Family members should not be shy about asking pointed questions about the ownership of the nursing home. It can indicate whether an operation is unstable and unreliable. Check the patient-to-staff ratio as well. Some homes have too few nursing assistants for too many patients, especially at night. A recent report from the National Citizens' Coalition for Nursing Home Reform, an advocacy group, said that some nursing assistants are responsible for as many as 15 residents to care for at a time.
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Ideally, there should be at least one staff person for every six to eight residents. You may also want to know whether the home staffs its facility mostly with nurses who have a higher degree of health care training, such as registered nurses, or those with very little, such as certified nursing assistants. Finally, pay attention to safety precautions and guidelines. Bathrooms should have handrails and call buttons near toilets and showers. There should be some privacy for residents, fences to prevent wandering and areas where you can meet privately with your loved one.
Other experts suggest asking about medical services, such as physicians who are available for emergencies, as well as pharmacists, dentists, podiatrists, and other specialists. Be on the lookout for evidence that the staff encourages residents to be dependent on them for care and other simple tasks. It prevents residents from getting better.
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It is much faster and more efficient for the staff to dress the residents rather than let them slowly do it themselves. It's easier to arrange for each resident to have a wheelchair so the trip to the dining room is faster than letting an elderly person walk there slowly. Most facilities issue the chairs with each new resident in order to save on labor costs for transportation and the residents and families like it, too.
But when left in wheelchairs, frail seniors eventually are unable walk any more. This may take only a month, and after that you often see residents spending the entire day sitting in wheelchairs. Some homes do not allow residents to have a wheelchair unless it's for special circumstances. Check on the programs the home plans for its residents. Many homes work with outside community groups to link them with pets, children, and volunteers who will read to residents.
Some homes have programs tailored to a resident's particular interests and needs.
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If a home has no such programs or connections, look elsewhere. Once you get a nursing home contract, the AARP advises residents to make sure it includes information about basic services included in the daily rate, itemizes the lists of charges for services not included in the rate, and describes how decisions are made to move the resident to a different room.
Be wary of contracts that limit the home's liability if the resident is injured or has his or her property stolen. Residents shouldn't be required to deposit all their income to the facility, or be required to pay up-front money when they are eligible for Medicaid, according to AARP. Reputable nursing homes also don't require residents to consent to medical procedures or to have a living will or health-care power of attorney in advance.
Finally, you should determine what plans the home has for holding a bed if someone has to be hospitalized temporarily. Experts say frequent visits -- daily if possible and at least two to three times a week -- are probably the best way to make sure your loved one is doing well. That way, your loved one will know he or she isn't forgotten and can ease into the home more comfortably.
In addition, the staff will know that you'll check to see if special medication instructions are followed, and that patients aren't left in dirty linens or moved so little that they develop bed sores. Mealtimes, weekdays, and evenings are best for unannounced visits. This may be tough to do if you live thousands of miles away. Calling every week or few days is another way to let the staff know you're vigilant and interested, even if you're not there physically; having a relative check in on them personally is also a good idea. That way the staff knows someone is interested in their loved one's welfare and may be more likely to drop in unannounced.
Call during different shifts to orient yourself with different staff members. When your loved one is ill, frequent and long visits or phone calls are critically important to the staff as well as to the doctor. In a few rare cases, some nursing homes have installed a security camera -- a so-called "granny cam" -- into a loved one's room.
Federal law doesn't forbid the use of cameras, nor does it necessarily allow them, and there are no studies that show that having a camera around will improve care. But if you really want a camera around, and the home allows it, you can introduce the idea by letting nursing home officials know that you simply want to keep tabs on your relative and make sure she is doing well. In addition, some nursing homes have policies through which they will cover a deductible for a lost or damaged hearing aid. Remember, the most important thing you can do for your loved one in a nursing home is to become an advocate for their care in its entirety, and that includes hearing care.
Scharf recommends being a participant in the initial plan of care meeting and in subsequent quarterly reviews as well. If you feel your loved one still is not getting the proper care and attention when it comes to hearing care, contact your local Long-Term Care Ombudsman. They are an excellent resource if you have any questions or issues regarding hearing care or patient rights. And, a visit with a hearing care professional in our directory from time to time goes a long way towards improving quality of life and making sure your loved one remains a part of the conversation.
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Be an advocate for hearing care Remember, the most important thing you can do for your loved one in a nursing home is to become an advocate for their care in its entirety, and that includes hearing care. Leaders of these groups, which advocate for residents in the home, can provide insight on any concerns about the facility. Staffing is among the top factors to consider. During your visit, observe whether residents are sitting around waiting to be fed at mealtimes or waiting to go to bed after dinner. If so, the facility probably doesn't have enough staff, McGinnis says.
Ask about the level of staff turnover, which tends to be fairly high in nursing homes.
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If they've had four administrators in one year, "it's a yellow or even red flag," Crandall says. Turnover among the nursing aides who provide most of the day-to-day care for residents is also exhausting for residents and families. Joi Holcomb, 56, a medical illustrator in Austin, Tex. Aides who don't know her mother well, for example, will simply give her fresh clothes and leave the room, not realizing that she needs help getting dressed. Ask the facility if it practices "consistent assignment," meaning that the same aide is assigned to care for the resident each day.
In facilities that don't use consistent assignment, residents can have as many as 20 or 25 different people caring for them in a month. If you have to teach that many people how you want things done, "you just give up," Crandall says. Ask about the total number of nursing hours per resident per day. Research has shown that at least 4.
Also ask about the ratio of staff to residents. A good minimum ratio would be about one to five during the day, one to ten in the evening, and one to fifteen at night, Grant says. Find out if there's a registered nurse on site around the clock. Federal requirements mandate that nursing homes have an RN on site just eight hours per day, which is "woefully inadequate," Grant says. RNs are the only members of the nursing staff licensed to assess a resident when his medical condition changes.
The high cost of care means that many nursing-home residents who enter a facility intending to pay privately will ultimately run out of money.
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Medicare only pays for limited nursing-home care. Therefore it's best to focus on facilities that accept both Medicare and Medicaid -- information that's available on Nursing Home Compare. When reading the facility's admissions contract, families should be aware of any provisions asking for a financial guarantor. Some facilities have asked relatives to "volunteer" to be financially responsible, he says. Another red flag in the agreement: Also look for broad language authorizing eviction without proper cause, such as when a resident is unmanageable or uncooperative.
And watch out for arbitration agreements, which remove the resident's right to take the facility to court if a dispute arises.
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