Written By: Molly Kavanaugh
Now that you and your loved one have decided moving to a skilled nursing center is in the cards, taking the next step can seem daunting. But it doesn’t have to be. There is a lot of information available and people to help you make this important decision.
Follow these 6 steps, and you will be more likely to find the best place for your loved one to call home.
1. Make a List
Compile a list of care centers you would like to visit. Ask for recommendations from your doctor, family and friends. Decide what basic criteria are important to you. Location? Immediate availability? Medicare and Medicaid certified? Being able to keep your personal physician, or be admitted to your preferred hospital? Cost? For-profit, non-profit, or religious affiliation?
Most of your basic questions can be answered with a phone call.
2. Take a Tour
Make an appointment to visit the centers on your list and meet with a staff member. You could also consider visiting at another time without an appointment. Inquire about their “drop-in” policy during your initial visit.
Make sure that you also talk with residents and their families as you walk through the center. Staff should encourage such interaction: but if not, this could be a red flag.
Bring with you a copy of the Nursing Home Checklist, provided by the Centers for Medicare & Medicaid Services. The list includes things to look for regarding staff, menus and food, activities and living space.
3. Ask Questions
In addition to the government checklist, there are several other helpful guides of questions to ask.
AARP asked a panel of experts and former nursing home workers for their suggestions, and they came up with 10 questions to ask to detect signs of improper care, such as:
What sounds do you hear? Do staff address residents by name (rather than something impersonal like Ma’am or Grandpa)?
What does it smell like? Nursing centers can foster some funky odors, says former Arizona nursing administrator Maryglenn Boals. There are unavoidable reasons for this: certain medications and diets make residents more gassy. And as health declines and people become more frail, they’re more likely to lose control of their bladder and bowels. So a faint whiff of something unpleasant isn’t something to complain about. However, if the home reeks of stale urine, it could be a sign that the facility is not cleaned properly.
The Patient Advice reporter at U.S. News & World Report interviewed a 52-year-old resident of a nursing center along with a patient advocate to compile her list of questions, which includes:
What about physical and chemical restraints? Most facilities no longer use physical restraints. But so-called chemical restraint is another issue.
Mitzi McFatrich, executive director of the nonprofit Kansas Advocates for Better Care, says she would ask, “How many of your residents currently receive antipsychotic, antianxiety or antidepressant medications as a means to control their dementia or related behaviors?”
This speaks to whether antipsychotic drugs, meant to treat certain mental illnesses, are instead being used inappropriately, McFatrich says. Moreover, "anti-anxiety and antidepressant [drugs] used to control elders, rather than providing adequate staff and attend to an elder's needs is unethical," she adds. Quality-of-life improvements and side-effect risks should be the top concerns when these drugs are considered.
4. Investigate Further
Visit Nursing Home Compare, a site maintained by Medicare. You can search by location or name, and review ratings for quality measures, staffing and health inspections.
Contact your state’s Long-Term Care Ombudsman and Citizen Advocacy Groups. These representatives can discuss complaints, and other issues to help you evaluate a center’s strengths and weakness. The National Consumer Voice for Quality Long-Term Care lists contacts for each state.
5. Cost Considerations
Do you know if your loved one has long term care insurance? This is good information to know before nursing care is needed. You or someone with financial power-of-attorney may need to help with the claim process.
Skilled nursing care is expensive. According to Genworth Financial Inc.’s most recent “Cost of Care” report, the annual median cost of long term care in the United States is $80,300 (semi-private) to $91,250 (private).
Most people who move to a nursing center begin by paying for their care out-of-pocket. As personal resources are depleted, they may become eligible for Medicaid. Not all centers accept Medicaid payment, and some may only allow a certain number of Medicaid residents at one time. Medicaid programs vary by state, so be sure to find out what your state and center allows. Certain veterans may also be eligible for financial support if resources have been depleted. Check with veterans services groups in the county where your loved one resides for more information.
6. Know your Rights
The 1987 Nursing Home Reform Law requires each nursing home to care for its residents in a manner that promotes and enhances the quality of life of each resident, ensuring dignity, choice, and self-determination.
As a resident, your rights include the right to complain without fear of reprisal, the right to privacy, and the right to participate in your care. As a resident in a Medicare- and/or Medicaid-certified nursing center, you have certain rights and protections under federal and state law to ensure you get the care and services you need.
The center must tell you about these rights and explain them to you in writing in a language you understand. They must also explain in writing how you should act and what you’re responsible for while you’re in the nursing home. This must be done before or at the time you’re admitted, as well as during your stay. You must acknowledge in writing that you got this information.
Written By: Molly Kavanaugh