Assessment Tips
Visit with residents
You should find at least one resident that you can visit in the facility. This will help you in evaluating the facility without a guided tour. Walk up and down the halls and talk to bedridden residents and those who are wheelchair bound. As you talk to them, check out their grooming, skin quality, nail care and oral care. See if the residents appear upbeat or if they are depressed. If almost everyone you talk to is confused and unable to have a normal conversation, this could be cause for concern.
Avoid restricted access
Avoid facilities where your access is restricted, and you are directed only to residents who are willing to talk to you.
Smells
The halls, rooms, and residents should not smell of urine or feces. If they do, residents may not be changed frequently enough to avoid life-threatening illnesses such as urinary tract infections or bedsores (also referred to as decubitus ulcers or pressure ulcers).
Timing your visits
Visit the facility at different times of the day. Sometimes a facility can look adequate in the morning when the staffing level is usually at the highest. Visit also in the evenings or weekend afternoons. Nursing homes are usually staffed less on weekends or weekday evenings.
Visit during meal times
Observe
residents who are being fed and see how much time the aide spends with each
resident, and how much of the food is eaten. Check the residents in the dining
room and see how many of them appear to be thin when compared to a general
population of seniors. Be concerned if there appears to be more than a few thin
residents. Check on the residents who are fed in their beds. Are the trays
sitting in front of the residents without anyone assisting them? Are the aides
running from room to room trying to feed bedridden residents? Is the food cold?
If possible eat a meal yourself at the nursing home to judge it's quality.
Water
Are water pitchers filled with fresh ice water within reach of the residents in their rooms? Look to see if any of the aides offer water to those residents who cannot get it themselves.
Staffing issues
Ask about the level of staffing for each shift, morning, evening, and night. Ask how many nurses are on duty and how many certified nursing assistants (CNAs) are on duty. Compare that to the number of residents. Also note how many residents are bedridden or in wheelchairs who require total care in the daily activities such as toileting, grooming, drinking and eating. If there are a large number of these types of residents, the CNA ratio to residents should be smaller. Check your state licensure rules and regulations for staff to resident ratios for comparison.
State survey
Medicare
regulations require that the facility have the latest state survey of the
facility readily available for review at the facility. Read it and see if there
are concerns that deal with basic nursing care and basic medical care.
The following website lists the most recent federal survey results, populations
of the nursing home, and facts about the nursing home's ownership. It can be a
valuable resource when selecting a nursing home for your loved one.
Medicare's website for determining the facts for a nursing
home under the Medicare program
Talk with family members
Talk with other family members or friends who have relatives in the home. If they have experienced difficulties with the home, it is likely that you will have similar problems.
Virtual visitation, aka using "granny cams"
It
is often difficult for family members to visit a loved one in a nursing home as
often as they would like. One solution that is becoming more and more prevalent
is the use of web cams (so called "granny cams") to keep an eye on
and visit with loved ones over the Internet.
See the University of Illinois article
for more information.
Other tips
- There are several important steps in assessing a nursing home's suitability to take care of a loved family member:
- Meet the
administrator -- don't just listen to what the marketing director has to say
about the activities and facilities available for the residents.
- Determine
how frequently the Medical Director sees the residents (daily, weekly, monthly,
etc.)
- Meet the
Director of Nursing and find out the number of registered nurses and aides who
work each shift - especially at night when most problems occur.
- Visit the
nursing home during the evening hours and weekends - determine for yourself how
clean and how well staffed the facility is.
- Ask to
meet and talk with a current resident - find out from the resident about how
responsive the nursing staff is, quality of the food, etc.
- Talk with a resident's family.