How To Choose a Good Nursing Home

Selecting an appropriate nursing home for a family member may feel overwhelming. With numerous options available, swiftly determining which facility offers the compassionate and top-tier care your loved one needs can be challenging.

There are multiple approaches to selecting a nursing home, and while seeking recommendations from friends and doctors is a good starting point, it necessitates more thorough research.

Nancy Avitabile, an aging life care manager and owner of an aging life care practice in New York, advises, “I always urge families to delve further and seek anecdotal, informal information.”

When selecting a quality nursing home, it’s essential to consider the following crucial aspects:

1. Facility location and amenities.
2. Staffing considerations.
3. Quality of care.
4. Quality of life.
5. Community and family engagement.
6. Legal and financial considerations.

Location and Facility Features

The geographical placement and design of a facility can significantly impact the well-being of your loved one. Here are specific aspects of the nursing home community to carefully assess when determining its suitability:

1. Proximity: The closer the facility is to your home, the easier it becomes to visit or communicate with the staff. Nancy Avitabile emphasizes not compromising on proximity to family and friends.
2. Grounds: Conduct a thorough tour of the building and grounds to gauge cleanliness and maintenance. The overall condition of the nursing home can offer insights into the level of care your loved one might receive. Additionally, look for outdoor spaces where your loved one can enjoy fresh air or spend time with visitors.
3. Room Amenities: Avoid basing your decision solely on the outward appearance of the building, courtyards, common areas, or rehabilitation units. Avitabile recommends requesting a view of all units, including those designated for long-term care, as they may differ from the renovated short-term rehab rooms. Assess whether the rooms exude a welcoming atmosphere or resemble sterile hospital environments.
4. Safety Measures: The Centers for Medicare & Medicaid employs a five-star quality rating system to aid families in comparing nursing home options and formulating relevant questions. Homes with a five-star rating perform above average, while those with a one-star rating indicate much below average quality. Familiarizing yourself with these ratings can assist in making an informed decision about the safety and quality of care provided.

Consulting the Best Nursing Homes ranking by U.S. News & World Report is another valuable resource to identify top-notch nursing homes in your vicinity.

Although no single ranking system comprehensively covers all factors essential for choosing the ideal nursing home, inquiring about past safety incidents can provide insights into the overall safety of residents. Each state operates its inspection and rating system, evaluating the safety and quality of care in nursing homes. Therefore, it’s crucial to also consult local authorities to ensure a comprehensive assessment.

Concerns Regarding Staffing

Maintaining sufficient staffing levels has long been a challenge for many nursing homes. The COVID-19 pandemic exacerbated this issue, prompting the Biden administration to announce reforms aimed at enhancing the safety and quality of nursing home care. These reforms include mandates for adequate staffing levels, increased accountability, and greater transparency. Anticipated to commence in 2024, these regulatory changes will be gradually implemented over the years, providing consumers with better information for selecting an ideal nursing home for their loved ones.

1. Staff-to-Patient Ratio: Adequate staffing is pivotal for the well-being of your loved one. A nursing home should be adequately staffed with a diverse range of professionals, including physicians, registered nurses, family counselors, certified nursing assistants and aides, physical therapists, and wound care specialists. Inquire about the staff-to-patient ratio, ensuring that the nursing staff feels appropriately equipped to care for residents without feeling rushed or overwhelmed.
2. Staff Retention and Turnover Rates: High turnover rates signal discontent among employees, potentially compromising the quality of care. Nancy Avitabile emphasizes the importance of staff retention, noting that the best nursing homes often boast a stable workforce, with some even having generations of family members working there. A consistent and experienced team contributes to a more stable infrastructure.
3. Staff Qualifications: Staff members must possess adequate training for their assigned responsibilities. Inquire about the training procedures, whether staff engage in continuing education, and whether comprehensive background checks are conducted on all employees. Thorough background checks are essential for preventing elder abuse and ensuring that your loved one receives quality care.

Quality of Care

Assessing whether the staff at a facility genuinely cares for their patients or merely goes through the motions is crucial. Although this evaluation may pose challenges, there are several indicators of how well seniors are looked after in a specific home.

1. Daily Care Routines: Nursing homes offer a spectrum of services, encompassing assistance with the activities of daily living such as toileting, hygiene, eating, and medication management. Beyond basic care, they also provide skilled nursing care to address chronic or acute health conditions. Understanding the specifics of individual care plans, the availability of specialized care services, and how your loved one can access these services is essential for a comprehensive assessment.
2. Medical Support: While nursing staff are typically available, it’s crucial to ascertain the frequency of a doctor or other medical provider’s presence and the procedures for accessing medical care when needed. Understanding the protocols for changes in your loved one’s care needs or during emergency medical situations is essential. Additionally, inquire about preventive healthcare services such as flu shots—whether the facility provides them or if your loved one needs to visit their primary care provider for such services.
3. Compassion and Respect: Beyond touring the facility and engaging with administrative leaders, request to connect with and speak to nursing leaders or activity leaders to assess their communication and caregiving skills.
4. Empathy and Compassion: Listen for signs of empathy and compassion in their responses. Dr. Frank Flowers, medical director at Kaiser Permanente in Southern California, suggests asking if they have family members in nursing facilities and how they made placement decisions. Inquire about what they find most rewarding in caring for residents.
5. Consistency in Assignments: Inquire about the consistency of caregiver assignments, as this fosters a deeper understanding of residents’ needs and preferences. Consistent assignments also contribute to residents feeling more secure and comfortable in their environment.

Quality of Life

When a senior transitions to a nursing home, an exemplary facility provides ample opportunities for building social connections, participating in enjoyable activities, maintaining a nutritious diet, and accessing amenities that contribute to longevity, overall health, and well-being.

1. Meal Plans and Nutrition: Nursing homes often prioritize providing nutritious meals tailored to residents’ dietary needs and preferences, including considerations for religious restrictions or health conditions such as diabetes, high cholesterol, or food allergies. Examine dining facilities, inquire about available meals and snacks, and some homes may even allow you to sample the food. Ask about flexibility in meal times and how the staff ensures well-fed residents, especially those with less interest in eating.
2. Social Activities: Diverse social activities play a vital role in supporting wellness. Beyond mindless games, look for nursing homes offering a variety of social, physical, interactive, and educational activities. Assess whether activities cater to individuals with disabilities, such as wheelchair-accessible yoga classes, and inquire about outdoor engagement for residents with mobility challenges.
3. Meaningful Tasks: Some nursing homes empower capable residents by involving them in meaningful tasks reminiscent of their activities at home. This may include tasks like delivering mail, assisting with water pitchers, or reading to fellow residents. While seemingly small, these activities can significantly contribute to residents’ sense of purpose and overall health.
4. Decision-Making Opportunities: Residents should have a voice in their care, influencing decisions regarding sleep and wake times, activity participation, clothing choices, and dining preferences. Inquire about communal meal times and whether residents have the option to eat in their rooms for those who prefer solitude.
5. Privacy and Independence: Assess whether seniors in the home are granted some level of privacy and independence, treating them as adults with respect for personal boundaries and preferences. Ensure that dietary, spiritual, and other personal boundaries are not only acknowledged but also accommodated. While these aspects may be more challenging to observe, closely watching staff interactions with other residents can provide insights into the caregiving philosophy aligning with your loved one’s deserving care.

Community and Family Engagement

Many nursing homes actively seek to foster connections with the broader community and encourage family involvement in residents’ lives. Volunteer programs offering caregiving support and entertainment, coupled with flexible family visitation policies, define each home’s unique approach. When seeking the right fit, it’s crucial to inquire about these options and policies.

1. Visitation Policies: While the COVID-19 pandemic disrupted normal operations, many nursing homes have reinstated standard opening hours and 24/7 access for families wishing to visit their loved ones. Recognizing the health concerns related to isolation and loneliness, particularly for seniors in long-term care, select a nursing home that prioritizes allowing residents to connect with their loved ones. Clarify whether visits can be impromptu or require scheduling, and inquire about the frequency and conditions for visits.
2. Alternative Visitation Options: In addition to in-person visits, explore alternative visitation options such as impromptu or scheduled video calls. Check if the facility provides residents with mobile devices for remote connections or if you need to provide one. If supplying the device, inquire about the staff’s role in ensuring its safety and security.

Legal and Financial Considerations

Enrolling a loved one in a specific nursing home requires careful consideration of legal and financial matters, with a primary focus on determining how to finance their care.

1. Cost and Payment Plans: Contrary to common assumptions, Medicare may not cover the entire cost of a nursing home stay. Stephanie Pogue, a Certified Medicare Insurance Planner, emphasizes that Medicare primarily covers medical expenses aimed at recovery, and its support for skilled nursing in a nursing home is limited to situations where improvement is expected. Importantly, this coverage has a maximum limit of 100 days, with associated copays for the latter 80 days. Long-term, custodial care typically associated with nursing homes and assisted living facilities falls outside the scope of Medicare.
2. Medicaid and Insurance Programs: Medicaid may provide assistance in certain situations, but it’s crucial to inquire about the insurance programs accepted by the nursing home and understand how financial and legal matters related to the cost of care will be managed.
3. Payment Plans: Some nursing homes collaborate with patients and their families to establish individualized payment plans, offering flexibility to ease the financial burden. When exploring potential facilities for your loved one, inquire about available options for managing the costs.

In conclusion, while finding a nursing home that aligns with all these considerations may pose challenges, it is indeed possible. Once a facility is selected, ongoing engagement is essential. Regularly asking questions and staying involved in your family member’s care helps address potential issues, such as changes in policies or shifts in cognitive well-being.

Dr. Frank Flowers emphasizes the importance of maintaining a connection with the chosen facility, reinforcing care and concern for your loved one, even if personal interactions with staff and administrators may be limited.