|
|
How to choose a nursing home? I recommend Centers for Medicare & Medicaid
Services Publication no. CMS-02174, "Your Guide to Choosing a
Nursing Home." I will comment on key issues mentioned in this
booklet but, my comments as well, will be based on my observations
and discussions regarding nursing homes. The patient usually is not
the one searching and selecting the nursing home -- the only case I
can think of is the still active person who anticipates the need for
short-term skilled-nursing after elective surgery. The (generally
reluctant) decision that the patient should go to a LTC nursing home
is usually an urgent one, with time constraints -- a serious hospital
stay that may have followed a previous home care stay, or a home care
stay that is no longer viable. If a nursing home under consideration
for LTC is in the vicinity of the patient's residence, it is possible
to involve him/her in the process. This is especially true if,
he/she, as a "matter of interest," has learned over the
years about reputable nursing homes through friends, relatives,
neighbors -- perhaps in the course of visiting them there. Even
though this nursing home long term-care probably may not occur until
age 85+, possibly years after the patient's earlier visits to nursing
homes, the leads developed by him/her may be useful.
The search and selection will or should probably be done
by family members, including the person who is designated to be the
principal overseer. The team, in addition to using possible leads
supplied by the patient, can look to other persons for help, such as
hospital discharge planners, social workers, physicians who serve the
elderly and, one of the best sources of information, your local
long-term care ombudsman. They are not allowed to recommend one
nursing home over another, but they can provide information on the
latest survey, and the number and nature of complaints and
investigations. I list the following ombudsman telephone numbers and
email addresses in my area: New York City-1-212-962-2720
(lpetta@nyfscltcop.org), Nassau County-1-516-466-9718 (ombudservice@familyandchildrens.org)
and Suffolk County-1-631-427-3700 (rberger@fsl-li.org). Another possible source is the
Long-Term Care Services Unit at the NYC Dep't for the Aging, tel. no.
1-212-676-0629. If the LTC is going to take place in another
geographical area, there will the same need to build a general
background file of nursing homes and community sources to consult
before selecting a nursing home.
Recommendations are a good beginning, but the nursing
home visit is probably the most important step in selecting the right
place. You, when indicating an interest in behalf of the future
patient, will be given a formal tour, and the checklist (in the back
of the CMS-02174 booklet) indicates basic information you should
obtain from administration and items to look for on your
"observation tour." More importantly you need the
opportunity to talk to residents and observe the interaction between
residents and staff. It would be ideal if you could accompany someone
who visits a resident of a particular nursing home. Possibly the
future patient, for whom you are doing this research, can refer you
to a resident in a home under consideration. If that is not possible,
ask administration what follow-up visits they can arrange, so you can
get a closer look at resident life. Near the beginning of your visit,
examine the nursing home's most recent survey report. This is an
inspection record made by trained surveyors of the state in which the
nursing home is located, which reports how well the nursing home
meets federal and state health and safety requirements. Deficiencies
are rated on scope (how often a problem occurs) and severity (how
seriously the problem impacts the health and safety of residents).
Nursing homes are subject to fines and other penalties if the
deficiencies are not corrected. Keep these deficiencies in mind when
you visit the nursing home, and see whether the home has corrected
them. I suggest the following quality of life issues (and you will
probably think of others) to focus on:
1. Are there a variety of activities available to residents that they
like? There may be a schedule posted at the nurse's station and/or
available for distribution to visitors and residents. If these
activities take place on various floors, it is an opportunity for you
to visit many more residential areas and be able to observe other
quality of life issues as you attend the "recreational"
activities -- so this is a good first step. You can see quickly how
residents will perk up in a discussion of current events or game of
Bingo. The challenge is to generate interest -- animation -- in the
passive resident. You may see a resident in the TV room, where the TV
is on but the resident is staring into space. Recreational therapy is
very important, and often is not given the same emphasis as other
issues. Available public space is often key to a good recreational
program. A lineup of residents in wheelchairs in the hall may be an
indication of lack of space.
2. Visit the nursing home at mealtime. Is there enough staff to
assist each resident who requires help with eating? If there are
persons in need of help, who are not receiving it, you should check
further; there may be other reasons a resident is not eating. On the
other hand, this situation may be an indicator of a patient/staff
ratio problem. However, one cannot come to a quick conclusion --
availability of staff when needed has to be a perennial problem,
because emergency situations are always occurring. In other words,
you cannot make a snap judgment on the basis of appearance -- you
need to question further.
3. If there are special medical circumstances -- dementia, the need
for physical therapy -- it is a good idea to make sure that the home
has the experience to address these circumstances. In fact, there are
nursing homes which have developed reputations in certain fields.
Updated: May 20, 2008
|
