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Tips for Selecting a Nursing Home or Assisted Living Facility

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When you have to put a relative into a nursing home or an assisted living facility, you want to make sure that the establishment is of the quality it advertises. To visit a place like that is one thing, to live there might be quite different. You should be aware that the person you are going to put into the institution might be quit vulnerable. His/her perception of things could be rather different from yours.

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It is therefore essential to look beyond the glossy brochure and to do some serious investigation into the operation of the facility. When choosing a nursing
home for a loved one, there are several things that should be considered. We have put together some guidelines that should help you to make the right decision.

The first group of items which you should consider have to do with the have to do with geography, the person you are putting into the institution and the facilities relationship with licensing and oversight authorities.

Make the effort and write your evaluation down. Keep the notes and all comments you write in a safe place. If you ever have a dispute with the care facility, these notes and observations might be a useful tool, to get things corrected. If your dispute escalates to a law suit, these notes might become invaluable. Not that we encourage litigation. On the contrary, getting solutions to a problem, in an amicable way, is preferable.

You should start with asking yourself the following Questions:

Who is going to visit the resident most often? Select a home nearest to that person. The resident will be happier and psychologically healthier if he or she receives regular visits. Moreover, regular visits by family members and friends will likely keep the staff at the nursing home "on their toes". We have noticed that a resident is likely to receive better care and attention from staff if they expect the resident to be well attended and looked after by family members.
What kind of care does the resident need? When evaluating a nursing home it is necessary to consider the type of care that will be needed. You should ask yourself a series of questions about the capabilities and needs of the prospective resident. These may include issues such as: Will the resident require equipment such as a ventilator, etc.? Does the facility have skilled staff that can operate such equipment? Is the facility able to provide the skilled care needed?
Enforcement History
Once you have short listed some care homes, check each facility's enforcement history. Do not be shy about this. Go to the supervisory authority in your state and ask (you might have to do that in writing!). Check the facilities enforcement history. Find out how many citations have been issued, whether penalties for violations were assessed and any other information that relates to the facility's relationship with the supervisory authority. If the facility is private, see who is on the board of management. Citations and how they were dealt with should be posted somewhere in the facility, if it is not ask the staff to provide you with this information.
You have to visit the nursing homes you are considering and take a look in and around the facility. How does the facility look, what kind of atmosphere does it provide? Do the staff conduct themselves in a professional manner? are they wearing clean clothes or uniforms. Are they properly qualified (ask for an individual list of the staffs qualifications, especially the managers and care people) and trained for their responsibilities? Assess whether or not you would want to live in the facility in question. Give an honest answer, based on what you have seen.

The Major Points to Note on your Evaluation Visit

Prepare yourself properly for the visit. It is not something you can do while taking children or the dog along. The visit of a facility should take a whole day. You do not have to spend the time continuously within the facility, but you want to see the facility and its working during breakfast, lunch and dinner. You also want to see what activity is available to residents, how they behave towards each other (sit with them and talk to them, without any staff being involved) and how the staff interacts with the residents. If the management of the facility objects (usually under the pretext that it upsets the running of the facility!) to that, go somewhere else. Because that management is unfit to manage the facility!

How do the residents look?
Are they clean?
Are they dressed, well groomed (hair combed, shaved etc.)?
Are they dressed in time for breakfast?

Are they occupied and happy or do they appear listless, disinterested or depressed?

When they sit or are confined to a bed, are they positioned comfortable in bed or in a chair?

Do they appear to be aggressive and cantankerous towards each other or are they relaxed and comfortable?
Does the facility have adequate staff
Is the staff cleanly dressed? Do they wear uniforms? Are those clean?
Ask what the dress code is for the staff and how often they change their working clothes/uniforms.
How many direct care staff members and immediate supervisors are there per resident?
How many direct care and support staff is there on duty for each shift?

Does care staff respond in a timely manner to residents needs?
What means do residents have to attract the attention of staff?
A call button? If not, how do residence call upon staff?

Is there a dispute resolution procedure for disputes between staff and residence?
What recourse do residence have, when they feel "mistreated" by staff?
Is there a residence representation direct to the management?

Is the staff respectful to residents? Do they address residence with Mister or Ms. or Mrs. and their name?
Do residents have privacy, i.e.. does staff knock before entering rooms etc.
What is the education level of the direct care staff and their supervisors?

Is there a resident qualified nurse or therapist and other professional staff employed. Is any of that staff residential or on call?

Who does the cleaning of the facility?
How does staff deal with emergencies?
What is the overall environment and the overall condition of the buildings?
When you enter the facility, does it smell clean or is there some urine smell?
Are there lounges and sitting rooms available for residents and their guests?

Is there a loud TV blaring in the common rooms?
Do residence have any say about what they can watch on TV in the common rooms?

Are the rooms bright, nicely painted, well aired and warm enough?
Is the furniture of the common rooms nice or just some old disregarded rubbish?
Are the carpets and floors of the common areas clean and without stains?
When you go to the individual resident rooms, is the linen clean and are the floors and carpets clean?
Are the rooms nice, well lit, well aired and do they have decent furniture?
How often are the rooms cleaned?
Are the beds prepared by staff?
How often are the resident's room linens and bath towels changed and washed?
Is there an organized schedule and a residence wide cleaning manual?

Do individual rooms have fire detectors/sensors?
How far from the room entrance is the nearest fire extinguisher?
Are residents allowed to smoke in their rooms?

Are stairwells bright and well lit, clean, free of debris and do they have clearly labeled exit signs?
Do stairwells, corridors and hallways have handrails?
How far are the bathrooms and toilettes from the room?
Are fire extinguishers visible in the corridors and common areas?
Is there an emergency lighting system?

Does an official evacuation plan exist and are fire drills practiced?
Are the evacuation plans known to the residents?
More about shared Resident Rooms
Are rooms shared?
If so, how many beds are there per room ?
(there should not be more than four beds per room with three feet between each bed and each bed should have privacy curtains surrounding it!)
Does each person have a bed, a bedside tables, a wardrobe and storage area and a comfortable chair for each bed
Can beds easily be access by resident and staff and does each bed have a call button?

Do residents have water on the bedside table and can personal belongings be brought in and safely stored when not used?
Where are the toilettes, baths and showers?
Are they conveniently located close to residents rooms?
Are there night lights to the bathrooms?
Do bathrooms and toilettes have handrails?
Are they clean, do they smell clean?
Are toilette bowls clean? Is there sufficient toilette paper?
Are the hand wash basis clean and are there towels and soap there?
Is there a call button in the toilette or bathroom?

How often can and do residents bath or shower?
How often are baths and toilettes cleaned?
Kitchen, Food and Dinning Areas
Is kitchen clean and orderly? Check the kitchen floor and the corners of the floor!
Does the kitchen have proper sanitation and garbage bags/containers that are changed several times a day?
Is the staff clean and do they wear clean uniforms?
Are their uniforms changed every day?
Does the staff have their own toilette with adequate hand wash facilities?

What is the background of the cook?
Does he/she understand nutritional needs?
If not what qualifications does the person have?
How many meals are being prepared for every meal time?
Who plans the meals, is it a nutritionist or a professional chef (not meant to include a "hamburger flipper!"?

Does the kitchen provide special menus for diabetics, or other special needs
Does the food look nice and is the food nutritious?
Is it fresh, canned or frozen?
Take a breakfast, lunch and a dinner with the residents!
Have them show you a weekly menu!
Is there a posted menu?
Do residence have any input in what they can eat?
Is there a choice of menus?

How is food served to residents, in real dishes with silverware or on disposable plates with plastic cutlery?
Is dining room or eating area comfortable, nice or pleasant
Is there a TV blaring during meals?
How many residents does the dinning room seat and how often does it provide meals and snacks

Is the food being served by staff, or do residence get the food on a sort of counter (cafeteria style)
What about those needing feeding assistance, is it provided?
If residents cannot eat in the dining room, how are they provided for?
Can residence choose to eat in their rooms (food provided by the facility)?
Activity and Entertainment
Are activities arranged for residents, if so how often and what kind?
Are there TV rooms in the facility?
Are there game rooms or reading rooms?
Is there a library with books residence can borrow?
Are there outings for residence (payable?)?
What is done for holidays, birthdays, religious services?
Medical and Miscellaneous
Do physicians visit the facility?
If so how often?
How is the use of the physician billed?
What about dentists?
How is medicine dispensed and who is responsible for that?
What hospital does the facility use in case of emergencies and how are residents transported there?
What are the costs involved in such emergency transports and how is it billed?

How long has the facility been under the current management?
Are they any changes planned

What is the facility’s billing procedure?
Ask for a breakdown of costs for a resident?
(usually shown as : Residence, Laundry, Meals, Entertainment, Medical, Therapy, Extras)
What is extra?
How is personal laundry handled?

Does the facility have security system for the protection of residents?

Asking these questions may make many residence facility managers uncomfortable. They might try to evade some questions with reference to "conforming with state regulations". Don't be satisfied with that, because state regulations, except for a few states, are minimalist, pretty poor and are not an indication of quality.

Remember, you are the client, or at least the person who pays the bill and places a client, that might not be able to do much, once he/she is placed there!

Books on Evaluating Elderly Care Homes and Assisted Living Facilities from
There are only a few books available in the USA on this topic. All the literature we found, is for the professional, who assists in setting up elder care facilities. Some are simply too complicated and technical to mention.

The best and only study we found is from the United Kingdom, not the USA. Though, many of the issues tend to be similar. If you really need a book on the topic, we can recommend that study. In general though, the above outline, if followed systematically, should be sufficient to make a valid assessment of the quality of a facility.

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