Over 5 million persons over the age 65 require assistance with one or more activities of daily living. Another 1.3 million, mostly severely disabled, are in nursing homes. Thus, about 80% of the elderly receiving long term care are cared for by spouses, children, family members or neighbors. However, the risk is high that those who live long enough will eventually require nursing home care. Nearly 1/3 of all men who turn 65 will use a nursing home before they die. For women, the likelihood of a 65-year old entering a nursing home for lifetime is 55%. About 25% of the over-85 population live in a nursing home. The average length of stay is 1-1/2 years.
Families consider several factors in selecting a nursing home, including:
(i) Cost (private pay versus Medicaid);
(iii) Qualify of Care;
(iv) Availability of Appropriate Bed; and
(v) Profit versus Non-Profit (with religious affiliation).
Unfortunately, the selection of an appropriate nursing home is made in many cases by a family member at a time of crises, such as an imminent discharge from a hospital, with little time for adequate planning and evaluation. Secondly, families may opt for the nursing home that is the most conveniently located to them without proper emphasis on the most important factor – the quality of care. The quality of care can vary dramatically from one nursing home to another. Medicare has published a useful checklist of what to look for in a nursing home at www.medicare.gov/nursinghomecompare.
The first step in the selecting a nursing home is to compile a list of facilities in your area. Hospital discharge planners, elder care attorneys, geriatric social workers, clergymen, and other professionals can assist you.
The second step is to tour the facilities. As your field of choices narrows, you should make unannounced visits at different times during the day (morning, afternoon or early evening) and on different days (week days and weekends). When you visit the nursing home, you must use all of your senses to evaluate the quality of care:
(i) Smell: All nursing homes have an odor. However, the odor should not be a lingering odor and should not be pervasive the moment you walk into the lobby or reception area.
(ii) Visual: Is the facility clean? Are the residents wandering around aimlessly in soiled clothes? Is the staff active in resident care or just socializing with one another? How do the residents’ rooms look? Are the residents actually involved in scheduled activities?
(iii) Hearing: Is the staff friendly? Are residents babbling or screaming?
(iv) Taste: Visit during mealtimes and taste the food.
Sensory perceptions don’t tell the whole story about the quality of care. Nursing homes are inspected at least annually by the state and the inspection reports are a public record. You can request a copy of the home’s latest inspection report if it is not posted. The inspection report covers a broad range of compliance issues, including improper or over-medication of patients, improper use of restraints, documentation of resident charts, etc. However, just because the state may find some violations doesn’t necessarily mean that the nursing home is bad. Obviously, some noncompliance issues are more egregious than others, especially if the same violations are not remedied and tend to be repeated year after year.
If you know other families with residents in the facility, talk to them about their experiences. Also, talk with the nursing home administrator to determine how many times the nursing home has changed ownership, changed directors of nursing, and changed administrators. Frequent changes may be an indication of problems with the quality of care. Talk to the local nursing home ombudsmen, although they usually are reluctant to recommend particular facilities.
For many, the nursing home will be an end-of-life care choice. It is important that this choice be made to insure the dignity and quality of life of our elderly loved ones, not just that the facility is fifteen minutes closer in driving time to the family. However, if you wait for the crises in care to happen, you will not have enough time to make an informed and intelligent choice. Even when you do your homework, there is no assurance that an appropriate bed will be available when the need arises so you need to plan for alternatives.