indicate a lack of supervision, it could indicate a lack of supervision, it could indicate over-medication.

"It could indicate a whole lot of things. It might also indicate that they’re willing to take people who are more at risk than some other nursing homes,” she said.

Tami Wacker, operations manager and regional ombudsman, East Central Illinois Area Agency on Aging

Wacker encouraged families call ombudsmen for help interpreting the information.

“A lot of times, when you’ve got homes that are rated a one star in all three of those categories, it’s a really safe bet that that’s a one-star home and that’s exactly what you’re going to get,” she said.

Wacker suggested:

  • Tour facilities you’re considering, ask to talk to families and residents.
  • Talk to people around town for their impressions
  • If you know your loved one has had a history of falls, be cautious of facilities that have a history of patient falls

“When you see a facility that has repeated types of problems, then that’s a red flag for you.

"If you’ve ever seen a facility who has been tagged at the level of immediate jeopardy, that means someone’s life was put into immediate jeopardy. Those are huge, definite red flags,” she said.
 


Recommended websites for evaluating nursing homes:

Medicare.gov

This federal website compiles annual survey reports of long-term care facilities and makes them available to the public. You can search for nursing homes by name, city, Zip Code and county.

The federal Centers for Medicare & Medicaid Services use a five-star system to rate the quality of homes that provide skilled nursing care and are certified to accept government aid payments. Each home is rated in three areas: health inspections, staffing and “quality measures.”

Nursing homes in Illinois report the hours their nurses and certified nursing assistants work to the state Department of Public Health. The federal agency uses this information to calculate each home’s average daily staffing hours per resident.

“Quality measures” are data on residents’ physical and mental health and well-being that nursing homes collect and report to the federal government. These include information such as the percentage residents with moderate to severe pain, the percentage of patients with bed sores and the percentage of residents whose mobility has declined.

Most advocates and nursing home administrators alike advise against basing your decision entirely on information from this sight as it gives a snapshot of nursing home care. But it can give a good starting point and alert you to some of the issues a nursing home may struggle with.

Illinois Department of Public Health

Search this site for information such as number of beds, number of residents and contact information. You can search by name, city and county.

Once you select a nursing home to review, click on “surveys” to review complaints and inspection reports dating back to 2000.

Please note that some of the information may be outdated and some surveys and inspection reports may not be available online.

Consumer Choice Reports

The Illinois Department on Aging now requires all nursing homes to fill out a Consumer Choice Information Report, which are available to the public. The reports answer general questions as well as specifics pertaining to each nursing home. Please note that the information is self-reported and not independently verified.

Illinois Department of Healthcare and Family Services

Look under “Reports for Long-term Care Facilities filed with the department” to see cost reports for nursing homes. They are listed in alphabetical order.  Within this file, you will find the amount of any fines paid for violations.


Checklists:

Questions to Ask When Reviewing Nursing Homes” by Sandy C. Burgener, Ph.D., R.N.C., associate professor, University of Illinois College of Nursing

Elderweb.com “Choosing a Nursing Home"

Medicare.gov: “Guide to Choosing a Nursing Home"