We’ve all probably read or heard about tales of nursing home abuse in the recent past. Well, a couple or so years back, I was faced with the unpleasant task of placing my mother (who was suffering from Alzheimer’s Disease) in a nursing home. Definitely not one of life’s more pleasant experiences but given the fact that life expectancy has gone up dramatically over the years more and more families are faced with this decision everyday. If you ever find yourself in this unpleasant position, here are a few things to be on the lookout for.
Choosing a facility
There are many considerations that should be taken into account when choosing a facility. I would recommend touring as many as you can before making your final decision. Most nursing homes will gladly let you tour their operations. If they don’t, your radar should go up and warning signals should flash inside your head. Things to take into account right off the bat are location, method of payment and any special needs that your loved one might have. After all, chances are they are going to spend their last days there and hopefully those days will be as comfortable as possible.
While you're on your tour, here’s a couple of things to your eye on…
Staff
First of all, are there enough of them? The administrator of the nursing home should be able to tell you the staff to resident ratio without blinking an eye.
While you're there, try and take note of how the staff responds to the residents. Are they polite and courteous or abrupt and demeaning? Since many of the residents might be suffering from memory loss, does the staff wear name tags? Does the staff have a condescending attitude towards the residents or do they treat them like human beings?
Does the staff respect the residents right to privacy or do they enter rooms without knocking or calling out? Are there any licensed therapists on the staff or are they contracted out? How about social workers? Are they full time? Are any of the members of the staff multi-lingual? Is the administrator of the facility open or hostile to questions about resident care?
Other Residents
Chances are that while you’re touring the place, you're going to bump into other residents of the facility. Here are some things you should look for.
What is their general appearance? Are they well groomed or do they appear slovenly? Do they appear somewhat active and alert or are they lethargic and trancelike? Are they up and around for meals or do they have to woken up hours before hand to get them ready?
What about their rooms? Are they single or shared? If they are shared, is there a curtain for privacy? Does the room have a window to let some natural light in or is it all artificial light? Are the beds comfortable? Do they have reading lights and a chest of drawers within easy reach? Does each resident in the room have their own comfortable chair to sit in? Are the call buttons within reach? How about fresh drinking water? Are the residents allowed to bring personal belongings into the room? What is the policy regarding televisions and radios?
Overall Facility
While you’re walking around try and notice the smells that you may encounter. Does the stench of urine and excrement invade your nostrils? How about the aroma of body odor? Does the facility reek of air fresheners? If so, they might be being used to cover up the aforementioned odors.
How hot or cold is it? Do the rooms have their own thermostats? Are the laundry such as linens and such stowed neatly and are the soiled linens stored properly or stacked in the halls?
What about the furniture that the facility provides. Is it sturdy or flimsy. Is it clean or dirty?
Are any stairways and exits clearly marked? Are there handrails? How about fire extinguishers? If there are lounges for the residents, how many are there? Are they clean? Is the furniture comfortable?
Last but not least, what about the floors? Are they clean? Are they slippery? Are the wide enough to accommodate wheelchairs?
Bathrooms
Chances are that residents will be spending a lot of time in these rooms so it would be good for you to check them out.
Are they conveniently located? How many residents per bathroom? Are there handgrips around the shower and the toilet? Is there a call button near each of them? Do the residents schedule their own bath/shower or must they rely on staff to assist them?
Kitchen and Eating
Even though your loved one’s appetite might have waned over the years, they still have to eat. I would never expect a facility to provide a “fine dining experience” but that doesn’t mean it has to be bad either. Keep on the lookout for the following.
To begin with, what does the kitchen look like? Is it big, small, clean or dirty? Is everything put away neatly or stored haphazardly? What about the food, is it properly stored? What does it smell like in there? How many kitchen staff members are there? Is there a professional dietician on board? How are any special dietary requirements met? What times are meals served?
What about the dining area itself? Is it large enough to handle the number of residents or must some of them eat in their rooms? Are the chairs comfortable and do they fit under the tables so that the residents can reach their food?
What about the food itself? Is there a menu posted in advance so the residents can choose their meals? How often do they change the menu?
Does it look good? Would you eat it if you didn’t have to? Is it mostly fresh food or mostly canned? Is what is supposed to be hot indeed hot? How about cold? What drinks are available? Do the residents seem to enjoy the meals or do they seem to dread having to eat them?
What about the dishes and silverware? Is it of the real variety is it disposable? If it real, how breakable it is it? Is it light and easy to use or heavy and cumbersome?
Activities
We’ve all probably got an image in our head about what kind of activities should go on in a nursing home. Here are couple of more items to bury in the back of your brain when considering this aspect of the facility.
First of all, is a calendar of activities even posted? If so, what activities themselves are listed? Do they meet your loved one’s interests? If not, is there an Activity Director on site? What staff members participate in the activities? What hours are they held? Are special occasions such as birthdays, anniversaries and holidays recognized? What about religious activities? Are volunteers brought in on a regular basis to add some variety to the number of activities?
In General
How many times have you said to yourself “Dammit, I wish I would have thought of that while I was there”? I’m sure there are many, many concerns and questions that you might have that you might not think of until you get home. These might be among them.
When and how many people can visit at time? Can young children come along?
How often do physicians visit the facility? How many patients do they see? What hospital is used in emergency cases?
How long has the management of the facility been in place? Has it been constant or ever changing? Are there any future plans to change?
What about the billing procedure? If there’s a problem, whom should I contact? Are there any exceptions made or special pay plan agreements that can be arranged? What is standard and what is extra?
What are the surrounding grounds like? Are there fences and gates to prevent people from getting in or out? Is there a security patrol? Are residents allowed outside only during certain hours of the day?
Do you have any information such as pamphlets, brochures and catalogues that I can take with me?
Folks, as I mentioned earlier, choosing a nursing home is one of the hardest decisions a person can make. I realize that each situation is different for a variety of reasons. I also realize that the information provided above, while obviously not all encompassing, hopefully gives one a reference point or some things to think about should you be faced with this difficult choice.
Good luck!