Entering a long-term care facility is a serious decision and one that must be made with as much information as possible. Knowing what to look for in a facility, the questions to ask, and what residents are entitled to are all necessary. This article can help senior citizens or family members who must make a choice to make a wise one.
Whether the responsibility of finding a long-term care facility, such as a nursing home or residential-care center, has fallen on your shoulders or you are a senior citizen checking all the options, there are things you should know when choosing a facility. Entering a long-term nursing-care facility is not a simple matter. You should thoroughly investiage the facility and its staff to keep everyone involved and happy and to protect their rights. A tour of any facility under consideration is a must, and the potential resident should have the final say if he or she is able to express a preference.
Major Considerations
Those seeking information about any care facility will have many questions that require complete answers. Begin with a phone call to the facility. Speak with the social worker, social services director, or nursing home administrator. Ask many questions, gather information and facts, and tour the site. If you or your loved one fails to feel that questions have been answered, it’s very important to see that satisfactory information is provided. Don’t leave until you have the answers you need.
The first thing to learn is what type of payment the facility can accept. Is the home a Medicare or Medicaid certified one? Do they accept your insurance? How and when will billing be done? Will there be ancillary charges for things like laundry? Can the family pick up dirty laundry and return clean garments? Can the family provide over-the-counter medications as needed or will these items be charged to the resident? How much of the burden of cost will fall upon the prospective resident and family? Answers to all these questions are some of the first that must be found.
Each nursing home or care facility is different. Some offer limited levels of nursing care. Find out up front if the facility offers custodial or skilled care. Some may offer both. Also be aware of the type care that you or your family member may require. Once that has been determined by the physician, make sure that a bed of that type – skilled or custodial – is currently available. It may be necessary to be on a waiting list to gain the type of bed needed. If a waiting list is in effect, ask for an estimate on how long it may be until a bed is available or how many potential residents are ahead of you on the list.
Learn what special services are offered at the facility. These are services that go beyond the basic nursing care offered and include things such as Alzheimer’s care, rehabilitation, ventilators, and physical therapy. Special treatment and therapy can aid in recovery from an medical event or surgery. It can also boost morale and give residents the best quality of life possible.
Consider the location of the home. Is it in a familiar area that the resident will be comfortable with? And, is the facility located in a convenient place so that family and friends can visit often? Many residents find themselves in a location so distant from their dear ones that they have few visitors. Ask if there are visiting hours or any limitations on when loved ones can visit. Find out now if it is possible to check out residents for a holiday, birthday, shopping trip, or other event.
When visiting the facility, look at the current residents to see how well cared for they appear. Look to see that residents are clean, that they are appropriately dressed, and that they seem comfortable. Check to see if residents may wear day clothing of their choice or if they are required to dress in pajamas or gowns.
Make sure that any facility under serious consideration has no odors. A clean and well-kept facility is a must and such homes will have no unpleasant odors. Remember that you or your loved one will reside here and that the surroundings should be clean.
Look for good lighting and a comfortable temperature. Rooms, common areas, and hallways should be well illuminated and thermostats should be at a comfortable setting no matter what the season. Furniture in common areas such as parlors, living rooms, day rooms, television lounges and the dining room should be sturdy yet attractive. Furniture should also be comfortable and functional. Make sure that all hallways and common areas can accommodate wheel chairs easily.
Search for a home that has outdoor areas accessible to residents. Ask if residents are allowed to sit on the porch. Find out if there is a patio or a garden area. Some homes have programs where some residents may be able to tend window boxes or grow flowers in an outdoor setting. Find out if field trips away from the facility may be possible for ambulatory residents.
Listen for noise levels. Does the noise level in the dining room seem comfortable? Are there residents who cry out or make other distractions difficult to hear? This is something that must be taken into consideration. Listen to see if music is played over an intercom system and if so, if it is something that would be enjoyable or annoying in the long-term.
Staff members should wear easy to read name tags for easy identification. Name tags should also identify the person’s position on staff. All staff should be respectful, polite, neat in appearance, and caring. Watch staff interactions with residents to ensure that residents receive quality care. Look for signs that staff members respect the rights of the residents. Knocking before entering a room is one indication. Listen to hear if staff address residents with kind tones.
Talk to the dietary staff. Find out if food choices are available or if all residents dine from the same basic menu at mealtime. Ask if favorite foods are available or if family can bring special foods as a treat. Ask if guests are welcome to join residents at meals and what the cost for a guest meal ticket may be. Other questions that should be asked would include information about holiday dinners, special diets, and taste. Tour the kitchen area and look for clean surfaces. If possible, try a meal to see if it is palatable and tasty.
A good care facility should offer an activity director with a wide variety of activities for both ambulatory residents and those who may be bedfast. Ask if continuing education programs are available and check the social calendar to see if there are musical performances, visiting talent, book groups or other amusements. See if daily newspapers are brought in for residents and if magazines are on hand. See if exercise programs are ongoing and if there are hands-on crafts. Ask if pets are ever brought to visit and if a special pet can come along on visits.
Make sure that staff members have a background check on hiring. This is one way to make sure that staff members lack a past history of elder abuse or criminal activities.
Look for at least one staff R.N. in addition to the Director of Nursing (who should be an R.N.). Consider the number of floor nurses and LPN’s in comparison to patients and look for C.N.A.’s on the floor. These are certified nursing assistants who have completed a training program to be qualified to care for the elderly. Facilities who offer ongoing training programs for newly hired nursing assistants are staffed with quality care givers. Ask if in-service training is present and if all staff members continue to learn. Make sure that staff will stay abreast of new trends, treatments, and information.
Check to see if there is a full time Social Worker or Social Services Director. This person should be one you deal with during the inquiry phase of a search for a facility but he or she is also a vital support for residents. Social workers will make certain residents receive the care necessary and benefits they are entitled to have.
A good nursing facility should have a staff doctor. Inquire about his or her schedule. While the staff doctor doesn’t have to be on site at all times, ask how often he visits and whether or not residents can also receive visits from a personal physician.
Look for a management team – administrator, assistant administrator, social worker, and activity director – who has worked together for at least one year. Many facilities experience high turnovers, which can create an unstable environment.
Care plans should be created for each individual resident. Ask if care plan meetings, which should involve the family, can be scheduled at convenient times. Input from both the resident and family should be weighed and considered. Everyone involved should be fully informed about care plans and any changes.
Ask to see the most recent state inspection report. Look for any deficiences and ask if these have been corrected. Avoid any facility that has a large number of deficiences listed.
Rooms and Rights
A resident’s room is the most important part of the nursing home. Residents will spend a large portion of their time in their assigned room and it will be their home base. Because home is such a vital thing, ask many questions.
Find out if residents can bring their own furniture from home and have personal belongings. Ask if there are any restrictions about some items or pieces of furniture. Make sure that the room has a window. It’s preferable if rooms have a personal telephone and television for each resident too. Ask if pictures or favorite photographs can be hung on the walls. A water pitcher should be easily accessible by all residents, especially those who may be confined to bed.
If roommates are going to be a fact of life, ask if residents have any input into who shares their space. If a married couple is considering a care facility, make sure that they can share a room. Ask if roommates can be changed should personality conflicts develop.
Most of all be sure that you and your senior citizen family member are aware of resident rights. Federal law protects these rights. All new residents should receive a copy of these rights and they should also be posted in a public, prominent location. If rights seem to be violated in any way, contact the home administrator and if that fails, seek outside assistance.
Resident rights are:
Respect. Everyone should be treated with dignity and respect at all times.
Services and fees. Residents must receive written confirmation of all services and costs before entering a facility.
Money. Each resident has the right to handle their own financial affairs or to designate someone to do it for them.
Privacy. Everyone has the right to privacy which includes being able to have personal belongings, to protect those possessions from others as long as doing so doesn’t interfere with someone else’s rights.
Medical care. Residents should be given full information about their own condition, health issues, treatments, and medications. Necessary medications should be administered in a timely manner. Residents also retain the right to say no to any treatment or medication.
Before choosing a long term care facility, consider all the key points. Visit as often as necessary to decide if this is the right facility. Observe the conditions in the home, residents, and staff. Because a nursing home can be someone's final home, it's very important to choose a place where he or she can be happy and function as fully as possible.