SPECIAL REPORT: Ten things to consider in nursing-home care

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Nursing home care: Interview with Sarah Wells

Wells talks about nursing home care.

Nursing home care: Interview with Gerald Kasunic

Kasunic talks about nursing home care.

Ten things to consider in nursing-home care:

1. What does the patient need? Getting a clear diagnosis and outlook from health-care providers, social workers and discharge planners gives a better picture of what sort of nursing home is needed, or if such care is needed at all. There may be options including home- or community-based care or other institutions rather than a nursing facility.

2. Start close to home. The closer a nursing facility is to family and friends, the easier it is to visit. Nursing facility staff notices who gets frequent visits and care may be given accordingly. Use the Nursing Home Compare Web site, (www.medicare.gov/NHCompare) or referral lists from state or local ombudsmen or aging agencies as a starting point in a search.

3. Study the ratings. Read up on deficiencies found during inspections, keeping in mind that Nursing Home Compare only includes information on complaints that have been confirmed. More information about complaints may be available from state survey and inspection agencies. Remember, different quality standards are used for short-term and long-term nursing-home care.

4. Meet the administrator. Don’t make an appointment if you can come in during business hours. There should be someone available to give you a tour and answer questions. This is the time to ask about care planning, specialized services, safety systems, policies and costs. Find out about volunteer programs and whether the home has a family council and how to contact that group.

5. Visit at a different time. If one visit was around a mealtime, make another at a time when staff may be less busy. Early evenings, weekends or just before a shift change time may be particularly revealing.

6. Check out a bathroom. Any restroom in a public area will tell a lot about cleaning, but also check for hot water — which is often lacking in larger homes. Look for signs of disrepair — water stains, mold, insects, peeling paint. Use sight, hearing, taste, smell and touch to measure the environment.

7. Staff helpfulness. From greeting visitors to answering call bells, does the staff respond promptly and cheerfully? Does the staff treat residents with patience and respect? Does the same nursing assistant provide care to a patient most of the time during each shift? How staff talks, or doesn’t talk, with patients can matter a lot.

8. Do a kitchen inspection. Many homes will invite you to have a meal -- and the food should be tasty, balanced and varied. The really good ones will give you a look at where food is prepared and stored. Ask whether there is a licensed dietitian on staff and if there are special files or lists of residents’ food allergies and particular dislikes.

9. Notice where people are. Clusters of residents engaged in games, activities, exercise and excursions outside are good. Groups lingering around nursing stations or camped around a television set in a day area aren’t so good. Take a dignity check -- are a lot of patients being restrained or propped up? Are they being dressed or toileted with doors left open?

10. Ask questions. You should be free to find out how things are from residents, their families and staff. Who handles problems or complaints? Are they responsive? Try to get a feel for how long key caregivers have been working there. If more than 25 percent are recent hires, worry about turnover and training.

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Sources: AARP; District of Columbia Long Term Care Ombudsman, NCCNHR (formerly National Citizens’ Coalition for Nursing Home Reform), Medicare.

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