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Choosing a Nursing Home

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As a volunteer long-term care ombudsman for three years—assisting consumers with questions and concerns about California long-term care facilities—I saw every kind of nursing home: good ones, bad ones, and in-between ones. I learned the most during my actual on-site experiences.

Here's what you need to know to pick the best facility—and ensure the best care—for your loved one:

1. File an appeal to buy yourself more time. About half of all nursing-home admissions follow at least a brief hospital stay, where you may get as little as 24 hours' notice to find a facility. If the patient is on Medicare, tell hospital administrators you want to appeal the discharge. This will automatically give you two extra days to check out the nursing homes in your area. Be sure to use all the resources the acute care hospital has on hand—social workers, nurses, doctors, administrators, anyone who is willing to answer your questions and give you information.

2. Get the list. Begin your search for a nursing home with the Eldercare Locator (800-677-1116). This agency will put you in touch with your local Area Agency on Aging, which will give you a list of nursing homes in your area. It also will provide contact information for the local long-term care ombudsman. Ombudsmen aren't allowed to recommend one facility over another, but if you ask them specific questions about staffing, continuing problems, and administration turnover, they will answer.

3. Look close to home. Once you have a list of facilities, start with the ones nearest your home. It's not only more convenient for you, it's also almost always a guarantee that your charge will be well cared for. That's because nursing home staffs are keenly aware of the residents who get regular visitors and, because they don't want any complaints, they tend to bestow just a bit more care on those patients.

4. Pop in unannounced. If your first visit is during regular business hours, don't make an appointment—you'll get a better idea of how the facility is run. Just walk in and ask for the administrator, who should be on site. If not, ask for the next person in charge to show you around. Be sure to ask about the ratio of caregivers to residents or seek a copy of the staffing schedule. Do you smell urine, feces, or other bad odors? Also, pay special attention to corners and windows: these are often the first places where shoddy cleaning shows up.

5. Go to the bathroom. Any restroom in the public areas will do. Sure, evaluate the overall cleanliness—but what you really want to check out is the hot water, the lack of which is a common complaint in a lot of nursing homes, especially larger ones.

6. Look for residents—in the right places. If you see them in activity areas, dining rooms, and outdoor areas, that's good. If you see them being changed, dressed, or toileted, it means the facility doesn't value their privacy—or dignity. Also, look for restraints being used on the residents—things like wheelchair trays, vests that keep patients sitting upright, or other devices that restrict movement. Although restraints may be temporarily necessary in a medical emergency, better nursing homes work to meet residents' needs using restraint-free methods.

7. Check out the food and drink. Ask to see the kitchen where the residents' meals are prepared. A good nursing home will have no problem with this request. (In fact, most will invite you to have a meal in the dining room with the residents.) Is the kitchen clean? Does it smell good? Are dry goods properly stored on shelves off the floor? Ask to see inside the refrigerator. Is the food covered? Also find out the following: Is there a licensed dietician on staff? Is there a list of resident food allergies and dislikes on record? Is fresh drinking water easily accessible? Dehydration is a special risk for nursing-home residents.

8. Chase the paper. All long-term care facilities must provide their most recent state inspection survey (Form 2567). The report lists the most recent violations found by state inspectors. Even the best of nursing homes can have problems sometimes, so read the report carefully, weigh the severity of each problem, and question the administrator about how the infractions have been corrected.

9. Join the residents. All nursing homes are supposed to support both family and resident councils—groups that work to ensure proper care and treatment of all residents by communicating concerns and needs with facility managers and ombudsmen. There should be a schedule of these meetings posted. Ask to sit in on one and you'll get a sense of what's going on within the facility. Ask questions. You'll get frank answers.

10. Come back—again and again. Once your charge is admitted, make sure there is a patient care plan on file. This document, required for all patients, includes an outline of care requirements including dietary needs, medications, and rehabilitation directives. The most important thing you can do is to visit often, to make sure the patient's care plan is being followed, and to consistently monitor his or her care.

In short, be vigilant and remember that these facilities are where people live and they should offer as many home-like amenities as possible. Never hesitate to speak up. It's your right.

Karen Westerberg Reyes is AARP The Magazine's Editorial Projects Manager.

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