If You Think You Need A Nursing Home...
What to look for...
How to choose a facility...
Choosing a nursing home for a family member can be one of the most difficult decisions in life. While every potential resident's situation is unique, there are some common criteria that may be used as a guide to selecting a nursing home that best suits the needs of a resident. In addition, adequate knowledge of local resources, residents' rights and
the potential problems that can occur in nursing homes can ease the
process of pre-placement. The following information highlights some of the
primary pre-placement issues to consider when seeking a nursing home.
Method Of Payment
Unless a resident can pay privately for an indefinite period of time, even if the initial stay is covered by Medicare, choose a Medi-Cal (Medicaid) certified facility. While the majority of nursing homes are certified for Medi-Cal, such certification is not mandatory and some facilities are private-pay only. Even someone with $100,000 in liquid assets can spend that down in two years in a nursing home, and private-pay only facilities can and will evict someone who converts to Medi-Cal. Given the average rate of private pay in a California nursing home, few people can afford private pay on an indefinite basis. Once a resident is admitted to a Medi-Cal certified nursing home, however, he/she cannot be evicted simply because of a change from private pay to Medi-Cal.
Although "duration of stay" requirements, i.e., making a resident pay privately for a set period of time, are illegal, California nursing homes have the right to review potential residents' finances prior to admission. Since the Medi-Cal program pays less per day than the private pay rate, the longer you can pay the private rate, the more options you will have when looking for a nursing home.
Location
It is important to choose a facility that is close and convenient to the person(s) who will be visiting the resident most often. Most studies of nursing home residents have shown that residents who are visited often may recover more quickly, may be happier and healthier for the love and attention received and may receive a higher quality of care if staff knows that visitors come often and unannounced. In addition, when family members and friends are close enough to visit frequently, they can monitor the resident's condition, participate in care planning and respond quickly to emergencies.
Special Needs
Special care needs of the resident should always be considered: whether the resident will require a ventilator, psychiatric care or extra supervision due to wandering or combative behavior. Although the majority of nursing homes are licensed as "skilled nursing facilities" (SNFs), they are licensed to provide both skilled and "custodial”
care. There are a number of different types of nursing homes, and levels of care, costs and admitting requirements will vary. California also has very stringent regulations governing nursing home admission agreements. Questions about such admission agreements should be directed to the long-term care ombudsman program in your area.
Quality
While quality of care should always be a primary consideration, it doesn't do the potential resident any good to choose a "fancy" nursing home if the resident can't afford it, if it can't meet the needs of the resident or if it is too far away for family and friends to visit. Do comparative shopping.
• Objective considerations: Nothing substitutes for a personal visit to the facility. Once you have identified a nursing home that seems (on paper, at least) to be workable, to have the services necessary and to have a vacancy, visit the facility. Ask to see the entire facility, not just the nicely decorated lobby and one wing or floor. Try to get a feel for the quality of care provided and how staff treats the residents. Resident appearance, use of restraints, residents' rooms, quality of food and activities are all-important factors in evaluating a nursing home. However, nothing is more important than the quality and quantity of nursing home staff.
• Word of Mouth: If possible, talk to friends, other residents' family members, ombudsmen, physicians' or others familiar with the facility. This personal feedback may prove to be invaluable to you.
• Record of Care: Information on nursing homes' compliance records, including penalties assessed for violations, defficiencies and consumer complaints are available from the local long term care ombudsman programs and the District Office of Licensing and Certification.
• Subjective Feelings: How do you feel when you visit the facility?
• How does it compare to others? How did the administrator and staff treat you? Remember that you'll be depending on these people to take care of your family member. If you don't like visiting there, imagine what it would be like living there.
Choosing a nursing home can be an emotionally wrenching experience. However, criteria listed above can give you the guidance needed to make the best possible placement and can alleviate many future problems.
