By Dr. Kenneth Scott, DO, CMD, CEO
SilverSage Management Services
One of the most stressful—and many times painful—mile markers in life arrives when the decision is made to place a parent in a nursing home.
Some of the individual mental burden may be assuaged if the parent is alert and capable of making that decision independently. However, it’s still difficult for adult children not to feel a nagging sense of guilt even with an independent parent’s personal decision.
It’s not easy to shake off thoughts like, “Mom or Dad cared for me when I needed it, so why can’t I do the same in return?” Unfortunately, all too often, the responsibilities of one’s own family and the need for both parents to hold down a full-time job to maintain a family’s basic standard of living stand in the way of the most heartfelt desires to take on the full burden of an elderly parent’s needs.
Thankfully, there are certain burden-lightening steps one can take to calm the natural fear and apprehension faced in these situations. Most adult children are still involved in their parents’ supervision and want to ensure that they get the best care possible, even if they can’t provide the majority of it themselves. Getting involved in helping your parent choose the most favorable nursing home for them can go a long way toward relieving some of the anxiety associated with the move—for parents and children alike.
Statistics show that for someone turning 65 now, there is a 70 percent chance they will need some form of long care services in their lifetime. When it comes to specific reasons why families choose nursing homes for their loved one, a major factor, naturally, is the proximity of the location for the obvious reasons of being able to visit and keep tabs on family members. However, there can be a world of difference in the quality of nursing homes within a few miles’ radius of family and friends most likely to lend support.
Here are eight factors family members should take into consideration when choosing a nursing home.
Check a Nursing Home’s Five-Star Rating
Medicare publishes a five–star rating of each nursing home certified to take Medicare patients. Although any nursing home might be a good fit for your loved one, the chances of getting excellent care on a consistent basis are much better the higher a facility’s five-star rating is. Medicare rates over 15,000 nursing homes across the US based on things like quality measures, health inspections, and staffing.
I recommend families start here and seek out the four- or five-star facilities closest to them and make them a part of your research.
Pop in for a Tour
Buying a house—or making any big purchase or investment—sight unseen is generally not a good idea. By the same token, you shouldn’t place your loved one in a nursing home without giving it the once over yourself first. That’s why when it comes to visiting a nursing home for the first time, I’m a big fan of the pop-in. Families need to walk the halls and experience things the way they will most likely be on a daily basis.
Additionally, first impressions are usually valid. If you walk in, for example, and staff members that greet you at the front door are not friendly, there is a good chance that is the type of reception your loved one will frequently experience as well. For these reasons, I highly recommend an unannounced first visit.
Visit During Mealtime
Showing up at mealtime is also a wise move. It is harder to get a tour at that time because so many of the staff may be involved in assisting patients with meals, but having a chance to look at the food and its presentation can tell you a lot about whether your loved one will be happy and thrive or struggle to maintain their weight.
Speak with a Nursing Assistant
The life and blood of a good nursing home is the nursing staff, including the certified nursing assistants. These are the people who will have the most daily contact with your loved one and, as such, the most direct impact on their well-being.
Ask to speak to a nursing assistant and take note of their personality. First impressions are sometimes hard to decipher, but key personality traits to look for are approachability and a caring attitude. In fact, the more nurses you can talk to, the better an evaluation you can make. When you talk to one nurse, you get a feel for that nurse’s personality. But if you talk to more than one, you start to get a feel for the culture of the building.
Check on New Patient Protocols
A lot of nursing homes will actually have set protocols, such as if a new person comes in, where that person will go. It’s a reasonable thing to ask specifics about what floor or hallway your loved one would be placed on upon arrival and then try to visit with nurses in that area.
Also, with the potential transmission of COVID in nursing homes remaining a valid concern entering 2023, many incoming patients are often isolated or placed in a private room for five days or so to make sure they are not symptomatic and potentially spreading the virus. It’s advisable to not only ask about those in-house protocols but also speak with nurses in those areas since they will be the first ones to interact with new residents. That will offer a better feel for what your loved one is going to experience on their way in the door.
Ask to See a Facility’s Most Recent Survey Results
Nursing homes are required to make available their latest state and federal survey results. Looking over these results will help families understand the strengths and weaknesses of each given facility and help inform any direct questions or concerns you may have in placing your parent there.
If the legal jargon in the survey seems hard to understand, find someone in health care that can help you understand it all.
Verify Availability of Therapy Services
Family members should be up to speed on exactly what type of therapy services are available onsite. These include services for speech therapy, physical therapy, and occupational therapy. Some facilities may not have all three available.
Go in with a good understanding of what your loved one will need. If the facility doesn’t have the modalities of care that your family member requires, they may still accept the patient and then send them for outpatient treatment. That is a lot of extra time out of the patient’s day and can be exhausting without the gain of the exercise required to improve.
Ask If There’s a Full-Time Doctor on Staff
Perhaps the most important question to ask is whether a nursing home has a full-time doctor on staff. Be skeptical of the answer you receive, however.
Most facilities will say “yes” when they are actually referring to their medical director. It’s important to clarify whether the medical director is physically in the building every day or not. It’s an extremely important distinction: Most medical directors have outside practices and show up to their nursing home one or two days per week at the most. Other nursing homes, however, have full-time doctors onsite five days a week to better meet the needs of patients on a daily basis.
For example, if your loved one has a medical issue, how will it be handled? Is there a doctor there to address the concern rapidly, or does the nursing home have to call a doctor’s office and wait for a return call? How quickly small problems get handled is often the difference between whether or not a patient must return to the hospital or remain stable and improving in the nursing home.
Making the decision to place a parent or loved one in a nursing home is difficult all the way around. But informed family members asking these key questions and knowing how to better evaluate what individual facilities will offer their loved ones in terms of high-quality care will be much more confident in their ultimate decision.