One of the most painful decisions a family caregiver has to face is when to place an old parent in a nursing home. Moving into a skilled nursing care facility involves big changes both in the life of the elderly and their children.
Caregiving and providing home care can be very challenging, particularly for those who are thrust into this role abruptly. They find themselves completely unprepared.
“People feel like to place someone is, “I’m giving up on them. I’ve failed in some respects,'” Niedens said. “But if you think through what is actually needed, sometimes a facility is the best place for them, and everyone.”Michelle Niedens, director of the Cognitive Care Network – at the University of Kansas Medical Center (medicalexpress.com)
Any family member who is a caregiver for an elderly person knows that it is challenging to manage constant hospital trips and phone calls from doctors and your jobs and meetings with social workers, bankers, and insurance agents.
On top of all of that there’s the issue of actually caring for your elderly parent, medication management, managing the household, physically caring for their personal needs if that’s necessary.
There may come a time when the workload is simply overwhelming and you need help. The solutions are either to call in help to the home or to bring your elderly parent to a nursing home.
So don’t be shy when you interview a nursing home – ask them the questions that are important to you and your senior loved one.
If you’re not yet sure whether a nursing home is the right choice, read our article on the Differences Between Nursing Homes and a Senior Living Community.
What Questions Should You Ask When Choosing A Nursing Home?
If this is your first time searching through a list of facilities for a nursing home, we urge you to “interview” several of them before you make your final decision as to which one is best suited for your aging parent.
On any given day, approximately 1.6 million people live in approximately 17,000 licensed nursing homes, and another estimated 900,000 to 1 million live in an estimated 45,000 residential care facilities, variously known as personal care homes, adult congregate living facilities, domiciliary care homes, adult care homes, homes for the aged, and assisted living facilitiesNational Center for Biotechnology Information
With so many elderly people living in facilities such as nursing homes – it’s important for family caregivers to be the best advocate that you can be for their elderly loved one.
Is the nursing home certified?
There are many nursing homes that claim to be certified, but not all of them actually are. And it can be hard to tell the difference between a real certification and one that’s just made up.
I recommend to contact your state’s health department to find out who to call to find out if the nursing home on your list is certified or not.
Does the nursing home have experience with the health problems that your parents have?
The experience level of the medical professionals in the nursing home is very important. If the nurses have had little to no experience working with someone with memory loss, dementia or Parkinson’s (as examples) it will make life a bit difficult for your senior parent.
Who are the physicians on staff at this nursing home?
You can ask for a list of the physicians, physician assistants and nurse practitioners who are on call and on staff at this nursing home. Then you can use Healthgrades, Yelp and CareDash to check their ratings and reviews.
How close is the nursing home to a local hospital?
The proximity of the facility to a local hospital can literally mean the difference between life and death for your aging parent. The closer they are to a hospital, the quicker they can get medical attention if and when it’s needed.
Does the nursing home offer various therapies that your parents need?
Is there a full staff of physical, occupational and speech therapists available 6 days of the week? Are there respiratory therapists available? What about recreational therapists? All of these therapy services help to make the lives of the residents richer and fuller.
In addition to the therapies, you will also want to know what types of activities are available that can provide some social interaction?
Is there a separate or special unit for special needs such as Alzheimer’s disease or dementia?
There are some nursing home facilities that offer what is often called a “memory unit” where residents with moderate to severe dementia or Alzheimer’s disease are housed. These units are locked to help protect their residents from wandering away from the facility.
How much does it cost to stay in a nursing home?
According to Senior Living.org, in 2020, a semi-private nursing home room may cost $245 a day. That’s $7,441 a month and $89,297 a year. A private room would be $275 a day, $8,365 a month and $100,375 a year.
Please know that rates do vary greatly from state to state.
So, you’re looking for a way to pay for care? One option are government programs. Medicare and Medicaid are two alternatives that can provide financial support in the event of need. If these don’t work out or your eligibility falls short, there’s always VA benefits which may cover other costs like home-help!
Is the staff certified and licensed?
The Centers for Medicare and Medicaid have a list of standards that nursing homes must meet. This includes having qualified employees, maintaining certification status with the CMMDA, keeping up to date records on any changes in patients’ condition or health information so they can be taken care of properly by these licensed professionals who work hard every day!
What is the staff-to-resident ratio?
Federal regulations state…
The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable level of physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facility’s resident population in accordance with the facility assessment . . . (see 42 C.F.R. § 483.70(e)).Centers for Medicare and Medicaid Services
These guidelines are vague and leave the exact ratio number to the discretion of the facility. But some states, like California have implemented their own stricter laws. In California, the law is at least 3.5 nursing hours per resident day with some waivers allowed.
When the nurses and staff have little time for the residents because they are trying to care for too many residents – well – the level of care will definitely go down.
Does the nursing home offer an abuse prevention training program for employees?
Not all nursing homes offer abuse prevention training programs, believe it or not.
More nursing homes are investing in abuse and neglect training to combat harmful situations. The training is usually provided by certified professionals who specialize in the prevention of cases like this as well as other related issues such as mental health or substance use disorders.
Abuse and neglect training aims to prevent senior mistreatment, which can be a difficult issue for many people due to lack of knowledge on how it happens – but that’s why trained experts exist!
What are the average ratings of the nursing home?
Nursing homes are rated on a 1-5 star system. Nursing Homes with 5 stars provide high level care whereas nursing homes that only get one star have below average care and conditions.
You can find the rating of a nursing home at the Nursing Home Compare Website.
Are there any inspection citations or lawsuits filed against the facility?
The nursing home is the place where people go to be safe and taken care of, not to be treated badly or to be injured in any way. But when they do end up getting badly hurt or killed on their stay there due to negligence by staff, then it’s time for an attorney!
You can consult with an elder law attorney to find out if the nursing homes(s) that you are looking into have had lawsuits and/or citations in the past.
Can residents in a nursing home make choices about their daily routine?
It’s true, that generally speaking residents in nursing homes do not have many choices but most facilities do try to make every resident as happy as they can be.
For example, you may want to eat dinner at 3 pm every day but all the other residents eat dinner between 4:30 and 6:30. The kitchen staff and the nursing staff would have to change their schedules to accommodate your dinner time request.
So, you can see how having this type of choice could cause a difficult time and is probably not realistic.
But on the other hand, nursing home residents do generally have a choice of how much social engagement they want to participate in, if they want to be inside or outside, where to sit in the dining room or if they want to eat in their own room.
What kind of amenities does the facility offer?
Many facilities have different offerings that can vary depending on where they’re located, how busy it gets during certain times, as well as other factors such as type of ownership or whether it’s privately owned versus publically-funded with government money.
General amenities that a nursing home offers include:
- 3 meals a day
- housekeeping staff for cleaning and laundry service
- rehabilitation services by physical therapy, occupational, speech and respiratory therapies
- recreational therapists are sometimes on staff as well
- 24 hour nursing care
- assistance with personal care such as showering, feeding and toileting
Some additional amenities that you can ask about include:
- pet friendly
- wifi access
- beauty salon / barber shop on site
- transportation services
- arts and crafts room
- active common areas
Is there an outdoor area for activities?
In your tour of the nursing home you will also want to see if there is an outdoor area for social activities (there usually is) but you want to see how big it is and is it being taken care of? No one likes to sit in an outdoor garden area where the plants look as if they are dying.
What menu options are available?
What types of foods are offered and can special diets be accommodated?
You may want to ask if you can sit down for a meal in the main dining room so that you can sample the food and the environment.
Can people continue to see their personal doctors while living at the nursing home?
Patients are still able to see their doctor despite being confined in a nursing home, and they also have the same rights as outpatients. If patients need mental, legal or financial counseling related to treatment provided by the facility then it must be given before any refusal can happen.
Is the facility fully staffed at night?
What is the staff to resident ratio during the night time?
How does the nursing home handle issues?
What happens if you have an issue with the nursing home? What are their policies and who do you contact?
It won’t hurt for you to take a stroll through the nursing home and interact with the visiting family members and ask them if they have had any complaints and how have they managed?
Are corridors well-lit and free of clutter?
As you go through your visit of the nursing home you’ll want to take notice of the hallways and rooms.
There most normally is enough light (but you should check it, especially in the evening) but the most common clutter problems that I’ve seen in nursing homes are an accumulation of chairs and wheelchairs, medication carts and medical equipment.
I’ve even worked in some nursing homes where the amount of space is so limited that the staff started storing medical carts and equipment in the patients’ rooms.
Are smoke and carbon monoxide detectors installed throughout the facility?
Believe it or not, not every state in the USA mandates that nursing homes have smoke detectors or carbon monoxide detectors. At least not in the older nursing homes.
So I would strongly recommend that you ask if they have both installed and how many.
8 Tips to Help You Find The Right Nursing Home for Your Parents
These tips will help you find the perfect care facility for your aging parents:
1. Find out the kind of place that can provide the best care for your aging parents need, know their requirements in detail. Frame out your budget. Most people look for daily living supervision, adult daycare for socialization, assisted living facilities that provide help with dressing, bathing, and eating, nursing home with 24/7 health. Nowadays, Care Planning Software is becoming more popular to help with these issues.
2. Talk to your parents. Get them involved in the decision-making process.
3. When you hire an eldercare consultant, ask them how they are paid. See if the consultant’s company receives a referral fee from the home where your parents finally move. If you find the consultant fine enough, then there is no harm with such a placement fee. Do ask for references.
4. Your parents should be comfortable with the facility socially. For instance, if your mother was a master sergeant, you probably may not want to place her in a facility filled with retired officers since they’ll probably look down on her.
5. Before you sign up for your parents for the facility, go and do a thorough inspection on your own. Make multiple visits and try doing it without the marketing person around. Let your perspective do not get influenced by their enthusiasm. Listen to your inner voice. Use your sixth sense. Literally, feel the place, taste the food, try to check if it seems the right nursing home for your parents.
6. Do thorough research about the place and state evaluations for the facilities you are about to confirm. Begin with a nursing home Compare site or ask the home for a copy of its assessment. Go through all the details about them. Do not only check the sheer number of deficiencies. The absence of doctors or improper supply of medicines is more severe than the lack of tissue papers.
7. Go through the contract carefully. Read it several times so that no serious financial obligation surprises you in the future. Please consult with your attorney, accountant, or financial planner to review it.
8. Always have a plan for the future. You should have options ready before you are in a crisis. Because during an emergency, you do not have time for research.
If you observe that the current living arrangement is not suitable for your old parents, you need to find a good nursing home where they could live enduringly and receive the care and supervision they need. Now, with the help of this insight we hope that you will be able to find the right nursing home for your aging parent soon.
What Are The 3 Most Common Complaints About Nursing Homes?
The 3 most common complaints / problems in nursing homes are:
- Poor food quality
- Poor response time to a call
- Poor sleep due to disruptions
Poor Food Quality
It can be very difficult to satisfy every palate in a nursing home so don’t expect everyone to be satisfied with the food that they are given.
The issue to check here is whether or not the kitchen staff is able to accommodate your loved one’s specific diet.
My mother was severely lactose intolerant and the first few days that she was in a nursing home she kept receiving dairy products at every meal. Either a container of milk, cheese in her sandwich, yogurt, etc. It took me almost a week to get the kitchen to give her the proper meals.
Poor Response Time
I have a friend who works in elder care. She told me that one thing you should always look out for is the staff-to-resident ratio, because this is a major factor that could tell whether or not your loved one is getting enough attention and care from those working there to take good of them 24/7.
If they’re really understaffed, this can cause problems like dry skin (which will then lead to bedsores), muscle weakness due to lack of activity and movement. Being understaffed contributes to increased stress levels among nurses which may result in decreased empathy towards residents’ needs – all red flags that something might be going wrong!
In a study of four Valley nursing homes, Schnelle found that occupants were subjected to a nightly cacophony of nurses gabbing, doors slamming and agitated patients shrieking. On average, residents were startled by 32 loud noises each night, he found.LATimes.com
It’s a difficult balance for the staff to care for residents that need help during the night yet keep quiet enough to let the other residents sleep.
We’ve gone over some of the most important things to consider when deciding on a nursing home placement. Certainly add your own list of questions and concerns to this list when you begin this next adventure in your life.
If you would like some professional direction, you may want to speak to a geriatric care manager to help you with this very important decision.