8 Tips for Choosing a Nursing Home: A Family’s View

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As a family caregiver of multiple elders, I needed a facility where more than one of my elders could live while I cared for others in various locations. My family was fortunate to find an excellent nursing home just a few blocks from my home. During the 15 years that my loved ones (different people at different times) lived in this facility, I learned a great deal about what makes a good nursing home tick. I interviewed a licensed nursing home administrator for her tips on selecting a nursing home not long ago, but as a family member, I’d like to add a few more ideas.

  1. Observe the staff. Note how the members of the staff interact with one another. Is there respect shown between them regardless of their job? When I saw how well the staff members interacted at the facility where my loved ones lived, I felt that these were good people who would do their best with everyone, which is what I wanted for my loved ones.

  2. Check out the ratio. Ask about the ratio of nurses to residents as well as the ratio of aides to residents. Be realistic. It’s an unfortunate fact that it’s very hard to find enough great people who can work this type of job for what is notoriously low pay. However, great homes that hire well and invest in staff training can still manage, and most have a reputation that helps them find more people to hire. This, in turn, provides a better ratio.

So, while understaffing is one of the biggest issues nursing homes face, better homes do better in all areas, including staff-to-resident ratio. Personally, I’d rather see fewer really great aides than more resentful aides who don’t truly love older adults. Still, this is an important question to ask. Even the best employees who dearly love their residents can only do so much. If they are run ragged trying to answer call lights, they are likely hard pressed to provide excellent care overall.

  1. Assess the reaction time. Great staff will be watching for call lights. People who simply don’t care may ignore call lights because they don’t want to bother. Again, be reasonable. Not every light will be answered in 30 seconds. People who want one-on-one care will have to find a way to pay for that since even good nursing homes can’t provide that kind of response.

  2. Staff retention. One of the things that made my elders’ home so good was that they had nurses, aides, and even social workers who stayed for years. One aide had been there 15 years, others longer. These were stellar employees, but they also made for more contented residents. Change is hard for many older adults and even harder for those living with dementia. Ask a question or two about how long their average staff members stay.

  3. Attentive and engaged. Do you see the people who are caring for the residents look them in the eyes when they speak with them? Do you see the caregivers kneeling or squatting down to the level of the people in wheelchairs? So you feel warmth in the interactions? These are all signs of a good, respectful relationship with the residents. They are being treated as people rather than a chore to attend to.

  1. Joyful atmosphere. Do you see humor among the staff and within the whole community? Don’t expect constant jolliness because many of the residents are in pretty grim condition, work is hard even on a good day, and the staff is often working with an emergency situation simply because the residents are in ill health. However, do expect to see some humor now and then. Expect to see some fun and enjoyment. Staff, residents, and family members should be able to smile and even joke appropriately during times when levity would be a part of life anywhere.

  2. Creative outlet. Does the facility offer activities beyond the expected bingo? Can residents make art? Listen to, or even create, music? Is entertainment from the community brought in? Do children sometimes visit? How about animals? Are there some live plants around? These are all signs that the facility is trying hard to provide a good life for people who are struggling with life quality in the first place. It’s a sign that they care.

  1. First-hand experience is the best. Hang around outside to get some good feedback. Try to snag other family members as they come and go. Ask them about their general satisfaction with the care in this particular home. Understand that you may get a person who expects more than is reasonable, or you may be someone who is happy with anything, so ask as many people as you can to get a decent sample of how families feel about the care. Questions to ask range from general satisfaction to if their loved one is toileted regularly or, if completely incontinent, is he or she changed when wet or soiled.

Most people feel some guilt when placing a loved one in a nursing home. Conducting the appropriate research can help caregivers work through this unearned guilt. Watch for evidence of neglect, of course, but equally important, keep an open mind. Enter with a friendly attitude rather than that of an adversary so that if you choose this facility you’ll have gotten off on the right foot.