It’s a difficult reality for the children of many parents; as much as you would like your mother and/or father to remain independent for their entire life, they may need to live in an assisted living or nursing home. As long as you do your homework, it doesn’t have to be as bad as many would believe.
Choosing a permanent residence for your parent is a stressful time, and in part, it should be; you want to make absolutely sure that their health and happiness is paramount to the staff of the home. You want to know that they are diligent and will do everything in their power to take care of the person who took care of you. With all of that in mind, here are some tips for choosing the right nursing home.
Before Your Visit
1. Assess Your Parent’s Needs
What level of care will your parent require from the home? Missouri has six separate types of homes which provide unique levels of care to their residents.
- Residential Care Facility – Residents are provided with shelter, board, and protective oversight, which may include storage, distribution or administration of medications and care during short-term illness or recuperation. Residents who live in an RCF are required to make a path to safety unassisted.
- Residential Care Facility* – On top of the aforementioned provisions, residents are provided with supervision of diets, assistance in personal care, and supervision of health care under the direction of a licensed physician.
- Assisted Living Facility – Residents are provided with shelter and board, as well as assistance with activities of daily living which include eating, dressing, bathing, toileting, transferring and walking. Care is based on the abilities, desires, and functional needs of individuals delivered in a setting that is more home-like than institutional. The dignity, privacy, and independence of an individual are paramount.
- Assisted Living Facility** – More than minimal assistance is needed if the need to evacuate arises. A plan of evacuation for each individual resident must be made. In addition to what a normal ALF provides, a licensed Nursing Home Administrator (NHA) is required.
- Intermediate Care Facility – Accommodation, board, personal care, basic health and nursing care services are provided under the daily supervision of a licensed nurse and direction of a licensed physician. An NHA is required.
- Skilled Nursing Facility – Everything is provided with skilled nursing care and treatment services. Treatment is given under the supervision of a registered professional nurse to those requiring 24-hour care. This includes: observation, care and counsel of the aged, ill, injured or infirm, the administration of medications and treatments as prescribed by a licensed physician or dentist, and other nursing functions requiring substantial specialized judgment and skill.
Being honest with yourself about the level of care your parent necessitates will go a long way to help you determine what type of home is right for them.
2. Do Your Research
This involves more than a simple Google search; although that’s not a bad place to start, there are many online resources which can give you a more accurate depiction of the quality of care provided by a certain home or facility. The Centers for Medicare and Medicaid Services (CMS) outlines their nursing home ranking system, how they determine nursing home quality and additional methods for you to compile all the information you could want about a potential home. You can even use medicare.gov to compare nursing homes. Remember that one site is not the end-all-be-all; corroborate reviews on one page with reviews on another.
3. Visit Multiple Homes
Many people will visit a seemingly nice, loving home on their first stop and decide to settle for it. While it may very well turn out to be the best home on your list, you still want to give diligence to the others. If you find a home you like, visit it again on a different day.
Try to not to focus too much on how close the home is to yours. It’s easy to choose the home that’s right by you, but it may not be the best fit for your parent. Don’t let proximity dictate your choice of homes.
4. Know the Questions You Want to Ask
Make a list ahead of time. Some things you may want to know: what is the facility’s plan for emergencies? What is the ratio of staff to residents? Is it licensed by the state? Does it accept Medicare or Medicaid? If they do, that makes them a little more legit, at least in the government’s eyes. Nursing homes and assisted living facilities have to have good reviews to qualify as a Medicare/Medicaid facility.
These are all important things you’ll want to keep in mind. How much it costs, while necessary for budgeting, should be one of the last things you ask. If you get to that point, you’ll know that all your other questions have been answered satisfactorily.
During Your Visit
5. Staff Interaction with Patients, and Each Other
While you might appreciate the level of respect a facility staff member may be showing your parent by calling them “sir” or “ma’am,” calling them by name shows a deeper level of care. Are they showing genuine concern for their well-being? Do they remain calm when a resident is frustrated? Are they quick to address a problem?
It’s just as important to pay attention to how the staff interacts with each other. Are they smiling? Do they help one another? If they’re rude to their co-workers, they are likely going to be rude to the residents as well.
6. Observe How Residents Spend Their Time
If you see residents milling about, even though it may seem rather aimless, this is actually a good sign. They are up and out of their beds, and the home encourages such activity. Even if it appears that all they’re doing is loitering around the front desk/nurses station, this is much better than all of them being in their rooms alone with the TV on.
Good homes should have a daily activity board visible. If your parent has to be isolated in their room, then activities should be brought to them by a member of the staff. Meals should be served at regular times, and be nutritious. It’s a good idea to plan your visit during a meal so that you can see how it’s prepared and what they serve.
7. Cleanliness of the Home
Nursing homes, much like hospitals or any other facility providing medical services, may have their own distinct musk about them. But foul odors of any sort should not be present. Are spills or accidents taken care of properly? Is the resident’s food being thrown away in a timely manner and dishes being cleaned? If you see (or smell) something that you would be uncomfortable with in your own home, then you don’t have to settle for it in this one.
8. Talk with Staff and Administrators
It’s amazing what simple conversation with those who are there every day can reveal. You can discuss technical matters with the facility administrator, such as policy and payment, and you can discuss the everyday happenings of the home with a nurse. This is a good way to get a feel for what you may not see during your visits.
After Your Visit (Parent Now Lives in Home)
9. Unexplained Bruising or Bedsores?
An older person’s skin is fragile, and bruising can happen easily. But finger shaped bruises on the arm is certainly just cause for alarm. As are bedsores. If you notice this then you need to ask why your parent is laying in one position for so long. This is especially true if your parent is capable of moving around on their own and has not refused food.
If you know in advance that your parent does have to be confined to a bed, a good question to ask during your visit is their rotation schedule. Bedridden residents have to be moved every so often to avoid the buildup of bedsores.
10. How Does the Staff Handle a Fall?
You can ask about their procedure for this during your visit, but sometimes you can never know for sure how they’ll react until you see it in person. If your parent falls, you’ll want to know that their medical well-being is properly assessed, not just immediately after the accident, but for a few days after to ensure that any injuries not immediately apparent don’t reveal themselves.
11. What If a Problem Arises?
If you do have an issue that you feel needs to be addressed, the first person that you need to talk to is the unit manager for your parent’s floor. They will be able to ensure that the nurses and attendees are aware of your problem and do everything they can to correct it. If the problem persists, that’s when it could be time to file a complaint.
Even though it’s rare, be wary of signs of abuse. We’ve mentioned finger-shaped bruises, but some abuse may be non-physical. If your parent has lost their appetite, appears depressed, or acts nervous around certain staff members, it may be a sign of psychological abuse.
It may be a little disheartening knowing how long it takes to find the right home for your parent, not to mention having to put them in one in the first place. However, if you take the time to observe everything about a home, your parent can be more than happy living there. Should you suspect that your loved one is experiencing abuse in his or her nursing home and would like legal advice, consult a compassionate Kansas City nursing home abuse lawyer.