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Tips for
Selecting a Nursing Home or Assisted Living Facility Retirement
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Selecting a Care Home - Assisted Living
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.
| 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 |
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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.
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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 more preferable.
You
should start with asking yourself the following
Questions:
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| Location |
| 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. |
| Care |
| 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. |
| Visit |
| 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.
| Residents |
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?
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| Staff |
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?
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| Facility |
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?
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| 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?
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| 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?
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| 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?
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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
|
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 done
systematically, should be sufficient to make a
valid assessment of the quality of a facility.
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