How to Choose a Nursing Facility

What is a nursing facility?

A nursing facility is a long-term care facility. Nursing facilities provide care for people with illnesses and disabilities that make it difficult for them to stay in their own homes. Nursing facilities are not hospitals. They provide a room; meals; help with daily activities such as eating, bathing, and dressing; and supervision. Nursing facilities are also called nursing homes or care centers. Because the facility is a home, people who live there are called residents.

The idea of living in a nursing facility does not appeal to most adults. It is a hard decision for them and their families to make. Nursing facilities can, however, be a good choice for both the resident and the family if they know what to expect.

What types of care do nursing facilities offer?

People live in nursing facilities for many different reasons. Nursing facilities provide:

• a short stay for recovery and rehab after surgery, stroke, or other illness
• respite care to give time off for the family caregiver
• long-term care for medical problems
• minimal care for people who are no longer able to live alone
• short-term comfort care for the terminally ill

Nursing facilities offer several types of services:

• Nursing services. This may include giving medicines, taking care of people after they get out of the hospital, caring for wounds, giving tube feedings, and telling primary healthcare providers about any health concerns.
• Personal care. This includes help with walking, moving from bed to chair, eating, going to the bathroom, bathing, and dressing.
• Rehabilitation services. These services are provided by speech therapists, occupational therapists, and physical therapists. They may include help with speaking and thinking, regaining strength and flexibility, preventing injuries, reducing pain, using crutches or walkers, and relearning skills. Several conditions need to be met for Medicare to pay for these services.
• Residential services. This includes a safe place to live, meals, and programs for social and spiritual needs.
• Medical care. A healthcare provider visits each resident routinely or as often as needed.

How do I choose a nursing facility?

Start by researching several facilities close to friends and family. You can get lists of nursing facilities from a hospital discharge planner, social worker, or the local Area Agency on Aging.

State or local ombudsmen are officials who work on behalf of nursing facility residents. They may be able to steer you toward good facilities and away from bad ones. The Area Agency on Aging or your state's department of aging can help you find the ombudsmen in your area.

Call each nursing facility you are considering. Ask about waiting lists and admission requirements. Then visit each facility even if some do not have a bed currently available. There is no substitute for on-site visits. Pay attention to how the facility treats your request for a visit and how much they allow you to see. This will tell you a lot about their attitude toward residents and their families.

Try to check out 3 or 4 nursing facilities. If possible, the family should visit each facility with the person who may live there.

Visit the facilities at different times of the day without calling first. Be there during meals and activities. Consider the size of residents' rooms and privacy. Look at the kitchen and laundry facilities, the recreation area, therapy rooms, and all other areas of the facility. Talk to other residents and their families to learn how satisfied they are with their care. Notice if the facility seems cheerful or depressing. Look at how staff members interact with residents. Ask the staff if they like working there, and if so, why.

What should I look for during my visit?

A good nursing facility should:

• Be safe, comfortable, and clean.
• Encourage the residents to keep the skills they have.
• Help with activities that the resident can no longer do by him- or herself.
• Monitor the health of residents.
• Allow for personal choices as much as possible.
• Meet each resident's needs for care and diet, including special diets such as a diabetic diet or soft food.
• Help the residents adjust to the new setting.

When you visit a nursing facility, answer for yourself the following questions about the facility, staff, and services.

Facility

• What is the condition of the building and grounds? Is it clean? Does it have a bad smell?
• Are there possible safety problems, such as things blocking the hallways, poor lighting, or lack of warning signs on exits that should have alarms?
• Do they have safety equipment, such as fire doors, sprinklers, handrails in hallways, and grab bars in bath and toilet rooms?
• How big are the bedrooms? Is the furniture in good shape? Is there enough space for personal belongings? Are there privacy curtains?
• Is there adequate lighting, ventilation, heating, and cooling in the bedrooms?
• Where are the bathrooms? Do they have wheelchair-accessible showers and sinks?
• Are common living areas accessible, adequate, and nearby?
• Is the dining room attractive?
• Are there safe areas to wander?

Staff and services

• Is the staff visible and busy taking care of residents? Do they seem overworked? Or do they seem to spend all of their time at the nurses' station rather than with residents?
• Are call lights answered promptly?
• Are residents treated and spoken to with respect?
• Are residents clean, well-groomed, and appropriately dressed in clean clothing?
• Are residents wearing their dentures, eyeglasses, and hearing aids?
• Do the residents appear content?
• Do the residents speak with each other?
• Are any of the residents physically restrained?
• Do the residents appear listless or seem to be over-medicated?
• Do the residents have bruises or act afraid?
• Are activities going on that would be of interest to the future resident?
• Does the staff offer help to residents when they need it to walk, get in and out of bed, or get dressed?
• Is there enough food and is it appealing? Are there alternative meal menus, including meals for the diabetic?

It may be quicker and easier for the staff to do things for the residents. However, most adults are happier and healthier if allowed to do as much for themselves as possible. Notice whether the staff encourages residents who want to walk, dress, and feed themselves.

It is also a good idea to find out how the facility deals with residents who have problems with bladder and bowel control. Do they encourage frequent trips to the bathroom and the use of adult diapers only when necessary? Do they often use urinary catheters?

What should I ask the nursing facility administrator?

The family and future resident should meet with the administrator of the nursing facility. This gives you a chance to get answers to questions about activities, care, and services offered to residents and families.

• Does the facility employ both a full-time activities director and a full-time social worker? (Generally, the better nursing facilities do.)
• Ask to meet the medical director and the director of nursing. How much experience do they have in long-term care? Do they seem to work well together? Do they seem to be responsive to residents and nursing staff?
• Are there enough staff nurses to meet resident needs? (If the facility uses a temporary agency to provide nurses, there will be less consistent care.)
• How are emergencies handled? Is a doctor always available by phone? Is there a registered nurse (RN) in the building at all times?
• Are the administrator and director of nursing available and accessible to patients and families? How are complaints handled?
• Who will be told about changes in a resident's health?
• Are podiatry, dental, and physical and occupational therapy services readily available on site?
• Do residents fall often? What is their procedure regarding falls?
• Do the residents have pressure ulcers (bedsores)? What skin care programs are used?
• Is special equipment available for resident needs (wheelchairs, special beds or mattresses, walkers)? Is there an extra charge for it?
• Can the facility manage residents with complex needs?
• Will a bed be held if the resident is hospitalized? If so, for how long, and what will it cost?
• Does the facility allow residents to bring some furniture from home? Do personal possessions get stolen?
• Are personal items safe from theft? Who will pay for the loss of clothes, dentures, hearing aids, or glasses?
• What telephone access do residents have?
• Is there a support group for families?
• Is there a volunteer program for residents?
• Is there a residents' council to meet with staff and plan activities?
• Is the facility Medicaid certified? If not, the resident will have to move when he or she runs out of personal funds.
• Is the facility Medicare certified? Medicare certification is very important since those facilities can offer more services to a resident coming back from a hospital stay.

In addition:

• Ask to have all rates and charges fully explained. Ask for a written list of the services and supplies that are included in the basic rate and what costs extra.
• Ask for a copy of the admission contract. Ask them to explain anything that you do not fully understand. A private attorney or one from legal services at the Area Agency on Aging can provide advice if there are terms you do not understand or that seem unreasonable. It should be possible to change the contract.
• Ask for a copy of the most recent state inspection report (also called the state survey) on the facility. According to federal guidelines, nursing facilities are required to provide their latest inspection report to residents and the public. The family is entitled to take a copy home. There may be a small charge for the copy. This report may also be available on the Internet. If you cannot get a copy of the report, there may be a problem in the way the facility operates.

  Most inspections identify some problems. Many of these are minor and may not affect the quality of care. You should be concerned if any major problems are cited. Find out if the problems have been corrected and what is being done to keep them from happening again.

You must feel confident that the nursing facility administrator is qualified, competent, and responsive to residents, their families, and staff. This individual is responsible for everything that happens in the facility and is the person to contact when there are problems.

How is nursing facility care paid for?

Nursing facility care can be paid for with personal funds, long-term care insurance, Medicaid, or Medicare. Sometimes several of these payment methods are used.

Living in a nursing facility is expensive. Nursing facility care costs $30,000 to $75,000 a year. The amount you pay depends on where you live and the type of room. Some nursing facilities will accept only residents who are paying with personal funds. Most people cannot afford these costs for very long. When they have spent all their money, many need government help to pay for nursing facility costs. The Medicaid program pays for most of the nursing facility costs in the US.