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How to Choose a Nursing Home: The ‘Do’s’ of Due Diligence

Where to start - These pointers may help caregivers with the sometimes daunting task

Realize closest may not be best. Many families, Harrington says, default to the nursing home closest to where they live. While this makes frequent visits easier, it often isn’t the best choice.

Check references. Ask around to find individuals who have had loved ones in the nursing homes you’re considering. These people could, in fact, be your most important sources of reliable, firsthand information. If you come up completely empty, try to introduce yourself to others when you are making in-person visits to the homes on your list—even if it’s in a cafeteria or parking lot.

Consult the experts. State and local ombudsman programs and citizen advocacy organizations can help you assemble the information that you need for making an informed decision about nursing home care.

Under the Older Americans Act, every state is required to have an ombudsman program to “investigate and resolve complaints made by or on behalf of older individuals who are residents of long-term-care facilities.” The website of the National Long Term Care Ombudsman Resources Center includes an extensive directory of state, regional and local programs.

The National Citizen’s Coalition for Nursing Home Reform maintains a directory of citizen advocacy groups that work on quality-of-care issues. California Advocates for Nursing Home Reform, for example, maintains an online database of 1,300 nursing homes in the state. You can search by name, address, city or county and find details on services, staffing and violations.

Drill down into the data for Crestwood Manor in Vallejo and you can see raw reports like the one from October 2007, which led to an AA citation and a $100,000 fine for the home: “On 10/14/07, a wheelchair-bound resident who suffered from dementia and was on a pureed diet choked to death on a cinnamon roll while in the dining room during snack time. … A staff member described the resident as the facility’s ‘number one high risk for choking’ due to a history of stuffing food in his mouth and because he had no teeth. The facility was cited for lack of supervision and for neglecting to take necessary precautions.”

This level of detail is exactly what’s missing from Nursing Home Compare and most state websites. Nursing Home Compare, for example, includes no mention of Crestwood Manor’s AA state citation, which means that the home was the “direct proximate cause” of a patient’s death.

Get copies of inspection reports. A CMS official notes that any family has the right to ask any nursing home for copies of its state inspection reports. These reports, known as Form 2567s, by law must be “readily accessible” to residents and visitors. State inspectors conduct the surveys for CMS every 12 to 15 months. (See Form 2567: How to read this very important document from Consumer Reports.)

Put nursing first. A 2001 federal study found that 90 percent of nursing homes don’t have enough nurses and nursing assistants “to avoid harmful outcomes." And a nationwide survey published last year by the American Health Care Association found alarming vacancy rates for registered nurses (26.7 percent), licensed practical nurses (11.1 percent) and directors of nursing (4.4 percent), leading the organization to declare "a serious workforce shortage."

Experts say that things haven't gotten any better. That's why it's especially important to make sure that you learn all you can about a facility's nursing staff. According to the National Citizens' Coalition for Nursing Home Reform, it's "the single most important indicator of quality." Be sure to find out whether your state collects its own data on nursing staffs.

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