Not all nursing homes are bad, but everyone’s heard at least one nursing home horror story.
You can search for a nursing home with eyes wide open, but amid bright online photos and pristine tours, how can you see the reality beneath the polish — and what you might really be signing your family member up for, possibly for decades?
Not all red flags are visible at first glance; they’re often hidden in plain sight. Read on to learn about the top nursing home red flags and key questions to help you spot them when choosing a nursing home.
1. Staffing and Workforce Issues
Staffing is often a top nursing home red flag, since the question of who will be caring for your family member is a high priority.
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Staffing shortages
Staffing issues continue to plague the industry, says Roxanne Sorensen, an aging life care specialist and owner of Elder Care Solutions of WNY in Buffalo, New York. This biggest culprit is often the challenge facilities face in offering competitive pay and retaining staff. The unfortunate aftermath is that families struggle with their loved ones having to wait hours for assistance sometimes.
“It is not uncommon to wait over an hour to use the bathroom,” Sorensen notes.
Nursing home red flags to consider:
— Does the facility have high staff turnover rates?
— How fast are their call light response times?
— Is there a lack of transparency with the facility staff-to-resident ratios?
Disrespectful staff
If you don’t feel comfortable talking to staff about addressing your questions, that is a nursing home red flag. Even more serious is when the disrespect becomes elder abuse, which happens to up to 10% of seniors ages 60 and above, many of whom reside in nursing homes, according to the National Center on Elder Abuse.
Nursing home red flags to consider:
— Does the facility lack a chain of command to report concerns you may have about your family member?
— Do residents show signs of abuse, like bedsores or broken eyeglasses?
— Does the staff lack the initiative or support to de-escalate when residents are frustrated?
“No-lift” policies
There is a new trend of nursing homes and senior care facilities employing no-lift policies, where nursing homes call 911 at the sight of a fallen resident, rather than having staff move or lift them.
“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,” says Vince Baiera, a San Diego-based nurse and post-acute care partner at Relias.
Nursing home red flags to consider:
— Are staff prohibited from assisting residents who have fallen?
— Does the facility lack fall prevention techniques, such as bed alarms and frequent rounding?
— Does the facility rely on calling 911 to get assistance with residents?
[READ: Best Exercises for Preventing Falls in Older Adults.]
2. Quality and Safety
A lack of quality and safety is a nursing home red flag, because even a small oversight can have lasting consequences.
Medication mismanagement
Medication management is a key service nursing homes provide to residents to help keep them healthy, but medication errors can be common. Although medication errors are almost always unintentional, as many as 1 in 4 residents may be a victim of some type of medication error, notes a systematic review in the Journal of the American Geriatrics Society.
Nursing home red flags to consider:
— Does the staff use antipsychotic medication in place of de-escalation and communication with combative residents?
— Do medication administration regimens fail to incorporate double-checks to ensure the right resident receives the right medication, dose, route, time and adequate documentation?
— Does the facility fail to notify family members of medication errors?
Infection control issues
You expect that a health care facility will care for your family member, not give them another illness. But, according to the Centers for Disease Control and Prevention, there are between 1 and 3 million infections in long-term care settings annually.
Nursing home red flags to consider:
— Is there a lack of sanitation supplies available, such as clean linens, wipes, masks, gloves and hand sanitizer?
— Are food trays remaining at bedside tables long after meal times?
— Does the facility smell unpleasant, such as smelling of bleach or cleaning supplies covering the smell?
— Do the staff fail to perform hand hygiene before entering every resident room, and after leaving every resident room?
[READ: Wandering and Elopement in Nursing Homes: What to Know]
3. Regulations and Transparency
A nursing home red flag is a lack of transparency around regulations, often a sign that standards are slipping behind the scenes.
Failed inspections and complaints
Nursing homes receive regular inspections from state agencies to make sure they are complying with laws and regulations. To see the name and contact information for your state agency, go to Medicare.gov. If you want to know how to find out if a nursing home has violations, you can see the most recent nursing home inspection with an explanation using Medicare’s Care Compare tool.
Nursing home red flags to consider:
— Are the staff unaware of when their last inspection was and when their next inspection is?
— Has the facility failed to make meaningful change since their last inspection?
— Is there a lack of protocol for handling formal quality complaints?
Hidden costs
Nursing home room costs can run between $8,000 to $10,000 a month, according to Genworth Financial’s 2023 Cost of Care Survey. The last thing you need are additional hidden fees.
Nursing home red flags to consider:
— Does it feel that the facility is not fully transparent about the facility’s fee structure and common add-ons?
— Are there frequent price increases outlined in your contract?
— Do they have bed-hold fees if your family member has to leave for a hospital stay or another reason?
[READ: Nursing Home Care: Where Does My Money Go?]
4. Resident Well-Being
Resident well-being isn’t just a nice amenity; it’s a necessity. Support and engagement can have a direct impact on the mental and physical health of older adults.
Lonely and isolated residents
If social activities aren’t a priority, that’s a nursing home red flag. According to the CDC, people who are more socially isolated have a 50% increased risk of developing dementia.
Nursing home red flags to consider:
— Are residents spending more time in their rooms than in common areas?
— Does the facility lack social programming and activities offerings?
— Does the facility suppress resident feedback, or do they have a resident committee so residents can get involved and share feedback on their living situation?
Poor food quality and lack of nutrition
Research shows that improper nutrition in older adults is associated with increase morbidity and mortality, as well as physical decline, such as increased difficulty with activities of daily living.
Nursing home red flags to consider:
— Does the dining room feel like a hospital cafeteria instead of a homey restaurant with appetizing food?
— Are meals stagnant, or are residents able to choose and customize their meals according to their diet and preferences?
— Are meals designed with cost as a priority or with nutrition and taste in mind?
Explore Top-Rated Nursing Homes With U.S. News & World Report
Amongst the nursing home red flags, there is some good news: “I have actually seen people improve in assisted living and nursing homes because they are getting the proper care needed for their medical needs,” Sorensen says. She suggests the best way to find the right nursing home fit is to start planning as soon possible for your loved one to enter the next phase as an older adult.
To find top-rated nursing homes near you, check out U.S. News & World Report’s Best Nursing Homes. In 2024, U.S. News evaluated more than 15,000 facilities throughout the country and rated most of them in two different areas, short-term rehabilitation and long-term care.
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Nursing Home Red Flags You Should Watch Out For originally appeared on usnews.com
