Choosing a nursing home for your loved one is a difficult decision. It can often leave decision-makers filled with mixed emotions and overwhelmed by the complexities of the enrollment process. Whether you are just beginning your research or have been considering a move for your loved one over a period of months, touring multiple local nursing homes and speaking with long-term care admissions professionals can be a helpful part of the search process. And, if you are not sure if your loved one is ready for skilled nursing care, this Questions to Ask When Selecting A Nursing Home Checklist may be a helpful place to start.
According to experts, online research and comparative ratings can provide useful data to inform your long-term care search process. However, the value that comes from experiencing the environment, meeting the staff, and observing “care in action” goes well beyond the numbers.
Plan to schedule appointments with admission representatives, including a full facility tour, at a minimum of three skilled care nursing facilities. Prepare a list of questions in advance to ensure that you collect the information you need for an informed decision and so you are making equitable comparisons between long-term care providers. If possible, bring other family members or a friend with you on your visit in order to gain diverse perspectives.
On the day of the tour, keep your eyes and ears open and trust your instincts. Look for observable signs that of all the places you visited, the long-term care facility you select as your first choice, feels like “home” for your loved one and your family.
Here are 5 things you will want to look for on the tour.
Being able to freely connect with your loved one’s care team both in person when you visit or by email and phone call with any questions that may come up along the way, is very important. When you visit a nursing home under consideration, take note of the number of staff members you see along the way and what activities are they engaged in. The facility skilled care administrator and director of nursing should be accessible and open to questions as well. Your confidence in the quality level of the senior services being provided is highly correlated to the relationships and open communication you establish with those caring for your loved one.
On the data side, ask for staff turnover rates, but also dig deeper to understand the number of staff members with longevity and the positions that they hold. A quality nursing home will have high staff satisfaction and many staff members that have been there for years.
“Resident-driven” and “elder-centered” are terms commonly used by providers throughout the senior services industry. You can best ensure that their descriptions are accurate by asking questions about a “typical day,” including dining options, personal hygiene choices, and availability of activities both within and outside the resident main living areas. You know your loved one best and whether or not he or she likes to read or watch television alone, or connect with others and join the fun. The nursing home’s event schedule and available amenities should align with your loved one’s interests.
Activities should also not just be limited to indoors. Understanding a nursing home’s options for recreational activities offsite and the opportunities your loved one will have for getting outdoors, including spending time in safe natural green spaces is an important part of the value judgement.
There is often a great sense of loss in the transition from independent living to skilled care. Providing your loved one with as many choices as possible in their new home, while maintaining safety, should be the goal of the care team supporting your family.
You can learn a great deal from observing the interactions between residents and staff members when you tour a long-term care facility. Listen to the conversations–Do they know residents’ names? Do they respond promptly? Is there mutual respect between fellow staff members and between residents and staff?
What do you experience as you take a tour? The first interactions you have from the time you walk into a skilled nursing facility are significant indicators of culture. Does every staff person you meet from the parking lot to the residential floors greet you with a smile and say “hello?” What values are upheld in the organization’s mission and vision statements? Do the words ring true in the actions you witness?
For more information, ask the long-term care provider for its policies concerning elder rights.
Alignment between your family values with respect to medical care and the skilled nursing facility’s philosophy of service is critical. How do they approach end-of-life planning? What best practices are followed by the medical director and director of nursing with respect to psychotropic medications and pain management? Does the facility provide its direct care staff with specialized training in dementia care services?
Senior services is an ever-evolving landscape with innovations coming into care in the areas of technology, physical environment (e.g., small homes model, inter generation residences), therapies, and more. Understanding if your tolerance for “being on the cutting edge” aligns with your loved one’s care provider, ensures your family’s confidence in and partnership with the care team.
From the manicured grounds to the cleanliness of the visitor bathrooms, the details matter when it comes to evaluating a nursing home. You are choosing your loved one’s next home and how the skilled care facility presents itself is an important indication of behind-the-scenes operations. Offensive odors, stained carpets, and broken furniture across the facility should be of concern.
Open your ears as well during your tour to make a full assessment of the environment. For loved ones with dementia, agitation and challenging behaviors can increase in environments that are chaotic, loud, and disruptive.
You will also want to observe the layout of the facility, the amount of resident space, and the location (distance from your loved one’s residence) of popular amenities like the gift shop, the salon, etc.
Following your long-term care facility visits, take time to process all you have learned. Look back at your notes and do not hesitate to follow up with the skilled care admissions professionals with any questions. It is a major decision to place a loved one in a skilled nursing home. Having the confidence that comes from doing your research, examining all of the options, and having trusted professionals support you along the way, will ensure a positive outcome for your loved one and your family.