Finding the right nursing home for a loved one can be a challenging proposition. The options are many, but the industry can seem completely opaque. That’s why visiting a home — and asking a lot of questions — before you move a loved one there is a critical part of the process.
The following nine categories, each with recommended questions, can help you determine whether a specific nursing home is a good fit for your loved one:
— Basic information.
— Living space details.
— Safety track record.
— Staffing specifics.
— Care approach.
— Memory and dementia care approach.
— Abuse prevention strategies.
— Quality of life concerns.
— Financial details.
Basic Information
Ideally, before making a decision, you’ll take a tour of the nursing home and meet the folks who will be caring for your loved one. During that visit, you can glean a lot of basic information that may help you decide if it’s the right fit. But you should also ask:
— How big is the facility, and how many residents live there?
— How long is the average stay for residents?
— Is the facility accredited?
— How is the facility managed? Who’s in charge?
— Is it organized as a for-profit or nonprofit entity?
— Does the facility have established relationships with nearby hospitals and other health care providers?
— What improvements have been put in place in the past year?
— What other improvements are planned?
— Is there a waiting list? If so, what’s the typical waiting period for a bed to open?
— Who’s the point of contact for family questions and concerns?
— What are the visiting hours, and how do you manage family and visitors?
[READ: How to Stay Connected to Your Loved One in a Nursing Home.]
Living Space Details
As part of your tour, you should first check out the living spaces, says Lisa Zamosky, chief communications officer with Purchaser Business Group on Health in Oakland, California. This assessment should include both the home in general and residents’ rooms.
Questions to think about include:
— Is the facility clean and orderly?
— Is it noisy or quiet?
— Is there a dining room where residents can go to eat in a more social setting?
— Are there residents sitting in the hallways?
— How large are the rooms, and how are they laid out? Are there options for personalizing these living spaces?
— How often are rooms cleaned, and what standards are in place to maintain cleanliness?
— Do residents always have a roommate, or are there private rooms available?
— Is there enough storage space, such as closets?
— Is there outdoor space available to residents, such as a patio area, where they can sit and get some fresh air?
[READ: Nursing Home Facts and Statistics.]
Safety Track Record
The Centers for Medicare and Medicaid use a five-star quality rating system to help families compare options. U.S. News also hosts a comprehensive nursing home ranking, and you can search for the best nursing homes in your area.
Each state also has its own inspection and rating system that provides information about safety ratings and quality of care in nursing homes. Check with your state agency for up-to-date safety and inspection reports for any home you’re considering.
What’s more, if an adverse event does transpire in a nursing home, an incident report must be filed with the state agency that oversees nursing home certification. The CMS compiles that information in a national database. ProPublica also hosts a comprehensive, searchable database of nursing home inspection reports.
Related questions you should ask the facility operator include:
— What was the outcome of any survey inspection reports?
— If any problems were identified, how were they fixed?
— How quickly were the problems addressed?
If something isn’t clear, don’t be afraid to ask for more details.
[READ: Things Nursing Homes Don’t Want You to Know.]
Emergency plans
In long-term care facilities where not all the residents are mobile, it’s important to understand how the care team will look after your loved one if an emergency occurs. Ask:
— Do you have an emergency evacuation plan?
— Do you hold regular fire drills?
— Do you conduct nightly bed checks?
— How often does the staff check on residents during the day?
— Do you use any high-tech resident monitoring services?
Falls
Falls are a major area of concern for older adults. In nursing homes, it’s an important metric that can help you determine whether a facility is taking care of its residents appropriately. You can check with the CMS to learn more about falls at a specific facility.
In addition, you should ask:
— How often do residents fall?
— What do you do when there’s a fall?
— What do you do to prevent falls?
Staffing Specifics
Staffing at nursing homes has long been a complicated issue, and the COVID-19 pandemic exacerbated that problem. For instance, in March 2022, KFF reported that 1 in 4 nursing homes nationally reported a shortage of at least one type of staff.
The Biden administration has since announced reforms to improve the safety and quality of nursing home care that includes mandates for adequate staffing levels. These changes are intended to improve care quality in nursing homes and boost patient outcomes while also increasing transparency, accountability and reporting.
Staffing questions to ask include:
— What is the nurse-to-patient ratio, and how many hours per day do residents get with nursing staff and other caregivers?
— What qualifications must staff have to work here, and how are they recruited?
— What kinds of background checks are conducted prior to hiring?
— What is the annual rate of nurse and nurse aide turnover?
— What is the facility doing to try to improve turnover?
— How often are agency temp nurses used?
— What proportion of families hire private nurses to supplement staff nurses?
— How often do nurses update doctors on residents’ health status?
Volunteer involvement
Many nursing homes work to connect with the wider community so that residents don’t feel as isolated. You can ask about these efforts:
— Do you have volunteer programs?
— Do you have a relationship with local schools or houses of worship to provide additional services or enrichment opportunities for residents?
— Do volunteer musicians and other entertainers visit regularly?
— Do children or young adults from classrooms or youth groups come to do crafts, perform or participate in other activities with residents?
Care Approach
Ascertaining a facility’s approach to care management is a broad topic that may include subsets of information ranging from meals to the use of diapers in the facility.
Activities of daily living
Activities of daily living include using the toilet, bathing, managing medications, cooking, eating, doing laundry and dressing. Most nursing home residents need assistance with one or all of these activities.
— How is toileting handled? For example, if my loved one becomes incontinent, how will that be managed?
— Do many residents use diapers?
— Are catheters used?
— Is there an on-site beauty salon or barber shop?
— How often will my loved one be bathed, and how is that typically managed?
— How often are bed linens and clothing changed and laundered?
Medical care
Some questions to ask regarding the approach to and quality of care offered are:
— Do you create individualized care plans for each resident?
— Do you offer specialized care services?
— How often is a doctor on-site?
— Are dental services available?
— Does the home arrange for regular hearing or vision screenings?
— How are residents’ medical records tracked and updated?
— Have there ever been any problems with electronic health system records, such as data breaches?
— Do residents receive preventive care, such as annual flu and pneumonia shots?
— Is vaccination mandatory for residents and staff?
— If my loved one has a medical need, who contacts the doctor?
— What happens if my loved one suffers a medical emergency, such as a fall or a broken bone? What hospital arrangements do you have in place for such emergencies?
— If my loved one needs to see their doctor, who arranges for transportation?
— Do you offer telehealth options?
— Will my loved one have access to counselors or other mental health professionals?
— If my loved one must leave the home for a hospital stay, how long will their bed be held, and what’s the procedure to retain that placement?
Nutrition
Eating and nutrition are key elements of any resident’s stay in a nursing home. The following questions can offer some insight into how the home manages this important piece of maintaining good health:
— How flexible is the menu? Can residents make choices?
— How is weight loss identified and tracked, and how is that situation typically addressed?
— What do you do to make sure residents are eating, especially those who have lost interest in food?
— Can residents eat meals whenever they want, or are meals only at scheduled times?
— Are healthy snacks available?
— Does the home honor medical, religious or cultural dietary restrictions?
— How do you ensure that your meals meet high nutritional standards?
Specific health conditions
You should find out how specific health concerns will be handled. For example, ask at the facility how they will deal with your loved one’s dementia, weight loss, diabetes, disability following stroke, cancer or any other conditions they may be dealing with.
Memory and Dementia Care Approach
Alzheimer’s disease and dementia care is a very specific type of senior care option that is offered in many long-term care facilities. But they don’t all have the same approach, so it’s important to ask how those sometimes difficult-to-manage conditions will be handled.
— Do you provide innovative services or therapy options?
— Are residents with dementia or memory issues separated from the rest of the residents?
— What safety measures are in place for residents with memory issues? For example, are there locks on the doors to prevent wandering?
— How are staff trained to manage patients with dementia?
— If my loved one becomes agitated, combative, disoriented or otherwise displays difficult behaviors related to their condition, how are those situations managed?
Abuse Prevention Strategies
Elder abuse is sadly an ongoing issue in the industry. Many homes work very hard to prevent these issues, but they can crop up. Some questions to ask include:
— How are incidents of elder abuse identified and reported? What’s the procedure for documenting suspected abuse?
— How involved are administrators? Do lower-level employees have adequate oversight?
— Do employees seem stressed out or rushed when dealing with residents?
— Do nurses and nursing aides seem warm and like they genuinely care about the people they’re looking after?
— Does the home immediately notify the family point of contact and local authorities when an issue arises?
— Have other families complained about neglect or abuse of family members living in this residence?
— Are there any monitoring systems in place, such as cameras or motion sensors?
— Do staffers receive adequate training on preventing abusive or neglectful conduct?
— What rights do residents and their families have when addressing alleged elder abuse and neglect?
Quality of Life Concerns
Activities to engage seniors are an important part of living in a nursing home. You should explore what sorts of activities are on offer and whether the facility offers more creative options. Ask:
— What activities are available?
— Who runs activities, and how are they managed?
— How do these staffers engage seniors to encourage them to participate in activities?
— Are there options beyond bingo and movies?
— Are there activities suited for different levels of cognitive ability?
— Do residents take excursions outside the home?
Financial Details
Figuring out how to pay for care is a key component of finding the right place for a loved one. Zamosky recommends asking which insurance plans the home honors and whether your loved one’s insurance plan covers nursing home care.
“Many people are surprised to learn that Medicare generally does not pay for most nursing home care except for up to 100 days in a skilled nursing facility after a qualifying hospital stay of at least three days,” she explains. “For long-term care in a nursing facility, people either pay out-of-pocket or tap into long-term care insurance if they have that type of coverage.”
When you’ve spent down all your reserves, Medicaid — the joint state and federal health insurance program that covers medical expenses for people with low incomes — will provide some financial assistance to people living in nursing homes.
“Medicaid benefits are guaranteed to certain individuals, including the elderly, who meet specific income limits,” explains Diane J. Omdahl, Wisconsin-based president and co-founder of the Medicare consulting firm 65 Incorporated.
However, not all nursing homes accept Medicaid, and there’s some fine print to wade through. Therefore, it’s best to ask ahead of time whether the home you’re considering works with Medicaid and whether your loved one will be covered if they outlive their savings and other financial resources.
Consider asking:
— Does your facility accept my loved one’s health insurance or long-term care insurance plan?
— Do you accept Medicaid payments?
— How do you bill residents, and what are your fees?
— What hidden extras might come up later?
— How often do you raise your rates?
— What happens if we’re struggling to cover the bill? Is there assistance available?
Other People to Talk With
While many of the questions you’ll have can be adequately answered by the nursing home’s administrator or sales team, it’s also important to spend some time chatting with other folks at the facility to get a more comprehensive view.
Nursing and care staff
Care staff, whether nurses or nursing aides, are on the front lines in nursing homes. How they respond to questions may shed light on the culture at the nursing home and whether your loved one will be cared for properly there. Zamosky urges you to learn as much as possible about the staff that will be caring for your loved one.”
Some questions to ask nursing staff include:
— How many residents do you care for? Is that too many or about right?
— How much time do you try to spend with each resident?
— Do you like working with older people?
— Is this a good place to work?
— What do you like best/least about working here?
— Do you receive training and continuing education?
Current residents and families
You should also ask to speak with current residents and their families, as they may be able to tell you what it’s really like to live in a particular nursing home. Residents who seem alert, clean, happy and relaxed can be a good sign of a top-notch home.
Some questions for residents may include:
— Do you like the nurses and aides?
— Do you have the same ones most of the time, or do they change a lot?
— Do they help you to the bathroom, and if you need help, do you get it in time?
— Do you ever need help eating? If so, do you always get help without waiting too long?
— Are you often thirsty?
— Do you have a special diet? (If yes: Do you like the diet choices?)
— Do you like the food here?
— Do you have friends here?
— Are you as busy as you want to be?
— Can friends and family visit whenever they want?
— Do you get to suggest or plan activities?
— Do your visitors ever bring pets with them?
Other families may be able to shed additional light on some aspects of care:
— Does your loved one get enough of the right kind of care?
— Does your loved one feel safe with the nursing home’s nursing staff?
— How well do you think the staff here manages your loved one’s prescriptions? Have there been medication-related problems?
— Have you ever arrived to find your loved one needing toileting help or sitting in their own waste?
— Is your loved one being bathed adequately and on a regular schedule? Is their hair neat, and are their nails trimmed often enough?
— Is there anything you know about this nursing home that you think would help me make my decision?
Ask yourself
Amid all the research, don’t forget to take a moment to assess what you’ve learned. Ask yourself some important questions about the facility, and assess your gut response. Some factors to consider include:
— Do staff members appear to genuinely be concerned about the well-being of residents?
— Are residents dressed in hospital gowns or their own clothes?
— Do residents seem socially engaged and happy?
— Do the nurses and aides inspire confidence that they can appropriately care for your loved one?
— Is the parking lot full?
— Are grandchildren or other family or friends around?
— Are there creative activities available, and are they well attended by residents?
The Bottom Line
There’s almost no end to the important questions you can ask when assessing whether a specific home is right for your loved one. Taking a printout of these questions may help you stay on task and get the important pieces of information you need.
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Essential Questions to Ask When Choosing a Nursing Home originally appeared on usnews.com
