Researching and touring nursing homes for your elderly loved one can be an overwhelming process. It takes time, research beforehand, and some type of knowledge or guidance to make each tour and your ultimate decision a successful one. This is one of the most important decisions you will make regarding your aging loved one’s care so it’s important to be fully prepared.
To help you along in your journey we have compiled a nursing home checklist to give you some direction and things to look for while touring.
First Things First
Is there a bed or room available?
Is the nursing home Medicare and/or Medicaid certified?
Are there different levels of care offered? Memory care, rehab services, etc.?
Is the nursing home located within easy distance of family?
Are there a licensed nursing staff available 24 hours a day, including a Registered Nurse (RN) present at least 8 hours per day, 7 days a week? (Law requires these regulations)
Is the nursing home clean, well organized, and free of overwhelming odors?
Is the noise level, lighting, furniture, and temperature pleasant and comfortable? (What is the general ambiance?)
Are the common areas (dining room, living room, recreational rooms, and outside grounds) clean, useful, and enjoyable?
Do the residents appear clean, well-groomed, dressed, and content?
What type of background checks are done on the staff members?
Does the relationship between the staff and residents seem to be friendly, healthy, and pleasant?
Has there been a high turnover rate of caregivers and/or administration? (If so, this can indicate a problem with the working conditions and daily operations.)
Do the staff members appear happy, friendly, compassionate, and do they engage with the residents? Do they know the residents by name?
Is there a social services member or liaison on staff?
What is the protocol if there is a medical emergency? Will the staff contact the resident’s doctor?
Are exits clearly marked and is there a clear evacuation plan?
Are there working smoke detectors and fire sprinklers?
Are there hand and grab rails along hallways and inside rooms and bathrooms?
Is the facility designed for wheelchair use?
Are care plan meetings scheduled with staff and family members regularly?
Are there windows in the rooms?
Can residents bring some of their own personal belongings into the room?
Does each resident have a phone and television?
Is there personal storage space for each resident and is there a lock to protect personal belongings?
If sharing a room, do the residents have a choice of roommates?
Is there a menu available for you to look at?
Are you able to sample a meal while you tour?
Is the kitchen able to honor special requests and allergies? (low salt, low fat, or liquid diets)
Are staff members available to help residents eat if needed?
Are healthy snacks available outside of scheduled meal times?
Do residents have a choice in participating in social activities?
Is there an outdoor space for residents to enjoy?
Is there a social or activity calendar for you to look at?
Are there activities for residents who are unable to leave their rooms or beds?
Is transportation available for outings and shopping?
Are there religious services available in-house?
This checklist is just a guideline and you should add any other questions you may have. It is also a good idea to visit the nursing home again at a different time of day than when you first toured. If you can, plan to attend a resident or family council meeting. You will gather very valuable information from other residents’ family members as well as have the opportunity to ask any other questions you may have.
Choosing the right nursing home for your loved one is not an easy task. If you need help please feel free to reach out to our senior care coordinators who are more than willing to walk alongside you at no cost to you. For more information on how to choose the best nursing home visit us here.
Many adults in America are currently providing full or part-time care for their elderly parents, and that is as it should be. We are serving the generation who served us. However, there may come a time when you are no longer physically, emotionally, mentally, or financially able to provide all of the care your aging parent(s) need. Some adults are still raising their own children while Mom or Dad also require their daily support, and others cannot financially survive and quit their job to provide adequate care for their aging loved one. So how do you know if it’s the right time to move Mom or Dad into a nursing home?
It’s important to note that nursing homes are generally for seniors who need daily medical treatment and support with activities of daily living. It is different from assisted living or retirement communities in that the patients are typically unable to provide basic care (eating, grooming, moving, pain management, etc.) for themselves and therefore require the daily support that trained professionals can supply.
The decision is not an easy one and the process can be overwhelming, so if you have family who can help weigh in then it’s a good idea to bring everyone together for a family meeting. Some families choose to include their elderly parents in the decision-making process, and some do not, but either way, it’s important to break the news from a place of love, compassion, and understanding.
Here are a few signs that it may be time to start researching and thinking about moving your parents into a place that can best serve their changing needs.
When an aging adult is involved in a life-altering injury such as a fall or car accident, you may very well be forced into making a quick decision about placing them in a nursing home. It may seem far-fetched, but falls and the complications that typically follow are the leading cause of death in adults aged 65 and older.
Remember that nursing homes can be a transitional housing solution for seniors recovering from a surgery or illness; it is not always a permanent placement.
Oftentimes family members alone are not able to provide the medical care and treatment that comes with recovery for an elderly family member, and if it’s too expensive or not possible to bring a skilled caregiver to the home then placed in a nursing home can be the most viable solution. When the patient has recovered enough to feed, move, and bathe themselves then they can be moved to a physical therapy unit or even return home.
Ongoing Illness or Disease
Cancer, Alzheimer’s Disease, heart failure, diabetes, Parkinson’s, and a host of other illnesses all play a large part in the health issues of the aging population. Some of these diseases can be managed for years before they take away a person’s ability to care for themselves, but when that happens it may be time to consider placement in a nursing home.
Late stage cognitive decline diseases like dementia and Alzheimer’s can take away a person’s ability to think rationally or remember to perform common daily tasks like eating and bathing. They may be physically able to do those things but have no will or desire to. Other diseases completely debilitate a person so that they are unable to physically perform activities of daily living (ADLs), even though their minds and reasoning skills are still sharp. In either situation, it may be necessary to place your aging loved one in a nursing home that can meet all of their needs.
End of Life Care
If a doctor has determined that a person has less than six months to live (usually because of a disease or illness) they can be placed on hospice, which is a medical term that enables the patient and the family to have access to a host of support benefits and treatments from professionals, and it’s often all or mostly covered by Medicare and other programs. Oftentimes this can take place in the hospital or home of the patient, but sometimes it happens in nursing homes. Typically there is round the clock care (or very near that) by medical staff to help with pain management, feeding, grooming, and the general comfort of the patient. It is meant to improve the quality of the last months of a person’s life, while also giving support to the grieving and exhausted family members.
Nursing homes in America are notorious for being understaffed, meaning the patient to employee ratio is higher than is legally allowed by the federal government. This presents a number of safety and health problems to the residents and also places a heavier workload on the existing employees.
With just under 1.4 million patients staying in a nursing home and skilled nursing facilities this is a huge issue that is affecting a large part of the elderly population. It’s speculated that most of the problems in nursing homes could be prevented by having enough properly trained staff available all throughout the day.
Nursing Home Rating System
A study done in 2018 by Kaiser Health News on Medicare daily staff payroll records found that nursing homes had fewer staff on their payroll than they were reporting to the government. This has essentially poked holes in the government’s nursing home star rating system, and now Medicare is using the payroll information to shed further light on actual nursing home ratings.
Click here to read about Medicare’s Five-Star Quality Rating system and what it means for you.
So what exactly are nursing home regulations and who is in charge of enforcing them? The short answer is that if a nursing home wants to receive federal funding from Medicare and Medicaid they must pass a series of inspections and surveys and meet certain health and safety requirements, although these are enforced by each state and each state’s standards vary.
According to several laws, regulations, and federal acts the following criteria are the minimum requirements for nursing home standards, and while these all sound wonderful you will notice that most are ambiguous and leave a lot of wiggle room. Nursing homes must:
Prevent and treat bedsores
Maintain an appropriate staff-to-patient ratio
Maintain accurate and detailed medical records, as well as prescription drug and medication adherence
Adequately clean, bathe, and groom residents
Ensure proper eating, nutritional, and dietary habits, as well as maintaining adequate hydration
Maintain and support a better quality of life, protecting patient dignity with respect
Ensure proper vision and hearing practices and treatments
By being available and properly staffed, prevent avoidable accidents and hospital visits
Ensure freedom of choice in activities and schedules
Prevent the deterioration of a patient’s ability to perform activities of daily living (ADLs)
To find your state’s specific regulations click here.
How To Report Poor Safety Conditions
What should you do if you notice or suspect abuse or less-than-stellar conditions in a nursing home? Your first step should be to talk to the administrative staff, family council, and social worker. The ideal outcome is resolving the issues at the management level, but if you fail to see changes or you suspect repeated infractions and especially abuse, then report it to your state regulator. (For California you can find it here).
What is a family council? For more information click here.
The best way to ensure proper nursing home practices is to visit as often as possible, develop good relationships with the staff, and visit at different times of the day. You will be more likely to notice if something is off or patients are being neglected if you are aware of what the standards should be.
For more information on how to find the best nursing home for your aging loved one visit us here.
For most families, it can be a difficult time to realize your aging loved one needs to be cared for in a nursing home. Perhaps they have succumbed to an injury or illness and their level of medical care has surpassed what you or other family members are able to give them. So you have done your research on nursing homes and you’ve come to the point where you are ready to start touring to determine which community will be the best fit for the senior in your life.
For information on how to find the best nursing home for your aging loved one click here.
Here is a list of questions to guide you as meet with different staff members and tour the communities:
How is the pricing tiered: all inclusive or per service?
When are payments due: every week, biweekly, or monthly?
Is there a deposit and if so how much is it?
Is there a cost if the resident needs to move their level of care? (For example, nursing home to memory care, long term care, or adding more hours to the care that’s already in place.)
Do you accept any form of Medicare, Medicaid, or other government subsidiaries?
What are the staffing ratios? (The federal government sets minimum standards for staff-to-patient ratios that are generally thought to be inadequate, but each state can regulate stricter standards. For a helpful tool to research communities in your area click here.
What is the staff turnover? If it’s high then ask why that might be.
How much time each day do caregivers and aides spend with their residents?
Nursing and Medical Staff
How many nurses are on staff and how much time do they spend with each resident?
What is this facility’s opinion on the use of mood-altering medication? Sometimes residents that are angry, combative, and difficult have been ‘calmed down’ by the use of drugs. Make sure to have a clear conversation about this issue.
How do you prevent bedsores? Most nursing home residents are bedridden or have severe physical limitations, so this question is important.
What is the cleaning schedule and process? Infection can mean something very serious for elderly patients, so keeping healthy hygiene practices is essential.
How do you deal with medical emergencies?
How do you enforce medication adherence?
Do you enjoy working here? What are some pros? What are some cons?
Kitchen and Dining Staff
(Make sure to eat a meal at every community that you tour. If they will allow it, ask to take a peek in the kitchens.)
Can I see a weekly menu?
How do you address food allergies and restrictions? Some residents can be on a liquid or soft food diet.
Are meals served buffet style or with servers? Is there room service?
Do residents have to eat at the same time or is there a window? (For example, lunch is served from 10:30-1.)
What happens if a resident misses a meal?
Are visiting family members allowed to join in on meals?
Do you enjoy living here?
What is something you wish was done differently?
How does the staff treat you and the other residents?
How often do staff members check on you and spend time with you?
When you ask for something how long do you usually have to wait?
Are you able to go where you want when you want? If you want to skip an event are you allowed?
Activity Directors and Aides
(Ask to see a monthly activity calendar)
What outdoor activities do you offer?
What type of hobby classes do you offer? (Music, gardening, art, etc.)
Do you offer game or movie nights? How do you keep the residents engaged?
Is there transportation available to the store or other outings? (Some nursing home residents are unable to leave the community for health reasons or physical restrictions.)
If they are physically able, how do you keep residents moving? Exercise classes? Walks outside or around the community?
You should add any personal or specific questions to this list, but starting here will give you a good idea if a community is the right fit for your aging loved one’s specific needs.
Having a senior care coordinator come along with you on tours is a good idea, as they may have questions you didn’t think to ask or they may already have a good relationship with the facility. Senior care coordinators usually know the best communities to tour, and more importantly, the ones to steer clear of. Reach out to a senior care coordinator today and let them help you find the best nursing home for your family.
Coming to the realization that your aging loved one needs to be placed in a nursing home can be difficult and feel overwhelming. Perhaps they have had an injury or illness they cannot recover from, or their recovery is slow and something you are not able to medically or physically assist them in. You are putting their complete care into the hands of someone else, and it is natural that you want to make sure all of their physical and mental needs are being met.
Some nursing homes can be located within residential neighborhoods (also called board and care homes), but most are special communities designed to meet the ever-changing needs of the seniors who live there. Essential amenities of a nursing home should include:
Three hot meals a day.
Medically trained staff to assist with medications, wound care, and recognizing and addressing medical emergencies.
Occupational therapists to help with grooming, personal care, and moving patients from place to place.
Social events such as music, games, outside activities, and more.
Record keeping of medical history, doctor’s appointments, and medication adherence.
Security in the form of cameras, guards, and/or locked main doors (to prevent wandering).
A safe and healthy patient-to-staff ratio.
Nursing homes come in all shapes and sizes so it is imperative that you do your homework in order to find the right one. When searching for a nursing home it is important to tour several different communities, research reviews online, know your specific needs, and come prepared with a list of questions.
A Care Coordinator
If you are using a senior care coordinator or placement service they will be able to help facilitate the entire process, giving you confidence that your choice will be the best one for your specific situation. A senior care coordinator has knowledge of the industry, relationships with the right communities, and experience in helping families provide care for their aging loved ones. They can help you manage your budget, be another person who ‘checks in’ on the patient, and they have a healthy outside perspective of a situation that you are most likely emotionally involved in.
Identify Your Needs
This is a monumental step in choosing the right nursing home for your loved one. If you walk into a community not knowing exactly what you need, you may walk out with a signed contract and paying for services that you don’t need or want. Here are some topics to consider:
What are the medical needs?
What does your budget allow?
How is this care is paid for and can we sustain long term?
Do you need a private room or can you share?
Do you need transportation services?
Where does the community need to be located? (Just like in real estate, location determines the price.)
Will your loved one need to transition in and out of different levels of care? (For example, they may only need a nursing home for a few months while they recover from an injury, or they may need to move to a more secure memory care facility in late stages of Alzheimer’s Disease.)
Of course, there are many more details to consider when searching for the best nursing home, but these will hopefully get you started in the right direction.
If you are using a senior care coordinator then they will do most if not all of the heavy lifting for you as you search for the best nursing home. If you are on your own, then it’s important that you take the time to research communities both online and in person. With the wonderful age of the internet, you can see reviews and ratings for almost any business in your area. When setting up appointments to tour nursing homes consider the following practices:
Choose at least three nursing homes and visit at different times of the day.
Request to eat a meal at each one. This is a normal part of the touring process and should be easily accommodated.
Ask to see any other wings (memory care, hospice care, etc.) You may need to move your aging loved one into one of these in the future.
Ask the employees how they enjoy working there. Ask them and the management staff about the employee to patient ratios.
Even after you decide on a place, make sure to visit often and drop in at different times of the day and during different events. It is important to see that all parts of the community are working well at all points. Elder abuse is a real and unfortunate part of our world, and studies show that as many as 1 in 10 seniors has suffered some form of it. By researching, asking questions, and visiting often you can help prevent elder abuse.
To learn more about elder abuse, recognize the signs, and what to do if you suspect it clicks here for resources from your state.
Finding the best nursing home for your aging loved one may seem overwhelming, but it doesn’t have to be. Senior care coordinators are available to help you and your family find exactly what you’re looking for. The aging process can be a difficult one, so make sure to reach out and find the support your family needs.
Your aging loved one needs daily medical care for the foreseeable future but is it beyond what you are able to provide for them? You may have looked into several senior care options and found that a nursing home is the right solution for your circumstance, but now you have to figure out how to pay for it.
It’s no secret that health care for seniors is expensive, in fact, in the United States the average daily cost for staying in a nursing home is $235. For a two week-stay that’s $3,290, which is more than most people’s monthly rent or mortgage payment. Here are some programs and options that can help you figure out how to best utilize your funds in order to get the care your aging loved one needs.
This is the federal government’s health care plan for adults 65 and older, but when it comes to covering the cost of a nursing home it can get a little tricky. Medicare will only cover the medical costs of a senior who is in a nursing home because of an illness or injury (surgery, a fall, a curable sickness), and not because of a long standing condition or diagnosis (dementia, Alzheimer’s). Medicare coverage is as follows:
100% of nursing home costs for the first twenty days
80% of the cost for the following eighty days
0% of the cost after one hundred days
The only exception is if the medical condition is psychiatric in nature, then Medicare will cover up to 190 days.
Some states offer this program as a supplement to Medicare and Medicaid, but it primarily supports seniors still living at home. PACE will sometimes help to cover the cost of a senior staying in a nursing home if it is no longer safe for them to stay in their own home, although it is more likely they would be moved to an assisted living facility. Click here to see if your state offers a PACE program.
Medicaid is one of the best solutions if you are looking for long term health care in a nursing home facility. This program is run differently in every state but is only for those families who are deemed to have low income. The financial guidelines are strict, and if approved the aging adult must stay in a Medicaid approved nursing home. There are, however, exceptions to these rules. Because of the confusing and involved nature of Medicaid, visit here to see if your loved one would qualify or if you would like more information.
4. VA Benefits
The Aid and Attendance Benefit is for veterans who served in war-time and/or those whose income is limited, and assets and finances are taken into account when applying.
The other option for veterans and their spouses is placement in a VA nursing home, although there are a few drawbacks. Each state and each nursing home have different financial and medical requirements, so while you may qualify for one VA nursing home, you may not qualify for another right down the street. There are typically waiting lists for VA nursing homes, as most have a limited number of spaces for long term care.
Note: A person cannot receive both Aid and Attendance and care in a VA nursing home at the same time.
5. Private Funds
Most people use a combination of one of the previously mentioned methods and private funds to pay for care in a nursing home. Some privately funded options are:
Reverse Mortgage. This option can only work if the spouse of the senior needing nursing home care continues to live at home, as it is essentially taking a loan from the current value of the home. Both adults need to be at least 62 years old. To find out if this option is right for you, click here.
Moving. This may seem obvious, but relocating your aging loved one to a more cost-effective area can have a big impact on the monthly payment. Just like real estate prices are driven largely by location, the same is true of nursing homes, so research other regional areas you are comfortable with to see if the price is any better.
Long term insurance. This varies by state and typically has very expensive monthly premiums. Adults with significant medical issues and aged 65 and older may not even qualify.
Income from existing property. Selling a home or renting it out can be another way to generate some monthly income to offset the costs of nursing home care. This is, of course, most beneficial when the home is owned outright or very little is still owed on the mortgage.
Paying for nursing home care can be overwhelming and may even seem impossible. With senior housing and health care in an almost crisis in America, every year there are new and improved programs and assisted living options being made available. Reach out to a senior care coordinator to help you weigh all your options, as they have experience and knowledge that can make this road an easier one for you and your family to travel.