7 Things to Ask When Considering a Nursing Home
There are so many things to consider when selecting a nursing home. Picking a skilled nursing facility for yourself or a loved one is a huge decision, so make sure to do your research and don’t be bashful about asking questions.
Some of the most important things to learn about a facility are available online, including quality ratings and inspection reports. For information about those resources, see my recent post: Many Resources to Help Find the Right Nursing Home.
In addition to the important information available through those online resources, it is important to actually visit the facility. When you do, here are seven of the most important questions to ask.
1. What is the cost?
Cost is obviously an essential consideration. The cost of nursing home care is staggering. The national average for a private room is more than $90,000/year.
Of course, several possible funding sources are available to help with some or all of the cost. However, unless money is no object and you can afford the finest nursing home care available, the sensible thing to do is to study the cost before you do much shopping.
Identify the funding available to you, which may include personal and family assets, Medicare, Medicaid and long-term care insurance. (A related question is: Is the facility certified by Medicaid and Medicare. Most facilities are, but not all.) Determine what you can afford, so you don’t go looking for a facility that is beyond your reach, which will surely end in disappointment.
2. Does the facility have an available bed? If not, what is the waiting period?
There is no point in studying a facility that does not have openings. According to the U.S. Census, in 2009 the occupancy rate of U.S. nursing homes was 82%. The rate in Oklahoma was a much lower 66%, the second lowest in the nation. So, here in Oklahoma your chances are good of finding availability at the facility of your choice. But it is something to ask.
3. How many nurses and other staff are on duty during each shift?
Federal law requires a Medicaid/Medicare-certified nursing home to have an RN on duty at least eight hours per day and to have at least one RN or LPN on duty at all times. An RN has a minimum of two years of nursing training, and an LPN has a minimum of one year of training.
So, you want to determine two things: Is the home you are considering meeting the minimum federal standard? And is it surpassing it? Of course, it is also important to know how many non-nursing staff members are on duty to assist patients during both days and nights.
4. Does the facility have physical therapists on staff or available?
Geriatric physical therapy is a specialty field. Older patients are more likely to fall and more likely to be injured when they do. Recovery from an injury often requires physical therapy. In addition, many health conditions common among the elderly, including arthritis, osteoporosis, and incontinence, can be helped with physical therapy.
Does the nursing home you are considering have a physical therapist on staff? Does it have an agreement with a therapist that makes PT conveniently available to residents?
A report on the value of physical therapy in nursing homes by the Alliance for Quality Nursing Home Care is available here: Therapy Services in Nursing Facilities.
5. Does the facility conduct background checks on all staff members?
Sadly, nursing home abuse is a significant problem. On this blog we have reported on several incidents of nursing home abuse here in Oklahoma and elsewhere in the nation. Background checks are essential to ensuring residents’ safety.
See our reports on Nursing Home Abuse.
6. Does the facility embrace “resident-directed care” and “culture change”?
The terms “resident-directed care” and “culture change” may be unfamiliar to you. However, any nursing home administrator who is current in the industry is familiar with those terms and can discuss them intelligently with you.
The 1987 Federal Nursing Home Reform Act was a milestone in improving the quality of nursing home care. Among the many provisions of that law was the delineation and enforcement of “residents’ rights.” During the more than 25 years since that law was enacted, two of the phrases that have become common to describe the goals of nursing home reform are “residents-directed care” and “culture change.”
The goal is to replace an institutional, impersonal approach to elder care with an approach that acknowledges that residents are people who have rights and deserve respect. To the greatest degree possible, they should be helped to live lives of dignity, freedom and personal preference, even when residing in a nursing home.
If a nursing home administrator seems unfamiliar with these concepts or reacts to them negatively, that is a red flag.
7. Does the nursing home have a Family Council and/or Residents Council?
A Family Council consists of relatives of nursing home residents who work together to keep each other informed, communicate with administrators and staff, and improve the residents’ quality of life. A Residents Council exists for the same purposes, but is composed of residents themselves, rather than relatives.
A good nursing home and a good administrator will welcome the presence of a Family Council and/or Residents Council. Communication works both ways; a facility benefits by having a group of informed relatives and/or residents with whom to communicate about issues and concerns.
Does the facility you are considering already have such councils? Do the administrators have a positive, supportive relationship with the councils? If no council currently exists, a telling question to pose to the administrator is: Will they cooperate with and support you if you decide to organize one?
See my article: Does Your Nursing Home Have a Family Council?