The importance of visiting nursing homes
Scenario: John, a retired teacher, moves into a nursing home with a high staff turnover rate and a poor reputation, but his family brushes off these red flags.
In just a few weeks, John develops bedsores because he isn’t regularly repositioned. The staff ignore his complaints of pain. Eventually, an infection sets in, requiring hospitalization, all because the nursing home fails to provide the basic care he needs.
With an abundance of senior living options, as well as startling stories about senior living conditions, choosing the right nursing home can be a challenge. You want a facility where the residents aren’t merely surviving but are also socializing and thriving, even in their advanced age.
To catch nursing home red flags, get started by comparing facilities:
— Rely on nursing home ratings from federal and state agencies. Using websites like Care Compare, you can search by region and view different metrics for nursing homes, long-term care hospitals, in-patient rehabilitation centers and other facilities. You can also try Medicare’s Nursing Home Lookup.
— Research state agencies for similar resources. For instance, the California Department of Public Health provides the California Health Facility Information Database.
— Check out U.S. News ratings. U.S. News assessed more than 15,000 nursing homes this past year and rated most of them on short-term rehabilitation and long-term care. You can also search for nursing homes by city or state.
— Look up online reviews. If you notice multiple negative reviews, consider steering clear of that facility. Nursing homes cited for abuse will have an icon showing a white hand within a red circle next to their name on Medicare.gov.
Even after sufficient online research, consider visiting a few nursing homes in person. Dr. Tanya Gure, section chief of geriatrics and clinical professor of internal medicine at the Ohio State University Wexner Medical Center in Columbus, says that ratings can lag behind recent updates or improvements a facility has made. On the other hand, the facility could have since taken a turn for the worse.
But when you take a tour, what should you look for? Here are 11 signs a nursing home isn’t right for you or your loved one:
1. A high number of infections and deaths
Infections have almost become an unfortunate guarantee with any type of senior care facility. As of 2020, the Centers for Disease Control and Prevention estimated that there were approximately 1.3 million nursing home residents, but between 1 million and 3 million infections every year among nursing homes, skilled nursing facilities and assisted living facilities.
Infections can spread into the bloodstream, causing a condition called sepsis. Even a minor infection can become life-threatening to an elderly adult.
Common infections that plague nursing homes include:
— COVID-19
— Methicillin-resistant Staphylococcus aureus, or MRSA
— Pneumonia
— Clostridium difficile, also known as C. diff
— Scabies
Infections can be transmitted through the air, fecal matter or from direct contact. For this reason, observe the staff in action while touring a facility.
“Do they wash their hands before and after handling a resident? If they don’t, this poses an infection risk, which is a big concern for older adults with weakened immune systems,” advises Dr. Gary Small, chair of psychiatry at Hackensack University Medical Center and behavioral health physician-in-chief at Hackensack Meridian Health in New Jersey.
2. Long response times
The call light is the link that provides residents access to anything from comfort to immediate life-saving measures. In fact, the Centers for Medicare and Medicaid Services also has regulations on call lights. The most important requirement is that every resident must have their call light within reach, no matter what. If residents don’t have access to their call lights, they don’t have access to proper care.
When visiting a nursing home, take note of the following:
— Active call lights
— How staff prioritizes answering call lights. Do they answer them in order? Are the lights color-coded? Do they have a nurse aide find out the needs, and then order them accordingly?
— How long the call lights are on until they are addressed
It’s normal for there to be more call lights on at certain times, like during meal times, shift changes or times that are common for medication administration. However, it is a nursing home red flag if there are unanswered call lights on throughout all hours of the day and night. One of those call lights, for example, could be a resident who fell and needs help or is having acute chest pain.
3. Short staffing
With growing concern for the health care staffing shortage, having an adequately staffed nursing home is a priority.
Research shows that residents in a properly staffed nursing home have a decreased risk of:
— Pressure ulcers
— Infections
— Uncontrolled pain
— Overuse and improper use of antipsychotic medications
— Hospitalizations
To determine if short-staffing is an issue at a nursing home you’re considering, ask the following questions:
— Does your facility track call light response time? If so, what is the average response time?
— What is the average time a nurse and aide spend with a resident daily?
— What is the nurse-to-resident ratio and nurse aide-to-resident ratio?
— What is the protocol if a nurse or an aide calls in sick?
There is no one-size-fits-all staffing ratio. It depends on the acuity of the residents and the type of care the facility offers.
4. High turnover among staff
Turnover among certified nursing aides at nursing homes is often near or more than 100% annually, according to researchers. This means that all nurse aides in that facility will likely have quit within a 12-month period and been replaced. Nurse aides are responsible for the majority of a resident’s day-to-day care.
In addition to turnover, look for:
— Nursing care availability overnight
— Procedures that are available in case of emergency
— On-site medical staff, such as a doctor
A high turnover rate among staff does not necessarily mean a nursing home is short-staffed, though it may affect the quality of care. Having the same nurse aide care for your loved one for a long period of time means they will be in tune with their mood, emotional and physical needs and any potential signs of decline.
With high staff turnover, staff don’t get to know their residents and their routines as intimately, and information can get lost between shifts.
5. Limited socializing
When you’re visiting a nursing home, be sure to pay attention to the social enrichment activities available to the residents.
This may include:
— How many residents are up engaging in activities by 11 a.m.
— Availability of nursing home activities, including arts and crafts, clubs and low-impact exercise, like walking or aquatic activities
— The amount of residents who eat in the dining halls during meals
— Whether residents feel comfortable interacting with staff, such as asking questions or socializing at appropriate times
— Availability and quality of outdoor space, as spending time outdoors can improve quality of life for nursing home residents
— Location of the nursing home, ensuring it’s in a safe neighborhood and that outdoor areas are secure to prevent residents from wandering
Social enrichment in these facilities is not just a nice amenity; it’s a necessity. If social activities aren’t a priority, that’s a nursing home red flag. That’s because social isolation and loneliness are linked to mental and physical health conditions. According to the CDC, people who are more socially isolated have a 50% increased risk of developing dementia.
6. Complaints to state inspectors
The state agencies that license and certify nursing homes are required to inspect these facilities at least once a year. Inspectors determine whether facilities are complying with federal and state standards.
One of the goals of these inspections is to ensure that each resident receives appropriate quality care. Inspectors also investigate complaints from residents, family members, ombudsmen or other third parties.
Unfortunately, some residents in bad nursing homes have been subjected to elder abuse. Such neglect could include withholding food, failing to administer medications or not providing access to health care.
Signs that a resident is being physically or emotionally abused include:
— Broken eyeglasses
— Disruption in the resident’s medication routine
— Unexplained bruising
— Thumb-sucking, mumbling or rocking
— Harsh treatment by a staff caregiver, which could include belittling or intimidating the resident
One of the biggest nursing home red flags is the prevalence of bedsores, wounds that manifest after prolonged time in bed — just like John experienced in our scenario. Nursing homes with inadequate or abusive staff often fail to reposition residents or perform proper hygiene. This leads to sores from continuous pressure on the area or from urine or feces irritating and damaging the skin barrier.
To research a facility, request a copy of the annual state survey and, if relevant, copies of complaint investigations. Complaints that led to investigations could be a red flag.
Gure adds that it can be helpful to learn about the facility’s background. You might have more peace of mind knowing they are associated with a reputable academic medical group.
7. Unresponsive residents
When touring a nursing home, if you notice there are a lot of residents out and about who are unresponsive, this could be a red flag. This can be a sign that the facility is resorting to antipsychotic medications, such as Haldol or Seroquel, as a way to curb behaviors that are challenging for staff to handle, especially in residents with dementia or Alzheimer’s disease.
Sometimes these medications may be necessary to prevent a resident from hurting themselves or to treat a genuine psychiatric condition. However, misusing these medications can limit resident communication and facilitate a decline in their physical and cognitive abilities.
When touring a nursing home, make sure to ask a member of the staff how they handle “difficult” residents and how psychiatric evaluations are used in their facility. You can also ask if they have policies and procedures in place for when residents become combative or aggressive to see how quickly they resort to physical or chemical restraints.
8. Unclean residential rooms
Small advises checking the cleanliness of resident rooms if you can. Issues with cleanliness and sanitation could also point toward a quality control issue or poor staffing. A nursing home doesn’t need to have exquisite interior design or break the bank, but it should be clean. Proper sanitation isn’t just about having tidy living quarters; it’s also about stopping the spread of germs and harmful bacteria.
Older adults have a weaker immune system, so they are more susceptible to infections, Small adds. Research also shows that a clean living environment may promote healing.
Signs of unclean rooms include:
— Trash cans that haven’t been emptied
— Food trays that are left in place long after meal time
— Beds that haven’t been made or linens that are soiled
— Clothes, shoes and other items strewn about on the floor
Nursing homes should take pride in having clean and tidy facilities that don’t smell unpleasant. A tour is usually when a nursing home puts its best foot forward to impress you. If you aren’t confident of a facility’s cleanliness on a tour, consider going elsewhere. Also note that their cleanliness could decline if staffing issues arise among the clinical staff or housekeeping department.
9. Poor and limited food quality
No one expects a nursing home cafeteria to offer a five-star menu, but it does need to provide healthy food that meets the nutritional needs of its older residents. Not only should the nursing home cater to residents’ likes and dislikes, it should also be able to provide meals to meet the needs of residents on special diets, such as:
— Lactose-intolerant diets
— Diets catered for residents to avoid individual food allergens, like tree nuts
— Meals for those with acid reflux who avoid trigger foods, like onions or garlic
Unappetizing food or meals that don’t follow dietary needs are a nursing home red flag. This could lead to a loved one not getting the proper nutrition and losing weight.
10. Disrespectful and evasive staff
You should feel comfortable talking to staff and having your questions or concerns addressed.
Questions you may need to ask include:
— Have there been any recent changes to my loved one’s care plan?
— Have you seen any growing signs of pain or discomfort in my family member?
— What does my loved one do to stay occupied when I’m not able to visit?
— Lately, I’ve been noticing this particular behavior in my family member. Do you have any concerns about that?
The care team at the nursing home — including therapists, health care providers, nurses and aides — should all be invested in the well-being of their residents.
A nursing home that cares will validate your questions and allow you to be a collaborator in the care of your family member. If they don’t, that is one of many possible nursing home red flags.
“If you find they are unwilling to answer questions or they behave rudely, consider going elsewhere,” Small says.
11. “No lift” policies
There is a new trend of nursing homes and senior care facilities employing “no lift” policies. This means when residents fall, the staff aren’t allowed to move them. The staff members call 911 to have emergency medical services do the moving and lifting.
The policy intends to prevent back injuries to staff and the liability of moving injured residents, but it is also “concerning,” says Vince Baiera, a San Diego-based nurse and post-acute care partner at Relias.
Baiera says this policy leads to problems like:
— Delay in care for fallen residents
— Overburdening local emergency services and transport staff
— Loss of trust between residents and their caregivers
Ask if the facility has:
— Fall prevention products, like bed alarms
— Training for staff to assist with moving and treating fallen residents
— A strict rounding schedule, so if a resident fell quietly and was unresponsive or unable to call for help, a staff member would encounter them quickly
— Equipment to help with difficult transfers, like Hoyer patient lifts. Equipment like this is expensive, which may be why facilities resort to EMS.
— Procedures to monitor vital signs of a resident post-fall
“No-lift policies reflect a troubling shift in senior living care, where risk management and liability concerns may be overtaking the core mission of providing compassionate and responsive care to residents,” Baiera adds.
Ask if the facility has a no-lift policy and how they respond to and prevent resident falls.
Watch out for these red flags in nursing homes:
— A high number of infections and deaths
— Long response times
— Short staffing
— High turnover among staff
— Limited socializing
— Complaints to state inspectors
— Unresponsive residents
— Unclean residential rooms
— Poor and limited food quality
— Disrespectful and evasive staff
— “No lift” policies
More from U.S. News
Nursing Home Statistics: What to Know in 2024
Nursing Home Costs and How to Pay
Nursing Homes vs. Assisted Living: What Are the Differences?
Nursing Home Red Flags You Should Watch Out For originally appeared on usnews.com
Update 09/12/24: This story was previously published at an earlier date and has been updated with new information.
