What questions should you ask when choosing a nursing home?

According to the Centers for Medicare & Medicaid Services (CMS), nearly one-third of all nursing home inspections result in a finding of a deficiency. To avoid placing your loved one in a facility with serious shortcomings, it's critical to know what questions should you ask when choosing a nursing home. A thorough evaluation can help ensure their safety, comfort, and well-being.

Quick Summary

A comprehensive guide to key questions for evaluating nursing home care. Cover crucial topics like quality of care, staffing, financial considerations, and facility environment to aid your decision-making process.

Key Points

• Assess Care Needs Thoroughly: Document specific medical and personal needs, including requirements for rehabilitation or specialized dementia care, before touring facilities.

• Prioritize Staffing and Training: Inquire about staff-to-resident ratios, turnover rates, and specialized training to gauge the quality and consistency of care.

• Understand All Financial Implications: Get a detailed breakdown of costs, one-time fees, and insurance coverage. Carefully read the admissions contract for any confusing liability clauses.

• Evaluate the Facility Environment: Conduct both scheduled and unscheduled visits to observe cleanliness, safety features, and staff-resident interactions. Trust your instincts.

• Check Inspection Reports and Ratings: Review state health department inspection reports and use online tools like Medicare's Care Compare to find recent violations or quality concerns.

• Talk to Current Residents and Families: Engage with current residents and their family members to gather firsthand feedback about their experiences with the facility's care and atmosphere.

Your Care Needs and the Care Plan

Understanding the individual's specific needs, whether for daily activities, rehabilitation, or specialized care, is the first step in evaluating a facility. The facility's approach to creating and updating care plans is crucial.

• How are individualized care plans created and updated? Inquire about who participates in this process.
• Does the facility specialize in a specific type of care? This is particularly important for complex conditions like Alzheimer's or dementia.
• What medical services are available on-site? Ask about physician availability and external services.
• What is the facility's process for handling medical emergencies? Understand their emergency plans.
• How are medications managed and administered? Ask about staff training and procedures.
• Are end-of-life care and hospice services offered? Understand their policies if this becomes a need.

Staffing Levels and Quality

Staffing is a key indicator of care quality. High staff-to-resident ratios and low turnover are generally associated with better outcomes.

• What is the staff-to-resident ratio? Request specific numbers for RNs and CNAs across different shifts.
• What is the staff turnover rate? High turnover can affect care consistency.
• What qualifications and training do the staff have? Inquire about specialized training.
• How does the staff interact with residents? Observe staff demeanor during visits.
• Does the facility use temporary staff? Understand their reliance on agency workers.

Financial and Administrative Questions

Understanding costs and payment options is essential.

• What is included in the basic monthly cost? Get a detailed list of included and extra services.
• Does the facility accept Medicare and Medicaid? Confirm if they are certified to avoid potential issues if financial assistance is needed.
• What is the policy for price increases? Understand how often and by how much costs typically rise.
• Can you review the admissions contract? Carefully examine the contract for clauses regarding financial responsibility.
• What happens if private funds run out? Ask about their process for transitioning to Medicaid.

Resident Life and Amenities

The environment and activities contribute significantly to a resident's quality of life.

• What is the weekly schedule of activities? Look for a variety of options.
• How does the facility accommodate special dietary needs? Request a sample menu and observe meal service.
• What is the resident's freedom of choice? Inquire about flexibility in daily routines.
• Are family members involved in care? Ask about family councils and communication methods.
• What are the visitation policies? Understand the rules for visitors.

Your Inspection and Observation

Personal visits are vital for evaluating a facility.

• Trust your senses: Observe cleanliness and maintenance.
• Ask to see the latest state inspection report. Look for deficiencies or violations.
• Talk to residents and visitors. Gather firsthand accounts.
• Observe staff interactions. Note how staff treat residents.
• Review the Medicare Care Compare website. Use this tool, but also consider your observations.

Conclusion

Choosing a nursing home requires careful consideration of care practices, staffing, finances, and the environment. By asking the right questions and observing diligently, you can make an informed decision. Utilize resources like Medicare Care Compare and long-term care ombudsmen to supplement your evaluation. The goal is to find a facility that provides compassionate, professional care and meets your loved one's specific needs.

Nursing Home Comparison

Feature	Facility A	Facility B
Overall Star Rating	4-Star	3-Star
Registered Nurse (RN) Staffing	8+ hours/day (Average)	6 hours/day (Below Average)
Staff Turnover Rate	Low	High
Dementia Care Specialty	Yes (Dedicated Unit)	No (General Care)
Recent Health Inspections	Few minor deficiencies	Several major deficiencies, including infection control issues
Visitation Policy	Open, flexible hours	Restricted to specific hours
Room Availability	Shared and private options	Primarily shared rooms
Medicaid Accepted?	Yes	Yes

Note: Example data for illustrative purposes. Always verify details with specific facilities and resources like Medicare Care Compare.

Frequently Asked Questions

What is the most important factor in choosing a nursing home?

While all factors are important, the quality and quantity of nursing staff are arguably the most crucial. A facility with a high staff-to-resident ratio and low turnover often provides better, more attentive care, which directly impacts a resident's well-being.

How can I check a nursing home's official record?

You can check a facility's health inspection reports, staffing data, and quality measures on the federal government's Medicare Care Compare website. Additionally, you can request recent state inspection reports directly from the facility or your state's health department.

Should I visit the nursing home more than once?

Yes, visiting more than once is highly recommended. You should schedule a formal tour but also make an unannounced visit at a different time of day or on a weekend to observe the facility's operations and staff interactions during off-peak hours.

What questions should I ask about the facility's safety?

Inquire about security measures for residents, emergency and fire safety protocols, fall prevention strategies, and how they handle infectious disease outbreaks. Also, check for features like handrails, grab bars, and accessible bathrooms.

Is a private room always better than a shared room?

While a private room offers more privacy and personal space, it can be more expensive and may not be the best fit for every resident. Some residents prefer the companionship of a roommate. Your loved one's personal preference and financial situation should guide this decision.

What if my family member needs a special diet?

During your tour, ask to see a menu and discuss your loved one's specific dietary needs with the staff. Ask if they have a registered dietitian on staff and how they accommodate special diets, religious preferences, and food allergies.

What is the role of a long-term care ombudsman?

The long-term care ombudsman is a federally mandated advocate who visits nursing homes regularly and investigates complaints on behalf of residents. They can provide valuable, confidential information about facilities in your area.