I have no idea where to start. I used a referral service for the assisted living home that my sister has been in but they don’t refer to nursing homes and I’ve heard nothing but horrible things about them. If you’ve chosen a nursing home for a loved one, how did you go about doing this?
Not all facilities are created equal. This applies to IL/AL/MC as well as NHs. WE have to be proactive and check them ourselves.
Although Medicare does have a "rating" system, it is only for Medicare approved facilities and who knows how good those ratings are? Does anyone think a Medicare employee sets foot in these places? Do they rely on input from residents or residents' families, or are there ratings from staff?
Check this:
https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/FSQRS
In there is a caution:
"Caution:
No rating system can address all of the important considerations that go into a decision about which nursing home may be best for a particular person."
YOU need to start somewhere, so these reviews and brochures can be used, but you, the family member, needs to get boots on the ground and check the places for yourself (this applies to ANY facility, not just NHs.)
Knowing nothing about it, I chose the one nearest my home that had the best parking, just barely before the ambulance taking her AWAY from the hospital pulled away. The distance paid off big time.
She had rehab there, and following a long very difficult 9 months being cared for in my home, returned there, and it was a sweet and wonderfully cared for life for 5 1/2 years before she died there.
As it happened, their public state and National ratings were top notch, but every other thing about it was wonderful too, a faithful and devoted care staff, some of the best therapy I, as a therapist myself, had ever observed, and an going sense that the needs of their residents came first.
Choosing? Pleasant cozy atmosphere, smells good, safety first always, aromas of something yummy at lunch, smiling residents, smiling staff, access to TV, activities, entertainment, welcome feeling as soon as you enter.
Actually, after you’ve past the care ratings, you can trust the decision making to where you’d like to be if you were frail or confused or ill.
I’ve already told the care staff at my mom’s SNF that if I were ever to need the type of care they offer, I’d want to be living right there with them, and they AND MY FAMILY know I MEAN IT.
We visited each place twice, once with an appointment and once just showing up.
The smell test is important. One place stank and the nurse said "oh, someone just had an accident". 2 days later, same smell. Nope.
Other than that, we based our decision on access to religious services and distance.
The thing that totally turned me off is when the owner told one of the residents to go wait on her room with the door closed while she gave me the tour. None of the other residents were visible. And all the bedroom doors were closed. It made me very uneasy about what kind of care or activities would be available.
The other MC facility was nice, but I didn't get a warm feeling. The residents that I saw were clean and neat and the facility was clean and odor free, but there was no joy.
The one I decided on was warm and inviting. The residents were all sitting in the living room playing as best they could, a trivia game. The building was spotless, odorless, and bright. There are activities scheduled every 30 to 60 minutes. What impressed me the most is the obvious love the staff showed to the residents. One lady was noticeably upset about something and the staff member knelt down, held her hand while listening to her, then hugged her. The lady sighed and settled down.
That is the care I want for my husband.
Online reviews for these facilities are very unreliable and often times the reviewers can be paid to write them and negative review can be removed specially if management company or ownership changes.
Make sure to ask for move in incentives. :-)
Best wishes and good luck. .
We also asked locally and the one we picked had had good reviews amongst neighbours.
The smell and how the residents seem is also an indicator. I think the telling thing is how the staff behave when you wander around. Do they seem aware of you? Or do they seem more concerned with the people they are caring for? Do they seem to know the tesidents individually? Or are the older people all closed off looking?
Good luck! x
In my case... I lived in a rural area where there few options to begin with, so I chose the closest after touring twice and observing the staff and residents (to the extent that they were visible from the hall). Fortunately, the facility was clean and odor-free, the residents looked content (even happy), the staff were pleasant and outgoing, and the aromas from the kitchen indicated a pleasant dining experience. I came away from both tours with a good feeling.
It contrasted sharply with another facility I had toured a few months earlier, which was dingy, seemed to be in ill repair and whose residents were aimlessly wandering the halls (I even witnessed a very loud verbal altercation between two residents, and the staff just rolled their eyes and walked on by). Moreover, the administrator advised me that my mother had too much money (i.e., her Social Security check was too large) and though she would not qualify financially for a "regular" room, they could place her in their memory care wing because the daily rate for those rooms was higher. That wasn't the level of care that my mother needed, and I was shocked that the administrator would even suggest it. Add that to the fact that their policy manual stated (in effect) that though "physical relationships" between residents weren't forbidden, they were okay as long as they were behind closed doors and the staff had no knowledge of them. That set off the alarm bells for sure. (And as it turned out, the home health aide I employed in the interim told me that she had worked there for six years, and it was a terrible environment for both residents and staff, and she only stayed that long because she needed the job.)
In short, do your homework, tour every available facility, and take careful notes of everything you're told - and everything you see. I was lucky - the best facility was indeed the closest one (a 10-minute drive), and that was a blessing when the lockdowns started shortly after Mama was admitted. I was able to do window visits every day, and keep close tabs on her care.
Good luck with your search, and God bless.
Tour any that you consider
Talk to other visitors.
Observe a lunch, see how residents that can not feed themselves are fed. In a general dining room or a “feeding room”. When my Husband was in rehab I observed one man eating his meals, they were what looked like pre made puréed food that looked like hockey pucks, no utensils and he just put his face into the plate and ate like my dog would! ( ok that was 1 person but I still can’t get over the fact that they could do that, where is the dignity?)
Ignore the fancy outside of the buildings.
Pay attention to staff, do they engage residents? Do they talk to them? This might be difficult to determine on a tour. Did a call bell bring staff to the room or did they ignore it or others? (Again not an indicator alone as some people ring for no reason, but did the staff look to see what room it was that was calling)
In some cases this isn't possible, such as when being released from hospital direct to NH. There are other cases, but in all cases, we have to do what we can to find the better places using the tools that are available.
Once restrictions are lifted, THEN one can do the checking needed by visiting different days/times without appointments. Using all senses and observing care for your own LO as well as others is important. If anything seems off, then it is time to start checking places that allow visitors access and facilitate a move.
But, I'm considering a Live In since the cost would be at least half of hiring several Caregivers doing 12 hr shifts.
I did think about a Nursing Home and I wouldn't put a Love One in a Nursing Home unless I've stopped by a few different times unannounced and looked around and talked to a few of the residents.
Main't thing I decided was if the Nursing Home wouldn't allow a Camera in a Lived Ones Room then I wouldn't check my Lived One in that Nursing Home.
I use Nest Cameras at my Dad's house so I can watch him and see how the Caregivers are treating him any time I want 24 7.
Nest Cameras are easy to install and gave me Peace of Mind.
Prayers
I understand and appreciate your desire to be able to maintain surveillance, but there are privacy concerns too.
you may find this website helpful.
Word of mouth, reading and visiting are all essential.
Check into Medicaid and what documentation you’ll need to begin to gather. Good Luck!
Be prepared for her to be slapped into a diaper even if she doesn't use one now - if she requires any assistance whatsoever to get to the toilet. When she can't hold it while waiting on help a couple of times, the diaper will go on.
If she is mobile right now, your job with visits will be to keep her mobile. Get her involved in exercise classes and other activities that get her out of the bed, out of the room and moving. Your job is also to watch for changes in her behavior that might suggest urine infection. As common as it is, it often goes unnoticed by staff - probably because they don't know what normal behavior is for your person.
2) if someone has problems holding their urine, it isn't just to avoid cleanup
Using disposable briefs also provides some comfort for the person. Would you want to soak your clothes every time you can't hold it or get help to the bathroom?
IF you refer to it/use it as a punishment, then you have issues.
IF you use it for the benefit of all, esp the person, then WHY is it a problem that they get "slapped into a diaper"?
You'll get a rep from the NH who will show you beautiful pics of a 'resort'--and often a decision is made based on those pics.
My mother picked her own place and when she went there--well, although we'd warned her it was an absolute dump, she still went. I think you could hear her yelling miles away.
She was totally non-compliant (I don't blame her at all) and my OS stepped in and found a better place, not so filled with activities and stuff, but a quiet, clean place. She paid the difference in cost and physically moved mother there and left her. I know she never visited her, not once, but hey, she'd solved the problem.
I'd check out a facility pretty thoroughly before we do that again. I mean, wander the halls and see the 'long term residents' rooms. Mom's was so depressing and it stunk and there were 2-3 patients per room, when she had been guranteed a single. That's how we were able to break her contract--they'd actually written in her contract that she'd had a private room--and there weren't ANY. Nobody had a private room!
Visit as often as you can--and keep it to a couple hours and no more. No need to stay longer, no need to 'live' there.
You are giving up a lot of personal freedom of mom's to have her placed, but in the long run, it's probably for the better.
Your job is to make sure she's cared for in a caring, safe, clean environment. The idea of pop in visits at different times is a good one.
A big box of candy for the aide station doesn't go amiss. I'd do that on the reg.
Things will not be perfect, but they can be as good as they can be.
Good Luck!!
Visit during meal time lunch or dinner. Now that restrictions are lifting there should be some people in the dining area; although many facilities are still not permitting outsiders into the dining area you should be able to peak in from the doorway. Some facilities only allow CNAs to assist residents who need help eating while others permit their activities personnel to assist in this area. Find out what the policy is because again..... if your loved one has to wait for the scare commodity of a CNA they aren't going to get much warm food. If possible, see if you can get a meal from the facility (this is hard to do in nursing homes; much easier in ALs because that is one of their marketing tools - restaurant quality meals ) and if you do get a meal at a nursing home don't be surprised that it may not taste special. The majority of residents in ALs are still independent and very aware of food. The bulk of residents in nursing homes have compromised health and as much as they would love to tuck into the salt and cheese laden lasagna, the kitchen will hit all sorts of state deficiencies if they cook like they would like.
So meals in nursing homes are usually gluten free, salt and pepper free, minimized sugar translation: kind of tasteless. Add to that the renal and respiratory diets and the need for thickened liquids, mechanical soft and pureed food..... you get it. But the hot food needs to be hot when it gets to the last resident so visit at meal times. See if their activities offered before and after meal times.
Nursing staff is the one who gives medications, handles emergencies and performs the skilled nursing tasks like wound suctioning, IV's, TPN. Find out how many RNs (not CNA) are on each work shift.
Therapy is so specialized these days that many facilities contract this service out. Find out who is doing the contracted PT, OT even if your loved one doesn't need it right now. Check out the size and layout of the rooms. Medicare pays for what is needed but Medicaid in most states will only pay for "shared quarters"
(CONTINUED)
Unfortunately all but the newest nursing homes who follow the Eden concept are built with the majority of rooms being shared. Generally, the older the facility the smaller the room. Owners claim that is the only way they hit their expense line. The new hospitals are all single rooms to minimize the spread of infection and hopefully after having dealt with the covid 19, any new nursing homes will be built to give residents a bit more space and more protection against infections.
This takes a lot of work and things can change. A nursing home that was outstandingly excellent 5 years ago might not be now. That's why after you look at all the numbers and state ratings you need to talk to friends and families of current residents.
Good luck in your search.
Start with checking online for NHs in the area, allowing a little extra range in case the closer ones are ruled out. From there, online checking can provide input from the facility (of course they will make it sound like the best!), and reviews from others. Brochures and online sites can show images to give you a vague idea of what it's like. Make a list including each place and bullet items under that regarding costs, room size/availability, staffing, hours it is open, including for visits. Call and ask many questions, including the answers into your list. Cost of the residence and what's covered for that cost. Ask about add-on and/or additional costs. For instance, my mother's "rent" covered up to one hour/day of personal care and 2 loads of laundry. Anything over that would incur additional costs. Deep cleaning the carpet happened a few times, when mom had "accidents." While cleaning her room was covered, this wasn't.
IF there might ever be a need for Medicaid in the future, make sure the place is certified for Medicare and ask how they handle existing residents who transition to Medicaid vs those who are on a list for a Medicaid bed.
The answers to these various questions can help rule out some on the list. For the remainder, try to schedule a tour/meal. Of course they may put out the red carpet for this, so as long as they allow visitors, go back at different times and on different days. Make observations using all 5 senses. As someone else posted, if it stinks this day and you go back and it still stinks, that likely isn't going to change! If possible, talk to residents, chat with family members visiting, etc. These are the real people associated with the place, so you'll likely get a better sense of how good the care is from them.
Compare those left on your list and choose the top 3. Perhaps another visit to each would help to make the final decision. Your profile doesn't mention dementia. Would your sister be capable of providing input? Could she be taken to see each of the final "contestants" and provide some feedback? After all, it will be she who is living there, so if she doesn't have cognitive issues it would be nice to include her thoughts/desires in the final decision.