In its most recent survey of nursing homes, the Centers for Disease Control and Prevention reported that there are 16,100 nursing homes in America holding a total of 1.5 million residents [source: Centers for Disease Control]. As the baby boomer generation begins aging, these numbers are certain to increase.
Yet making the decision to put a loved one in a nursing home is never easy. When examining quality-of-life factors however, it often emerges as the best option for both the elderly family member and the caretakers. And while the standards of nursing homes can vary dramatically, if you are armed with the right research tools and information, you will be much better equipped to find a facility that treats its patients with respect and allows them to live healthy, vibrant lives.
Here, we give you 10 of the most important questions to ask before making this important, life-changing decision.
Are residents free to make choices?
One of the hardest challenges for someone who has taken up residence in a nursing home is their loss of independence. Oftentimes, a person moves to such a facility directly from their own home where they could decide when to sleep, when to eat, when to watch TV, and when to enjoy peace and quiet. Because of the communal nature of nursing homes, this independence and privacy can diminish.
That's why it's important to ask the facility how much freedom they afford their residents. Can people choose what time to eat and, in fact, what type of food they'd enjoy for each meal? Can they arrange their rooms in the way they like, and can they furnish and decorate it with personal items? Are residents free to go outside when they want? Are there designated quiet hours or quiet spaces where someone looking to escape a blaring TV could find refuge?
The more freedom a nursing home gives its residents, the more likely those residents will be happy with their day-to-day lives.
Is the facility certified and accredited?
The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) is a not-for-profit organization that inspects, accredits and certifies health care organizations and programs across the United States. If a facility you are considering has been accredited by JCAHO, it means that it has satisfied a strict set of quality control and safety guidelines that include infection prevention as well as medication management. While you can certainly ask the nursing home's representative about JCAHO accreditation, you can also keep your eyes open for its "Gold Seal of Approval" decal, which indicates that the facility has passed a successful evaluation by JCAHO.
Another important certification to ask about is the one provided by Medicare. This is crucial if you are expecting financial assistance from the organization, as Medicare only pays for facilities that it has certified.
How does the facility compare to others?
If a nursing home has been certified by Medicare or Medicaid, then it will also be listed by their "Nursing Home Compare" Internet service. This service allows you to search for a nursing home based on geographic criteria (or by nursing home name) and then lets you sort the results based on a variety of criteria. Medicare gives star rankings for health inspections, which include the results of onsite examinations of resident care; staffing, which examines the number of staff hours per patient per day; and various other quality measures that are self-reported by the nursing home.
Nothing beats an actual visit to a facility you are considering, but Nursing Home Compare is a great way to pare down your list before heading out.
What are the official policies?
It's important not to assume anything when evaluating a nursing home. Just because one facility might have an open door policy for visitors, you can't assume another does. That's why it's critical to be sure you understand all of the potential nursing homes' policies. Most will be able to provide them to you in writing, but if not, some questions you might want to ask include the following:
- Is smoking allowed?
- Are there restricted visiting hours?
- Do residents have access to a phone and TV?
- Are they provided a choice of roommates?
- Can they still see their own doctors?
- Are pets allowed to visit and/or live in the facility?
- What approach does the nursing home have for treating behavioral difficulties?
When composing this list of questions, it can be helpful to think of yourself living in the facility. What would an average day like be for you? What would you want to know before moving in? The more you ask, the better prepared both the future resident and your family will be.
What are the facility's security and safety precautions?
While you're no doubt going to be concerned about the medical attention someone will receive at a nursing home, you should also do your best to find out what the facility's plan is for keeping your loved one safe and secure. Do they have their own hospital transport? If not, what is the average time for an ambulance to reach them?
You'll want to investigate the building's fire safety systems. Are there sprinklers? Fire alarms? Adequate escape routes from all floors? Has the staff been trained in proper evacuation techniques? If the nursing home resident you care about is dependent on a medical machine, you'll also want to ask about back-up power generation.
Lastly, ask the nursing home what precautions they take to protect residents' belongings. Are there safe deposit boxes? Do residents have something they can lock in their rooms? Is there a security guard to prevent unauthorized entry into the building? There are plenty of concerns to occupy your mind when moving a loved one to a nursing home -- safety shouldn't be one of them.
What is the staffing situation?
In many ways, the staff at a nursing home becomes a surrogate family to a patient. So you'll want to spend time talking to as many of them as possible to find out what their attitudes are toward the residents. Do they seem stressed? Too busy to speak with you or do their jobs in a calm and nurturing way? If this is the case, the facility may be understaffed, so be sure to ask about the patient-to-staff ratio or do your homework on Medicare's Nursing Home Compare site.
Once you've determined that there are enough employees at the potential facility, find out exactly who comprises the staff. Is there a social worker? How many RNs are on duty? Does the nursing home have its own doctor or one who's always on call?
You may also want to inquire about any specialized training the staff receives -- such as abuse prevention -- either upon being hired or on an ongoing basis.
One key question that should be at the top of your list is to find out if staff members work with the same patients at least four to five days per week. This can build positive relationships between staff and patient and can mean the difference between a cold, impersonal experience and one that truly feels like family.
What kinds of activities are available?
All nursing homes offer a degree of activities for their residents, and you'll want to ask about these when investigating. Find out what the daily schedules are like and ask about unscheduled activities. Can residents use an arts and craft room even when something isn't scheduled? How about a gym or pool? Is there a library? Computer work stations?
Your goal in making these inquiries is to try to match the person going into the nursing home with a place that will appeal to his or her interests. Does she like to watch old movies? Then find out if the home has a movie night. Does he like to work on puzzles? Be sure there are several tables and puzzles available.
You might also want to ask about what the nursing home does for holidays, birthdays and special events. Do they have a room where you can bring friends and family in to have a party? Do they decorate for the holidays, or bring in trick-or-treaters for Halloween or carolers for Christmas? In fact, it is a good idea to ask about any outside entertainment the nursing home brings in. The more interaction residents can have with people from the "outside world," the more vibrant and engaged they are likely to be.
What is the fee schedule?
After quality of care, cost is probably the biggest factor in choosing a nursing home. That's why you want to be sure you fully understand what is -- and what is not -- included in a facility's fee structure. Nursing homes are required by law to spell out their exact fees for service, and you should take a copy with you in writing so that you can compare all of the potential facilities in the quiet of your own home. Don't assume that something like meal choice, gym access or physical therapy visits are automatically included in the monthly rate. Such line items can quickly balloon what might seem like a bargain rate at first glance. You'll also want to ask about the nursing home's policy regarding the increase of fees so that you are not shocked by skyrocketing prices once you choose a home.
What type of preventative care is offered?
Not only do you want a nursing home to care for your loved one's current condition, you also want to make sure that they do all they can to keep the resident's health from declining. So ask about their preventative care programs. Do they offer nutritionally rich meals? Are residents encouraged to exercise? Is there a program for flu and pneumonia vaccinations?
Something else you'll want to investigate is what steps the nursing home takes to keep residents' minds healthy, as well. Are there group chat sessions? Regular visits by a social worker? Are brain-building or memory-testing games available? A stay in a nursing home does not need to lead to an inevitable decline in health. With the right focus from the facility, patients can sometimes even improve their overall condition.
How does the facility work with the ombudsman program?
You might have never had cause to talk to your local ombudsman (or to even know that you had one), but when you are considering putting someone in a nursing home, they are good people with whom to become acquainted.
If the potential nursing home welcomes visits from your local ombudsman, this is a good sign, as these officials can act as an advocate for patients, investigating everything from unanswered call buttons to complaints about sanitary conditions or even the quality of the food being served. Once you've narrowed down your nursing home choices, set up an appointment with your ombudsman and find out what he or she thinks about the different facilities. Their insider view is priceless as you work through your decision-making process.
To find your local ombudsman, visit the Web site of The National Consumer Voice for Quality Long-Term Care.
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- Centers for Disease Control and Prevention. "Nursing Home Care." (June 8, 2011) http://www.cdc.gov/nchs/fastats/nursingh.htm
- Centers for Medicare and Medicaid Services. "Guide To Choosing a Nursing Home." (June 8, 2011) http://www.medicare.gov/publications/pubs/pdf/02174.pdf
- Holland, Hope. "Questions to Ask Potential Nursing-Home Facilities." Fox Business. July 28, 2010. (June 8, 2011) http://www.foxbusiness.com/personal-finance/2010/07/28/questions-ask-potential-nursing-home-facilities/
- Medicare.gov. "Nursing Home Checklist." Medicare. (June 8, 2011)
- Medicare.gov. "Nursing Homes." Medicare. (June 8, 2011)
- The National Consumer Voice for Quality Long-Term Care. "A Consumer Guide to Choosing A Nursing Home." Aug. 2009. (June 8, 2011)
- The Senior Source. "Services for Mature Adults: Resolving Nursing Home and Assisted Living Issues." (June 8, 2011) http://www.theseniorsource.org/pages/nursinghome.html#what