Nursing Homes -- Comparing for Aging Parents

Nursing Homes -- How to Compare

How Nursing Homes Help Your Aging Parent

Main Reasons For Taking an Aging Parent to a Nursing Home

Finding a Nursing Home for Your Aging Parent

Types of Nursing Homes

Shop Among Nursing Homes

Judging a Good Nursing Home

The Reconnaissance Tour of a Nursing Home

The Secret Nursing Home Inspection Report

Making Your Aging Parent Comfortable in a Nursing Home

Visit Your Aging Parent Frequently

(Excerpted from the book Helping Your Aging Parent)

How can we compare one nursing home to another? Are there real and tangible differences in the quality of care at different homes? The burden of finding a good nursing home for our aging parents usually falls on our knowledge or ability to judge a nursing home from it's appearance in a quick visit. Or we may have a recommendation from a friend or professional. Here is some information to help you compare nursing homes and the quality of care that they offer.

Nursing homes aren't always pleasant places to visit. They can conjure up unhappy images of awkward visits to some ailing older person tied in a wheel chair muttering incoherent words, or howling like some rare type of monkey. But, according to surveys from actual nursing home residents, those images exist mostly in our minds as visitors to a nursing home. Many older people actually enjoy their stay in these homes. This may be because of the attention they receive while at the home, or maybe because they find companionship with others their own age and in the same predicament.

More than 40% of people over age 65 will stay in a nursing home at some time in their life. For some it will be an extended stay, and for others it will be just a temporary stay while recuperating from trauma or an operation.

My mom was referred to a home straight from a hospital. Since my sister and I were ignorant about which home to send her to, the hospital made the choice for us. Looking back, I don't think that it was the best choice. The nursing staff didn't speak English well and conversed to each other in a foreign language. Sometimes when we would ask for something they would speak to each other in this language and laugh. At times, because of the language barrier, I was never quite sure what they were saying, even when they were trying to explain something relating to mom's condition. I'm sure they got tired of me asking them to repeat their words over and over. Also there was the smell of unchanged diapers. The odor seemed to have worked its way into the ventilation system.

Luckily my mom was only there a short time. While there, she recuperated from emergency surgery for a plugged colon. In the nursing home, she learned how to speak, swallow, and care for herself again. Although she was never the same after the surgery, the nursing home helped her get back on her feet. Soon she was well enough to return to the residential board and care facility she lived in before the operation.

For me, it was very difficult to see mom in a home. And not just because the quality of her life was suffering but, also because I knew from this point on, that I would be taking a more active role in her welfare and her finances. Nursing homes are expensive. When your parent lands in a home, they'll need your help in ways you may not have considered before, as well as your active participation in the choices in their life. This chapter will tell you what you can do to provide that help and make those important choices.

Nursing homes are primarily designed to give high-maintenance care for people recovering from illness or operations. They also provide long-term nursing supervision for people with chronic medical problems. A nursing home isn't a hospital, and can't provide surgical care for acute conditions as a hospital can. The goal of a home is to provide therapeutic care and treatment to return a patient to their highest possible level of physical, mental, and social well-being. After a major operation, your parent may be discharged from the hospital directly to a home. If your parent has been admitted to a hospital via the emergency room, or under a doctor's orders, they'll usually have 100 days in a home for convalescence that will be paid for by Medicare.

Here is a list of the main medical reasons for being admitted to a nursing home.
* stroke
* Alzheimer's disease
* hip fracture
* heart or circulation problems

Other problems that may require nursing home care for seniors
* senility
* confusion and forgetfulness
* no main medical condition - family cannot care for them
* fracture, other than hip fracture

Nursing homes offer special care from qualified, trained nurses and visiting therapists. They usually have a regimen of exercise, good nutrition, and therapy to help your parent get back on their feet. Their job is to push your parent back on the road to recovery. By the time your parent gets to a home, they may be tired of the highway of life and ready to take the nearest off ramp to the parking lot of no return. The staff is usually highly aware of this. Their job, as they usually see it, is to get your parent back to where they can take care of themselves. Part of that job is to motivate your parent back to the road of recovery and to that onramp leading to the highway of life.

To protect patients, all states require some form of licensing for nursing homes. State inspectors regularly visit homes to make sure they comply with state laws, and Medicare and Medicaid regulations. For a look at those regulations visit http://www.medicare.gov/Nursing/Overview.asp. Those licensing requirements help ensure that nursing homes today are well regulated and subject to regular state inspections. It may be difficult to find a really bad nursing home, but your goal should be to find the best one for the money -- the one that best fits your parent's need for the price. At this point, probably the worst thing you can do is pay for more , or less, care than your aging parent needs. You'll want to find the type of nursing care that's the best fit for your parent.

Here is information on three types of nursing homes. I've included acronyms for these different types of homes. You'll see these acronyms used a lot so it's a good idea to remember them when you go to check out the homes as you do your own inspection.

* Skilled Nursing Facility (SNF) _ provides 24-hour care and nursing supervision by registered or licensed vocational nurses. These facilities provide long- or short-term health care and assistance with many aspects of daily living. They also provide speech, occupational, and other therapy a patient needs for daily living.

* Intermediate Care Facility (ICF) _ provides only 8 hours of care a day. These facilities do not always have licensed nurses available. They provide medical, intermittent nursing, dietary, pharmacy, and activity services.

* Skilled Nursing Facility (SNFSD) _ provides 24-hour care for people with severe mental disabilities. Many of these facilities have locked or secure areas where patients reside for their own protection and the protection of others.

When a hospital has to send your parent to a home they'll consider your insurance options and ask you to pick a nursing home covered by your parent's insurance plan or by Medicare. Usually the hospital will ask you to recommend a nursing home, otherwise they'll pick one from their list of favorites. These favorites may be homes they receive special favors or kick-backs from. As I found out, they may not be the best place for your parent. Before your parent is discharged from the hospital, get to work to find a good nursing home right away. Don't accept the nursing home referrals the hospital gives you right away. Follow the guidelines listed in the paragraphs below to find the best home for the money. While bargains in nursing homes are few, you can find big differences in the care offered by homes within the same price range. You just have to shop around a bit.

Look in the yellow pages of your phone book, your local Eldercare directory, or visit the local senior center for a list of nursing homes. A few great Web sites to check are www.seniorcarehelp.com and www.nursinghomereports.com. They both issue reports, for a small fee, of nursing homes within driving range of your home. These reports list how the state inspection graded the homes based on cleanliness and other inspection factors.

What ever you do, don't ever judge a nursing home by the size of their ad in a publication or newspaper. Plan on devoting a few mornings for reconnaissance visits. Make a list of nursing homes by location, get out your map and make a route so you can inspect a few each time. Use the checklists in Adobe Acrobat listed here:
Nursing Home Evaluation Checklist 1
Nursing Home Evaluation Checklist 2
Nursing Home Evaluation Checklist 3

You should be able to walk about freely in most nursing homes. I recommend taking a reconnaissance tour for your initial impressions, either by yourself, or, if you can arrange it, with another family member. As you walk through a nursing home, unannounced, and on your own, try to imagine that you have been admitted, as a 90-year-old patient. Ask yourself how you feel about the home. Would you be comfortable there while convalescing from a fall, stroke, or major operation. Follow the list of questions shown in Figure 7-1. If it helps, print out the checklist and take it with you on the tour.

After conducting your initial reconnaissance tour you may want to take the official tour. Though nursing homes may look the same on the outside, you are looking for the subtle things that can identify the exceptional from the usual.
Let the staff, or the marketing manager of the home, give you the complete tour package. Look for the unseen. Here are nine things to look for:

1. As you walk in the front door and wander the halls, let your nose be your guide. What do you smell? Is it feces and urine or is it bleach, vinegar or Pinesol? Does it smell clean or is it putrid? If you smell dirty diapers, mark that on your checklist. This smell can tell you that while the staff may be good, they may be spread too thin to give your parent the type of care you're looking for. That smell may indicate that patients aren't having their diapers changed regularly or soiled garments that aren't disposed of properly. You don't want your parent or yourself in an environment that smells bad.

2. Does the staff speak English as a second language? Many countries export nurses who take low-paying nursing jobs in nursing homes. While they may be great caregivers and possess compassion and gentleness, the day may come when you'll need to communicate a problem and find that no one truly understands you. They'll smile and nod, but you'll feel that a great chasm exists in your communication with the staff that hold your parent's life in their hands.

3. Are there activities planned for the patients throughout the day? Are there daily activities and entertainment, or are patients left to sleep and watch TV in their rooms? Do you see the wheelchairs corralled in a big room watching live entertainment or special shows to increase socialization?

4. Do the residents and their families seem happy in their environment? How do the residents appear to you? Are they wandering around aimlessly? Do they appear to be under the influence of sedatives? Do you see any residents tied to their wheelchairs or beds? (restrained patients may also indicate a lack of staff). If you can, muster up your courage, and take one of the residents aside and ask them what they think of the place. Make sure you're out of earshot of the nurses or orderlies. Sometimes you can get the real lowdown this way. It may surprise you that most of these residents will be happy to share with you what they think. In fact, they may be flattered you asked.

5. Meet the orderlies. These are the people who are really in the trenches. Do they appear content in their work? Do they look like someone from your church? Or do they look like tattooed gang members? If someone is going to take advantage of your parent while they're in a nursing home, chances are it will be someone in this bunch. They are the lowest paid and most-worked employees.

6. Check out the noon meal if you get a chance. You'll see how the orderlies help the residents firsthand. Do they have a caring relationship with the residents or are they simply shoveling food down? Do they have a sense of humor? Is there a dining area where residents can socialize? Are the patients socializing within their ability?

7. In case of a medical emergency, is a doctor available at all times, either on staff or on call? Do you see any doctors in the facility? Can your parent keep their own doctor, or do they have to use a doctor from the facility who you do not know?

8. What kind of day-to-day dental care is available? Is there some kind of care for brushing, flossing, and denture cleaning? Or do you have to pay extra for this?

9. Are call buttons located near each bed and in the bathroom? Are fire sprinklers located overhead? Are there phones in the personal rooms?

If you find a nursing home you like, and you think your parent would approve too, ask for the Inspection Report from the Health Care Financing Administration. This is the final X-ray inspection into violations that may have been committed and found during inspection. Look for the violations that affect residents, such as over-restraints or unhealthy kitchen procedures. The staff may give you dirty looks and develop a haughty attitude when you ask for this report, but don't let this faze you. You want the best for your parent. And if the home is really good, you shouldn't be made to feel bad for wanting to look a little deeper to see if it is truly as great as it seems.

Once you've made your choice, bring your parent there (if you're able to) and explain to them why you like this home. It's best if they approve of your decision. If they disagree, try not to get angry. Take them to one of the homes you rejected. Explain to them patiently how much time you spent on research trying to make the best choice, and why you decided on the one you did. Most of the time, your parent won't be in a position to be involved in the decision process of a nursing home. The decision making process may be entirely yours.

Once you settle on the home of your choice, you'll meet with the administrator and sign the papers. If your parent is able to come with you, take them around and introduce them to the residents and the nurses. If your parent is already in the hospital, you and a family member will probably have to go through this process without them. The ambulance will move your parent from the hospital to the nursing home after all the papers are signed.

If your parent is moving from a hospital or other facility, it's best to be at the home when they arrive, even if you have to take off work, or find someone to baby-sit the kids. It's important to be there for reassurance. Take some familiar photos with you and place them around the room so your parent feels at home. Bring a bathrobe, slippers, and some comfortable shoes for them. Find out from the staff what your parent may need. Be sure to use a permanent marker to write your parent's name on all their clothing. Clothing can get mixed up in the laundry.

Practical knowledge and solutions for dealing with family, retirement, and aging -- that arrive after age 50, whether you're ready or not.

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Nursing Homes -- How to Compare

(Excerpted from the book Helping Your Aging Parent)

How can we compare one nursing home to another? Are there real and tangible differences in the quality of care at different homes? The burden of finding a good nursing home for our aging parents usually falls on our knowledge or ability to judge a nursing home from it's appearance in a quick visit. Or we may have a recommendation from a friend or professional. Here is some information to help you compare nursing homes and the quality of care that they offer.

Nursing homes aren't always pleasant places to visit. They can conjure up unhappy images of awkward visits to some ailing older person tied in a wheel chair muttering incoherent words, or howling like some rare type of monkey. But, according to surveys from actual nursing home residents, those images exist mostly in our minds as visitors to a nursing home. Many older people actually enjoy their stay in these homes. This may be because of the attention they receive while at the home, or maybe because they find companionship with others their own age and in the same predicament.

More than 40% of people over age 65 will stay in a nursing home at some time in their life. For some it will be an extended stay, and for others it will be just a temporary stay while recuperating from trauma or an operation.

My mom was referred to a home straight from a hospital. Since my sister and I were ignorant about which home to send her to, the hospital made the choice for us. Looking back, I don't think that it was the best choice. The nursing staff didn't speak English well and conversed to each other in a foreign language. Sometimes when we would ask for something they would speak to each other in this language and laugh. At times, because of the language barrier, I was never quite sure what they were saying, even when they were trying to explain something relating to mom's condition. I'm sure they got tired of me asking them to repeat their words over and over. Also there was the smell of unchanged diapers. The odor seemed to have worked its way into the ventilation system.

Luckily my mom was only there a short time. While there, she recuperated from emergency surgery for a plugged colon. In the nursing home, she learned how to speak, swallow, and care for herself again. Although she was never the same after the surgery, the nursing home helped her get back on her feet. Soon she was well enough to return to the residential board and care facility she lived in before the operation.

For me, it was very difficult to see mom in a home. And not just because the quality of her life was suffering but, also because I knew from this point on, that I would be taking a more active role in her welfare and her finances. Nursing homes are expensive. When your parent lands in a home, they'll need your help in ways you may not have considered before, as well as your active participation in the choices in their life. This chapter will tell you what you can do to provide that help and make those important choices.

How Nursing Homes Help Your Aging Parent

Nursing homes are primarily designed to give high-maintenance care for people recovering from illness or operations. They also provide long-term nursing supervision for people with chronic medical problems. A nursing home isn't a hospital, and can't provide surgical care for acute conditions as a hospital can. The goal of a home is to provide therapeutic care and treatment to return a patient to their highest possible level of physical, mental, and social well-being. After a major operation, your parent may be discharged from the hospital directly to a home. If your parent has been admitted to a hospital via the emergency room, or under a doctor's orders, they'll usually have 100 days in a home for convalescence that will be paid for by Medicare.

Main Reasons For Taking an Aging Parent to a Nursing Home

Here is a list of the main medical reasons for being admitted to a nursing home.
* stroke
* Alzheimer's disease
* hip fracture
* heart or circulation problems

Other problems that may require nursing home care for seniors
* senility
* confusion and forgetfulness
* no main medical condition - family cannot care for them
* fracture, other than hip fracture

Nursing homes offer special care from qualified, trained nurses and visiting therapists. They usually have a regimen of exercise, good nutrition, and therapy to help your parent get back on their feet. Their job is to push your parent back on the road to recovery. By the time your parent gets to a home, they may be tired of the highway of life and ready to take the nearest off ramp to the parking lot of no return. The staff is usually highly aware of this. Their job, as they usually see it, is to get your parent back to where they can take care of themselves. Part of that job is to motivate your parent back to the road of recovery and to that onramp leading to the highway of life.

Finding a Nursing Home for Your Aging Parent

To protect patients, all states require some form of licensing for nursing homes. State inspectors regularly visit homes to make sure they comply with state laws, and Medicare and Medicaid regulations. For a look at those regulations visit http://www.medicare.gov/Nursing/Overview.asp. Those licensing requirements help ensure that nursing homes today are well regulated and subject to regular state inspections. It may be difficult to find a really bad nursing home, but your goal should be to find the best one for the money -- the one that best fits your parent's need for the price. At this point, probably the worst thing you can do is pay for more , or less, care than your aging parent needs. You'll want to find the type of nursing care that's the best fit for your parent.

Types of Nursing Homes

Here is information on three types of nursing homes. I've included acronyms for these different types of homes. You'll see these acronyms used a lot so it's a good idea to remember them when you go to check out the homes as you do your own inspection.

* Skilled Nursing Facility (SNF) _ provides 24-hour care and nursing supervision by registered or licensed vocational nurses. These facilities provide long- or short-term health care and assistance with many aspects of daily living. They also provide speech, occupational, and other therapy a patient needs for daily living.

* Intermediate Care Facility (ICF) _ provides only 8 hours of care a day. These facilities do not always have licensed nurses available. They provide medical, intermittent nursing, dietary, pharmacy, and activity services.

* Skilled Nursing Facility (SNFSD) _ provides 24-hour care for people with severe mental disabilities. Many of these facilities have locked or secure areas where patients reside for their own protection and the protection of others.

Shop Among Nursing Homes

When a hospital has to send your parent to a home they'll consider your insurance options and ask you to pick a nursing home covered by your parent's insurance plan or by Medicare. Usually the hospital will ask you to recommend a nursing home, otherwise they'll pick one from their list of favorites. These favorites may be homes they receive special favors or kick-backs from. As I found out, they may not be the best place for your parent. Before your parent is discharged from the hospital, get to work to find a good nursing home right away. Don't accept the nursing home referrals the hospital gives you right away. Follow the guidelines listed in the paragraphs below to find the best home for the money. While bargains in nursing homes are few, you can find big differences in the care offered by homes within the same price range. You just have to shop around a bit.

Judging a Good Nursing Home

Look in the yellow pages of your phone book, your local Eldercare directory, or visit the local senior center for a list of nursing homes. A few great Web sites to check are www.seniorcarehelp.com and www.nursinghomereports.com. They both issue reports, for a small fee, of nursing homes within driving range of your home. These reports list how the state inspection graded the homes based on cleanliness and other inspection factors.

What ever you do, don't ever judge a nursing home by the size of their ad in a publication or newspaper. Plan on devoting a few mornings for reconnaissance visits. Make a list of nursing homes by location, get out your map and make a route so you can inspect a few each time. Use the checklists in Adobe Acrobat listed here:
Nursing Home Evaluation Checklist 1
Nursing Home Evaluation Checklist 2
Nursing Home Evaluation Checklist 3

The Reconnaissance Tour of a Nursing Home

You should be able to walk about freely in most nursing homes. I recommend taking a reconnaissance tour for your initial impressions, either by yourself, or, if you can arrange it, with another family member. As you walk through a nursing home, unannounced, and on your own, try to imagine that you have been admitted, as a 90-year-old patient. Ask yourself how you feel about the home. Would you be comfortable there while convalescing from a fall, stroke, or major operation. Follow the list of questions shown in Figure 7-1. If it helps, print out the checklist and take it with you on the tour.

After conducting your initial reconnaissance tour you may want to take the official tour. Though nursing homes may look the same on the outside, you are looking for the subtle things that can identify the exceptional from the usual.
Let the staff, or the marketing manager of the home, give you the complete tour package. Look for the unseen. Here are nine things to look for:

1. As you walk in the front door and wander the halls, let your nose be your guide. What do you smell? Is it feces and urine or is it bleach, vinegar or Pinesol? Does it smell clean or is it putrid? If you smell dirty diapers, mark that on your checklist. This smell can tell you that while the staff may be good, they may be spread too thin to give your parent the type of care you're looking for. That smell may indicate that patients aren't having their diapers changed regularly or soiled garments that aren't disposed of properly. You don't want your parent or yourself in an environment that smells bad.

2. Does the staff speak English as a second language? Many countries export nurses who take low-paying nursing jobs in nursing homes. While they may be great caregivers and possess compassion and gentleness, the day may come when you'll need to communicate a problem and find that no one truly understands you. They'll smile and nod, but you'll feel that a great chasm exists in your communication with the staff that hold your parent's life in their hands.

3. Are there activities planned for the patients throughout the day? Are there daily activities and entertainment, or are patients left to sleep and watch TV in their rooms? Do you see the wheelchairs corralled in a big room watching live entertainment or special shows to increase socialization?

4. Do the residents and their families seem happy in their environment? How do the residents appear to you? Are they wandering around aimlessly? Do they appear to be under the influence of sedatives? Do you see any residents tied to their wheelchairs or beds? (restrained patients may also indicate a lack of staff). If you can, muster up your courage, and take one of the residents aside and ask them what they think of the place. Make sure you're out of earshot of the nurses or orderlies. Sometimes you can get the real lowdown this way. It may surprise you that most of these residents will be happy to share with you what they think. In fact, they may be flattered you asked.

5. Meet the orderlies. These are the people who are really in the trenches. Do they appear content in their work? Do they look like someone from your church? Or do they look like tattooed gang members? If someone is going to take advantage of your parent while they're in a nursing home, chances are it will be someone in this bunch. They are the lowest paid and most-worked employees.

6. Check out the noon meal if you get a chance. You'll see how the orderlies help the residents firsthand. Do they have a caring relationship with the residents or are they simply shoveling food down? Do they have a sense of humor? Is there a dining area where residents can socialize? Are the patients socializing within their ability?

7. In case of a medical emergency, is a doctor available at all times, either on staff or on call? Do you see any doctors in the facility? Can your parent keep their own doctor, or do they have to use a doctor from the facility who you do not know?

8. What kind of day-to-day dental care is available? Is there some kind of care for brushing, flossing, and denture cleaning? Or do you have to pay extra for this?

9. Are call buttons located near each bed and in the bathroom? Are fire sprinklers located overhead? Are there phones in the personal rooms?

The Secret Nursing Home Inspection Report

If you find a nursing home you like, and you think your parent would approve too, ask for the Inspection Report from the Health Care Financing Administration. This is the final X-ray inspection into violations that may have been committed and found during inspection. Look for the violations that affect residents, such as over-restraints or unhealthy kitchen procedures. The staff may give you dirty looks and develop a haughty attitude when you ask for this report, but don't let this faze you. You want the best for your parent. And if the home is really good, you shouldn't be made to feel bad for wanting to look a little deeper to see if it is truly as great as it seems.

Once you've made your choice, bring your parent there (if you're able to) and explain to them why you like this home. It's best if they approve of your decision. If they disagree, try not to get angry. Take them to one of the homes you rejected. Explain to them patiently how much time you spent on research trying to make the best choice, and why you decided on the one you did. Most of the time, your parent won't be in a position to be involved in the decision process of a nursing home. The decision making process may be entirely yours.

Making Your Aging Parent Comfortable in a Nursing Home

Once you settle on the home of your choice, you'll meet with the administrator and sign the papers. If your parent is able to come with you, take them around and introduce them to the residents and the nurses. If your parent is already in the hospital, you and a family member will probably have to go through this process without them. The ambulance will move your parent from the hospital to the nursing home after all the papers are signed.

If your parent is moving from a hospital or other facility, it's best to be at the home when they arrive, even if you have to take off work, or find someone to baby-sit the kids. It's important to be there for reassurance. Take some familiar photos with you and place them around the room so your parent feels at home. Bring a bathrobe, slippers, and some comfortable shoes for them. Find out from the staff what your parent may need. Be sure to use a permanent marker to write your parent's name on all their clothing. Clothing can get mixed up in the laundry.

Visit Your Aging Parent Frequently

Once your parent is settled, try to visit at least twice a week. Stagger the visits among family members so you all don't appear on one night, and your parent is lonely for the next several nights. Bring the kids, just about all the people in a nursing home enjoy seeing youngsters. Let your parent brag about their grandchildren to the other patients. If you can't visit often, use the telephone. Keep in mind that when your parent is in a nursing home, it's probably a good time to have that heart-to-heart talk that you've been putting off. This is the time to tell them how much you love them and that you're praying for them. Tell them how much you care for them. This is the time to tell them everything as if there's no tomorrow.

Volunteering Opportunities • Book Reviews • Bookstore • Order • Books on Legal Help • Books on Helping Aging Parents • Books on Retiring
• Links • About Boomer Books• Health News• Home

Once your parent is settled, try to visit at least twice a week. Stagger the visits among family members so you all don't appear on one night, and your parent is lonely for the next several nights. Bring the kids, just about all the people in a nursing home enjoy seeing youngsters. Let your parent brag about their grandchildren to the other patients. If you can't visit often, use the telephone. Keep in mind that when your parent is in a nursing home, it's probably a good time to have that heart-to-heart talk that you've been putting off. This is the time to tell them how much you love them and that you're praying for them. Tell them how much you care for them. This is the time to tell them everything as if there's no tomorrow.

Volunteering Opportunities • Book Reviews • Bookstore • Order • Books on Legal Help • Books on Helping Aging Parents • Books on Retiring
• Links • About Boomer Books• Health News• Home