Caregiver to Caregiver

One of the questions I am asked most frequently is, “How do I choose a nursing home?”

This is probably one of the most difficult decisions any of us will have to make. There are so many aspects to consider. Although I have never had to make this choice, I have worked in two long-term care facilities as a charge nurse, and I have visited many, many others. It doesn’t take long to recognize the good, the bad and the ugly.

My first suggestion is to visit the facility – unannounced. Security has tightened up in recent years, but you should be able to visit most facilities without making an appointment. You will receive a much more realistic impression by dropping in and looking around. Introduce yourself, be prepared to show a photo ID (just in case), and explain that you may be needing to choose a facility for a loved one (I would not be too specific) in the future and would like to have the opportunity to check out what they have to offer. If you are refused, then this is probably not a facility you would want to utilize. If you do make an appointment, expect to be given a grand tour that showcases the best features; remember that nursing homes are businesses that are trying to sell you a service.

You can start your unguided tour by making this quick “sense assessment”:

• Sight: Are the surroundings attractive, clean and well kept? Do staff members look and act professionally? Do residents appear comfortable and well groomed? This might sound petty, but to me, an efficient way to surmise the quality of care your loved one will receive is by checking out the fingernails on the nursing assistants (and nurses). All facilities have rules that prohibit long or fake nails. If this isn’t enforced, chances are other guidelines are not followed as well.
• Hearing: Listen. What sounds do you here? Multiple too-loud televisions, residents calling out, uproarious or inappropriate laughter from staff or other unpleasant noises? Is there at least a modicum of peace and quiet? Could you rest well in this setting?
• Smell: Inhale…deeply (if you dare). This will be the fragrance of “home” for your loved one. The odor of feces, urine, and stale smoke are telltale signs that management is not managing well.
• Taste: Ask if you can purchase a meal in the dining room. If your loved one will be on a special diet (low-sodium, no added sweets, puree etc.) ask for that type meal. If this request is declined, at least try to observe what the residents are eating. There is a world of difference in the quality of food in facilities. Unless you want to be “taking in” food every day, make sure the meals will be satisfying to your loved one.
• Touch: How would you describe the overall ambience? Pleasant or uninviting? Too cold or too hot or just right? Is there an appealing and easily accessible outdoor space for fresh air and sunshine? Make sure you ask if this space is smoke-free.

If the opportunity presents itself, I would encourage you to strike up a conversation with a resident or family member. Those who already have loved ones in the facility are a good source to answer your questions.

Do not rule out a facility based on looks alone. (Of course you want it to be clean and well maintained.) Some older or not-quite-so-elegant homes make up for it by hiring only the best staff. It is not the fancy furnishings that are going to make this a first-rate place, but the people who work there.

If the facility passes the sense assessment with flying colors, then it is time to schedule an appointment and talk to someone in admissions.

Before making a final decision, research state agencies that provide information about how well facilities meet requirements.