Choosing a Nursing Home Can Be Harder In Some States than Others

  • Few people say, during their middle years, that they hope to take their last breath in a nursing home. However, the reality is that many of us have, and many more of us will. I know. Juggling the care of five elders at one time, plus two children and other demands on my time, made a nursing home for a few of my elders a necessary choice.


    While, for years, I made the rounds of homes and condos to care for the elders in my family who could still live at their respective homes, there were health issues with my uncle, then my dad, and eventually all of my elderly loved ones, that made a good nursing home the only viable choice. We were fortunate.There was an excellent home within walking distance of my house. I spent 15 years going to that home nearly every day.

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    As the years went by, sharing what I'd learned during my years of caregiving became a passion for me. My first step outside of my comfort zone was to write a book. It was during the interviews with caregivers that I conducted for my book that my eyes were opened. Not all nursing homes were as good as the home where my loved ones lived. Later, as I became more involved nationally, I was often shocked by what people told me about homes in their communities.


    As with so many issues, awareness is half the battle. During the last century, nursing homes, while still having distinct personalities, still leaned toward the staff efficiency, military model. This was not beloved by the public, but accepted because, well, that was the way nursing homes were.


    However, Baby Boomers have become more aware of nursing home culture as their parents hit the age where such care is needed. And Boomers haven't been, in general, pleased with the average facility.


    Activists to the core, this generation has been pushing for change and they are getting results. Change is slow, and much depends on state regulations and expectations. But progress is being made. In another decade, through hard work and awareness, most nursing homes should reflect the new attitude of person-centered care that is the goal of culture change.


    Person-centered care simply means that each resident of a nursing home is treated with the respect and dignity they deserve as a unique individual. The facility learns as much about the individual as possible and tailors care to that person's needs.


    This idea, while at one time considered too expensive by many facilities, is proving in many to be the best business tool they've used. People who are well cared for and treated as individuals are, in general, easier to "manage." Fewer drugs are needed. This is not to say medication is bad, or that good care means no medication. Quite the contrary. Good care means tailoring the mediations to those that are needed, while eliminating those used for staff "convenience." Happy residents mean happy families. There is no better advertising.


    How Do You Choose a Good Nursing Home?

    As I've noted, finding a very good home is easier in some places than others. However, there are some tools you can use:

    • First, you can check out the Medicare nursing home rating tool. I mention this with some trepidation. It's a good tool, but it must be used as just that - a tool. Many of the categories are self-reported, thus some nursing homes may be more honest than others. It seems to me, the better the home, the more likely they are to be honest and perhaps "ding" themselves in a category where a poor home may cover up flaws. Some categories are regulated, but this too has problems. The inspections are locally done and different states have different standards. In other words, a home that registers five stars in one state may only get two in another. This is not to say the tool is unworthy, but just treat it as one tool.
    • Check the home in person. Visit different times of the day. See if the staff seems to genuinely like the elders. See how the staff treat one another. If there is respect among the staff, no matter what their level of work, then you are likely to have found a nursing home where the staff is fairly stable and of good quality. This is vital.
    • High staff turnover is a danger signal. The flip side, of course, is stable staff is good. So is what is called "consistent assignment." That means that caregivers on the staff get to know the elders in their group, and the elder has a better chance at becoming attached to the caregiver. Having someone strange show up to give you a bath can be disconcerting. Consistency in care is good.
    • The obvious things, like cleanliness, should be checked. Please don't be put off by an occasional smell. Many people are incontinent. The test is what does the home do about it? Are people taken to their rooms and changed as soon as possible? Are they still treated respectfully and not scolded?
    • Look for humor. Good natured humor is important. If there seems to be any ill-nature, disguised as humor, among the staff - especially at the expense of a resident - then look elsewhere. Some residents are difficult to handle no matter what kind of care they get. Nursing home staff are, in general, overworked and underpaid. Yet, humor with a cruel twist is a danger sign. Be aware.
    • Look for families who are visiting their loved ones. If you can, try to talk with a few. One family won't do. There will be people who no home can please, and there will be those who give a blanket "A plus" to any home that will keep their elder. So, look around and try to tap a few families. This can work better than a list of approved references give by administrators.
    • Go with your gut. Yes, you want a tour. Yes, a nice building is good. But good people will make a bigger difference and so will a few visits on your own. If you hate a place, ask yourself why. Then tour a few more facilities and see if it's your unrealistic expectations that are turning you off, or if you really did see an inferior home. Trust your instincts and look around.
    • Good luck. If all else fails, you may have to move to a state with higher standards. I'm only half joking. There are amazing differences in nursing homes. That is something I hope will change within the next decade. All of our elders deserve the same high quality of care.

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Published On: April 10, 2010