How to Choose the Right Nursing Home

People are often forced to choose a skilled nursing facility to provide rehabilitation services when their family member is being discharged from the hospital within the next day or two.  With such a limited time frame, families rarely have the opportunity to go out into the community and choose a nursing home. Families and seniors have the right to choose which facility will provide their treatment, but they’re often not given adequate time to do so.   Nursing homes hire commission-based marketers whose job it is to meet with hospital discharge planners, doctors, patients and their families in order to admit as many patients to the nursing home as possible.  A patient with Medicare Part A and a good Medicare Supplement means a potential of 100 days of Physical, Occupational and Speech Therapies, providing the highest profits to the nursing home.  Marketers will promise just about anything, such as private rooms or special accommodations, in order to get the patient in the door.  Once they’re admitted into the facility it’s often a different story – they might not be able to provide the extra services they promised, but they’re counting on your not being upset enough to make things difficult for the patient by moving him to another nursing home.   The hospital discharge planners may refer you to their favorite nursing home, to one that recently brought them lunch, or to a nursing home with which the treating physician or hospital is affiliated – it has nothing to do with the quality of care the nursing home provides.  Unless you have a Medicare Advantage Plan, almost any nursing home is able to provide the care that your family member requires.   The best course of action is to start looking for a nursing home as soon as the senior is admitted into the hospital.  There have been a few extreme cases of patients remaining in the hospital for over a year because there wasn’t an acceptable nursing home in the immediate area – while I’m not suggesting that you follow this lead, you can delay the discharge a day or two while you locate a facility.   Once you choose a nursing home, ask them to evaluate your family member for possible admission.  If they’re able to meet the senior’s medical needs, you have the right to choose that facility and the hospital has to assist with the discharge.  Beware that the hospital might try to intimidate you into sending your family member to the facility of their choice – if this is the case, remember your rights.  Speak with the hospital administrator if you need to – and mentioning that you’ll have your attorney call never hurts.      When choosing a nursing home, there are many factors that should be considered.  If it appears that your family member will require long-term care, you should look at nursing homes that can provide this service.  Not all skilled nursing facilities provide long-term care; some will only serve patients in the first 20 days of the Medicare benefit while others only provide care for the first 100 days, after which the patient will be discharged to a long-term facility.  It’s more difficult to get a nursing home to accept your relative if they’ve already used up the Medicare benefit.   If your family member was sent to a nursing home that you don’t like, you have the right to have the patient transferred to another facility.  Once you locate a nursing home, ask them to evaluate your family member.  The nursing home where he’s currently located has to cooperate, and can’t drag their feet by telling you that the doctor refuses to discharge the patient.  They might delay the process a few days in order to get the paperwork in order, but if you encounter problems with a discharge let them know that you will contact the nursing home ombudsman – and follow through with that call.   There are many things to look for when choosing a nursing home; below is a printable checklist of recommended steps to take before selecting a nursing home.

• Call the nursing home and set up a tour – if possible, make the appointment for a mealtime so that you are able to observe whether the residents appear happy with the food and how the facility smells.
• If they say that they don’t have any beds available, this might be because they’re popular and provide excellent service – but it might also be due to their admissions being held by the Centers for Medicare & Medicaid Services (CMS).  Request additional information as to why they don’t have any beds, and ask if they’ll place your family member on a list for a future bed.
•  Is the nursing home located in an area where you’ll feel safe visiting after hours?
• Is there enough guest parking available? Is the area lighted at night?
• Are there activities posted in a public place?  Do the activities posted look interesting for an elderly person?
• Do they take patients on activity trips outside the facility?
• Does the facility have a wheelchair equipped van?  If not, how does the nursing home provide their transportation?
• Do staff members call patients by their names in a respectful manner?
• Do patients have personal items in their rooms, or does that appear to be discouraged by the management?
• How does the facility smell?  If it smells strongly of urine, there’s a problem.  But if it smells strongly of cleaners while you’re there, go back at a later time and see if it was an attempt to cover up unpleasant smells for your tour.
• Are the patients lined up in the hallways, looking bored?  Although residents tend to congregate around the nursing stations, if this is happening at all hours it’s possible the activity program is lacking.
• Does the staff appear to be disorganized, with paperwork everywhere?
• Are patient charts sitting open on the counters where they can be easily viewed by anyone?
• Are there medications sitting out unattended?  This is unsafe (at best).
• Are telephones answered in a reasonable amount of time, or are they ringing off the hook?
• Are there outside areas available for the patients, with enough shade?  Are these areas easily accessible to patients and family members?
• Are there smoking accommodations for residents?
• Is the facility well known in the community for having a high staff turnover?  If a facility can’t keep its staff, that’s an indication of problems.
• Look on the Medicare site (www.Medicare.gov) and review the information listed in Compare Nursing Homes under the Facilities & Doctors tab.
  • How does the overall rating of the nursing home compare to the other nursing homes in the area?
  • Review the most recent inspections – any Deficiency rated a Level of Harm #3 or above is serious.
  • Review the article “Understanding Inspection Reports” on this site for information as to how to interpret the reports.
• Call the state ombudsman and ask about the facility.  They might tell you if there are identified problems, but aren’t able to discuss ongoing investigations.
• Ask friends, neighbors, or anyone else if they’ve had any experiences with the nursing home; if one has had a bad experience that’s to be expected, but if several people have – consider another facility.
• Review the actual Inspection Report from the last state survey that is located in the nursing home.
• Use the Internet to help:
  • Search online for information about specific nursing homes.
  • Search information about the parent corporation of the facility if it’s a chain of nursing homes.  How do their other facilities rate?
  • Some states post annual survey results online under the Department of Health or on the Nursing Home Licensing page.
  • Search the administrator’s name.  Has that person been fined by his/her board of licensure for misconduct or improper dealings?

In addition to the items listed above, please refer to the page “Nursing Home Oversight Agencies” on this site for details as to how to interpret the annual inspections performed for each nursing home and group home.  Remember, not every nursing home is perfect; but you should choose the best option available in the community for your family member