How to Find the Best Nursing Home

Even at a well-known, fully licensed nursing home, there is the possibility of abuse or neglect. That is why you need to make sure that a facility will provide your loved one with quality care.

Touring a facility is only the first step, because a scheduled visit is unlikely to reveal everything that is happening beneath the surface or when no one is visiting. Certainly, your goal is to assure quality care for your loved one, as well as peace of mind for your family. To accomplish this, it's helpful for you to take the following steps before selecting a nursing home:

• Talk with other residents at the nursing home that you are considering. You can simply walk the corridors of the facility, and speak with residents, including those who are bedridden.

• In addition, your own physical observations are extremely important. Do the residents appear well groomed? Do any of them have visible wounds or sores? How is their oral care? If you find several residents who seem confused and disoriented, you may be witnessing signs of neglect.

• Federal regulations require that all nursing homes have the latest state survey of the facility readily available for review. Ask the management for this survey, read it carefully, and ask questions. Be on the lookout for signs of any problems with basic care.

• Ask questions about the staff at the facility. What is the size of the staff during the different hours of the day and night? How many staff members are nurses? How many are nursing assistants? Are there social workers and clergy on the staff? Consider how the staffing of that facility compares to other nursing homes with a similar number of patients.

• Speak with the relatives of other residents at the facility. Have they observed any problems? Do they have any issues with the management or staff at the facility? You may wish to find out whether any of the residents' families use of web cameras (sometimes called "granny cams"). Although this cyber visitation is a new practice, some families who cannot visit their loved ones every day are placing special internet cameras in relatives' rooms to allow them to see what is happening at any time. If you see a "granny cam" at a facility, ask to speak with the family of that resident, to learn what they have observed. If possible, inquire if the facility would mind if you used this kind of device.

• When walking the halls of the facility, use your senses. One of the most effective methods of inspecting a facility may be your sense of smell. A nursing home should not smell of urine or feces. If it does smell, residents may not be receiving adequate toileting care. Often, this basic care is essential to preventing life-threatening illnesses, like urinary tract infections or bedsores.

• Watch as residents are being fed. Do many residents look underweight? How much of the food are they eating? Is staff helping residents who have problems feeding themselves? Do the aides who assist with the food seem overwhelmed? Are the aides spending enough time working with each resident during mealtime?

• If at all possible, visit the potential nursing home more than once and plan your visits at different times of the day and week. If you can only visit the nursing home once, go at night or on a weekend afternoon. Staff levels may be lowest during these "off" times.

• Is water easily available to all residents at the facility? If some residents are incapable of helping themselves to a drink, is staff offering assistance at regular intervals?

• When you attempt to look at the facility, are you deliberately steered to certain rooms or residents? If you feel that you are being denied full access to the facility, you should find out if there is a good reason.

• Ask to meet all of the key executive personnel at the facility. Speak with the administrative head, the medical staff administrator, and the nursing staff administrator. Ask how often physicians actually examine residents. Find out about the facility's staff turnover rate, including the average length of employment for nursing assistants and other primary caregivers.

Nursing Home Evaluation Checklist

You should be alert whenever you visit your loved one's nursing home. The following are questions to ask yourself during each visit:

• Do you notice signs that your loved one is suffering from dehydration (lack of water) or malnutrition (lack of food)?
• Have you noticed the resident is less active or less able to move about?
• Have you noticed emotional changes, mood swings, withdrawal, anxiety, or other fears?
• Are residents dressed appropriately for the season and time of day?
• Are the resident's living quarters clean?
• Are the resident's medical conditions being treated in a timely manner?
• Does the resident seem to suffer from chronic viruses and/or infections?
• Are all medications administered in a timely and appropriate fashion?
• Has the nursing home staff delayed reporting an injury or incident to a doctor or to the resident's family or guardian?
• Has the resident suffered frequent falls or broken bones?
• Does there seem to be adequate staff and supervision?
• Are the caregivers ignoring the resident or describing him or her as a burden?
• Does any caregiver react defensively to routine questions about the resident's care?

Nursing homes must provide good nutrition and hydration to residents. Poor diet and lack of water are among the most common forms of nursing home abuse and neglect. Some of the health problems associated with malnutrition and/or dehydration include:

• Increased risk of infections
• Confusion
• Muscle weakness (possible immobility and increased risk of falls)
• Pressure ulcers or bedsores
• Pneumonia
• Increased risk of becoming ill from exposure to bacteria or viruses

The Importance of Proper Nutrition and Hydration

Nursing homes should conduct regular nutritional assessments and provide residents with well-balanced, palatable meals. When you consider a nursing home for a loved one, you may wish to ask to sample a random meal at the facility. Also, ask to speak to the staff dietitian about the factors they use to develop meal plans for the facility. The following is a list of reasons why an individual may suffer from malnutrition and/or dehydration:

Personal causes of malnutrition:

• Illness
• Adverse drug effects such as nausea, vomiting, diarrhea, cognitive disturbances, or sleepiness
• Food and drug interactions that decrease the ability of the body to absorb vitamins and minerals
• Depression
• Swallowing disorders
• Mouth problems such as tooth loss, dentures that do not fit properly, mouth sores, and mouth pain
• Tremors or shakiness, which affect residents' ability to feed themselves

Environmental causes of malnutrition:

• Inadequate staff attention for residents who need help to eat
• Staff who lack training about malnutrition and the proper ways to feed residents who need help
• Reliance on liquid supplements
• Special diets

Signs that a resident is malnourished:

• Clothes fitting more loosely than usual
• Cracks around the mouth
• Pale looking lips or mouth
• Dentures that no longer fit
• Hair thinning or getting sparser
• Wounds that take longer to heal
• Confusion (which is unusual for that individual)
• Skin breaking down
• Sunken eyes
• Weight loss

The following questions may help you pinpoint the reason for a particular person's problems with nutrition or hydration:

• Can the resident feed him/herself?
• What is the resident's favorite meal of the day
• When and where does the resident prefer to have meals serve
• Does it take a long time for the resident to eat?
• Is the resident rushed through meals?
• Is the resident unable to finish meals?
• Does the resident seem to eat more when someone is there to help with the meal?
• Does the resident seem uninterested in food?
• Has the resident lost his/her appetite?
• Does the resident like the food at the facility?
• Can the resident choose from a menu?
• Are snacks readily available to the resident?
• Is the resident on a special diet?
• Has the resident started taking any new medications?
• Is the resident's weight monitored on a regular basis?
• Has the staff informed family members of weight loss?
• Has staff asked family members for assistance?