What questions should you ask a nursing home?

Babalou
Yes to that. I had 48 hours and a list of 50 facilities to consider so my mom could be discharged from the hospital.I was very fortunate to have a good friend(social worker) who went over the list with me and said yes or no to the various places. In a previous job she had been working with medicare patients and helping families with placements. She was a great source for me and has kept in close touch and given me a lot of "hints" on how to get things done.
Still I only saw 6 of them in two days. and could only give the hospital 2 names. I was working on looking at more when the place who was our number 1 called and said they would take her in sub acute. She has since transitioned to skilled/long term care and we couldn't be happier with the facility. She is adjusting slowly, has started to trust the staff and go to a few activities. I give her a lot of credit to be doing this when she is 95. I hate change myself and I am a lot younger than she is and don't know how I would cope with it.

Ah, Betty; yes, you're in good company here in the "magical thinking" department! As my brother and I raced from nursing home to nursing home last year, we said " what were we thinking? She was going to live forever?"

Colleen1
one thing this whole experience has taught me: plan ahead. Mom is 95 and lived on her own (successfully) until October 2014. Then her health declined rapidly and was in hospital 2 times in 30 days and went to subacute rehab and now in skilled nursing. I think I was a victim of "magical thinking" that nothing like that would every happen to her. it was easier to ignore the possibility ( my fault) even though I had seen many friends go thru the same thing with their parents. The last three month have been hectic with meetings with an elder attorney, social workers, healthcare professionals, even a funeral director. It would have been so much easier to preplan for some of these issues. I am lucky to have two brothers and a sister who have been very supportive and helpful but I believe it would have been easier for all of us, esp. Mom, if we had discussed some of these issues in detail prior to this point when she was not in such a frail state and there was so much to consider.

I'm so glad to have checked here. I have to start planning ahead to move my dad out of AL into NH. Great, great questions and resources. Thank you!

Medicaid pays a certain set amount. It does not specify that the room has to be shared, but most nursing homes charge so much more than Medicaid pays for a private room that they can't afford to absorb the difference between Medicaid's payment and what the room could rent for to private payers. Sad? Yes. And I think that is going to change as the Boomers become the residents, but for now that is how things are. In the small town where two of my aunts were in the nursing home, all of the rooms were singles. They were tiny, but the home was built with government payments in mind.

I will say that the level of care does not seem to depend on private/Medicaid payment. Most aides and nurses and staff want to do a good job for everyone. (Or bad staff are equally bad with everyone.)

Nursing homes seem to have a wide variety of ways to prevent falls, None of them include 24-hour monitoring, as you do at home.

I'd suggest you look a little further, just to satisfy yourself about what is available. You may never need to use a NH at all, but it is wise to be informed in case the need arises.

Babalou, yes some roomies are great and even helpful. In our family we had a grandparent who could only afford 2-bed room, and the roomie was noisy and even destructive. Eventually they moved him out but th next roomie was not any better. Grandparent lost so much sleep from bad roomies, we feel it contributed to pneumonia and death but of course that is impossible to prove, but OTOH if they were in private room there would be better sleep and fewer germs from both roomie and roomies visitors. When they did get penumonia, instead of moving to a private room to die, they moved him to an even smaller (!) room which had a half-curtain separating him from the other death bed. I distinctly remember 4-5 family trying to pray around his bed and feeling like we were bothering the family crammed in aaround the other death bed. It was not a good "death experience" and do you know what, the NH charged us MORE money for that crappy little death room. So sad. Nowadays I would hate to have either of my parents stuck with who knows what faith tradition 3-feet and a half-curtain away.....while were reciting the 23rd Psalm they might be reading the Koran or witchcraft. In our current complex and diverse culture, and especially upon one's death bed I would expect a little more sensitivity to the situation, but it didn't happen for Grandpa and it won't be getting any better (for most of us).

I can only speak from my experience with my mom's nursing home, St. John Paul in Danbury, CT. They have both private and double rooms. My mother is private pay and is in a double, since it's about $1000 less per month.

Having a roommate has been a good thing;once, mom fell transferring from her lift chair and the room ate buzzed for help.

Mom's bed is alarmed. There is room for personal furniture. There are no triples or unusually cramped rooms that I have seen in any of these facilities. There is a large community room that they allow us to use for family celebrations several times a year. We don't take mom out, except for a rare followup doctor appointment following a hospitalization. She goes by ambulette.

Re the multi-occupancy rooms: yes, the Medicaid residents do have multiple occupants per room. And yes, the salesperson will purposely not show those rooms (if you are shopping as a private pay customer they will show you the private pay rooms.......). And yes, you can enter as private pay and 3 years later after spending your entire life savings on your private, homey room, the facility will as quickly as possible move you to multi-occupant room, to make way for another private-pay customer to occupy your former room. All nursing homes, assisted living, they all do this. They have to make lots of money from thr private pay clients to keep themselves solvent. If every one was on welfare, they would go out of business.

To littlemisskitty:
The facility where my mom is does not like to use bed alarms either. They do rounds at night every 1/2 hour. However, your point is well taken; if your parent/loved one wakes up right after the "round" they could get up on their own. Or if they are like my mother, who is feisty and stubborn, she does not want to ring the call light. she will get up on her own. I spoke with the head nurse/manager for the unit and insisted on an alarm anyway. Mom got it right away and I noticed that several other people had them also ( on their wheechairs and I assume on their beds). I understand the philosophy but I don't want my mom to fall and break a hip, etc which could have severe consequences. I have been there when she did get out of bed (with me assisting her). The alarm went off and everytime someone was in her room within a minute or two. I deliberaately did not turn the alarm off, because I wanted to see how long it took them to get there. Mom told me that they do come right away when she is alone and the alarm goes off which aggravates her because she wants to do things on her own. Unfortunately, she is not steady enough on her feet to walk (with walker) unassisted. So I think they are not just responding quickly when they know I am there.

great comments. Thanks to all of you.
Along with questions prior to admission to a facility, a most important thing is to visit your loved one often, at different times of the day. I am fortunate to have two brothers and a sister and someone is there everyday. We go to activities with mom at times and watch how the staff treats the people who are in the activity class. So far, everyone I observed has treated the patients with respect and kindness ( and I don't think it is because I am there). I watch when call lights go on and how long the resident waits for it to be answered. Also how quickly things are taken care of--my mom needed a consult with a GI doc. I wanted her to go to a certain group;the unit secretary got her an appt. within 5 days (it was not an emergency visit, just a routine consult). The social worker calls you back within 24 hours and agreed to stay late one night to meet with my siblings since that was the only time we could all get together. It hasn't been easy for mom but she is learning to trust her caregivers and adjust as best she can. I don't know how I would react in her situation. It is hard to make changes when you are 95.

From the 4 nursing homes I toured they all had bed alarms and some for wheelchairs depending on the resident's needs. Nursing homes usually are converting lately to one per room it seems, but I have never heard of more than 2 residents to a room as this seems a bit packed in. I would definitely do a little more checking around to see what other nursing homes are doing. I would think that alarms would be required for safety reasons.

I visited a nursing home and will visit another after the holidays and I have a question. Are all nursing homes having two people to a room unless it's private pay? The reason I ask this is because the nursing home I visited was bragging about how they had 30 single rooms. I was excited about this aspect especially seeing how the rooms were set up and were decked out with their personal furniture and looked sort of homey in a not quiet home way. She was bragging about how people there felt that this was home and that they would die peacefully there even sometimes surrounded by their loved ones since it was their home. She talked about how so many residents have their relatives come to have Christmas there with their loved ones instead of checking them out to go home (as we asked if we could do). Then she avoided a section of the hallway and I asked why. I don't like it when areas are avoided and not shown because it makes me think there is something to hide. After my insistence she admitted that it was a few rooms that had up to three residents at a time. I asked if it was a sort of holding room for people who needed care and were unable to get into the real personal rooms. She told me it was the other way around. The personal rooms were private pay individuals or individuals who needed care and were on Title 19 and were not lucky enough to get right into the multiple resident rooms. I asked what that meant and she said all people who are on state pay get a room with multiple people. If you are placed in a personal room while on state, you will be moved at first opportunity to a multiple room. Those rooms were filled with the normal things such as a hospital bed (all rooms were required to have that), a nursing home chair (not always required as some were able to bring their own personal lift chairs with them) and a single dresser. There were no pictures on the wall and the room was completely cramped. There were three chairs to the room which were one per bed. There wasn't much room to even move around. The closet was shared between all members of the room but we were informed, if you labeled any belongings it should be fine. This bothered me as I assumed we are moving our loved ones into a nursing home so that they could have a room away from home and instead we are moving them into a room similar to a dorm room (which is meant to be temporary and usually not used except for sleeping) and instead they are living in it. Is that how all nursing homes are? Do people adapt well to this kind of environment?

The other question I have is about bed alarms or something to prevent falls. We right now follow her around assisting her as she walks. She has fallen 4 times this past year and now we have her on around the clock care at our house even walking her to the bathroom but still she forgets sometimes and tries to get up on her own. We use a bed alarm and a tithered alarm but the nursing home said they do not use this as it's disturbing to other patients in the home. Is this normal? Right now my mom and I are taking turns on the night shift and not leaving her alone in rooms unless the baby video monitor is on her, making sure she doesn't get up by herself and fall because when she wakes up she has to go to the bathroom and is so groggy she will almost fall without us there to assist her in reaching the toilet and bed. She has diabetes so her head is always dizzy feeling. So if there are no bed alarms to alert them when people are getting up out of bed or out of their chair, how do they ensure the people don't fall? She answered saying they do hourly rounds but if grandma got up right after they left (which she probably would since she tries to avoid asking for help when she is able), she would fall and be there for an hour before found? Is this normal?

For that reason we are very nervous about ever putting her in a nursing home since we would be putting her there after an injury which required more care than we would be able to do alone.

Should we keep looking and trying nursing homes or is this how they all are? We are so new to this process I feel so overwhelmed by what we saw. I still don't even know if I asked the right questions. The nursing home was supposed to be a really good one for the area in CT where we live. The place looked clean and the walls were bright. There were Christmas decorations and the people looked clean. This is where grandma had gone to rehab and it seemed like an ok place temporarily but long term, it didn't. What are you guys' suggestions as to what is normal and what is not? Are we expecting too much from a nursing home?

What upsets me the most is something that likely upsets the workers because they don't have the time. Each one of those elders had a full life, including things we may not have agreed with. That should be respected.

Hello Carol,

My mom's name was Carol-Ann, so that makes me smile. Not many Carols around are there?

Anyway, thanks for your response. It's a good thing your elderly neighbor wasn't truly addicted to alcohol. I minored in psych, so you are smarter than I but even I know someone who is truly addicted and then cut off could die.

When I spoke of smell it = the smell of urine for the most part - not just "old people" smell. And, yes, I agree....the "smell" should be taken into context. Things do happen, often right before a visitor arrives. Murphy's Law?

I've never been a smoker but I understand the patch. A elderly neighbor of mine (I became his primary caregiver) was a heavy drinker. When he broke his hip and was hospitalized there was zero understanding from the doctors about his withdrawal. It was awful and I was really angry.

This was a number of years back - I think they know more now. But smoking would be much the same. People need to be treated and weaned when possible.

Good point about the tightly wrapped sandwiches - Duh! Someone should figure that out.

About the smell - I know that people talk about nursing home smells and I'm sure it happens, but the only time there was a smell issue at the home where my parents were at the end of their lives (or any of our community NHs that I've visited) was/is if there had been an "accident" just prior to my arrival. They kept that place clean and under nearly all circumstances it smelled just fine. My point being that people should judge immediately until they know if the smell is constant or circumstantial.

Great observations, everyone!
Carol

Definitely go by the smell test. Figure out what's most important to your grandma as well as the family.

My mom was briefly in a rehab place/nursing home. It smelled okay, but they ignored two very important things (you can always nitpick about minor things):

1. She had severe arthritis and they would provide sandwiches so tightly wrapped in Saran wrap that even I had trouble unwrapping it for her. What would've happened if I didn't visit? Stay hungry and just stare at the sandwich she couldn't eat?

2. My mom was also a smoker. Non-smokers won't understand this but the lack of nicotine causes a huge amount of anxiety. I made sure her file said to give her a nicotine patch daily. They would use a magic marker/sharpie to note the date/time applied directly on the patch. I noticed she was missing a patch. Again, no big whoop to a non-smoker but a HUGE big whoop to someone who is. I spoke to the nurse in charge and she didn't think it was "necessary." WHAT???? If Coumadin (blood thinner) was also listed in her file would it be okay if she thought that wasn't necessary? Insane. We got her out of there quick smart.

It seems that some nursing homes appear to do well as long as the resident or patient does not have too many problems...which is why our loved ones are there in the first place. I would not depend on "lucking out" nor the sales pitch of nursing home administrators, but talk to people that have loved ones in these places.

when my mom needed subacute rehab I had about 2 days to make the choice.
I did all of the things mentioned above. I just "dropped" in on the facilities and noticed how I was treated and who took the time to give me a tour. I used my nose to detect odors. I looked staff in the eye in the halls, etc and noticed who said hello or smiled. I watched the staff interact with the patients. I looked in patient's rooms. I noticed who was in the hall by the nurses desk in wheelchairs
( a horrible thing)
I did go on line and look at ratings. I contacted a social worker friend and read her the list of the 50 facilities I was given and asked her opinion. i talked to everyone I knew who had placed a relative in a facility.
I finally chose 3 ( I had to give the hospital social worker three names). The one at the top of my list had a bed for sub acute and worked with me to keep my mom in the same room, with the same caregivers if she needed long term care, which she did. She has been there for 7 weeks now. In the meantime everyone I have spoken with (nurses, lawyer who deals with elder care issues, social workers, hospice nurses, therapists) have said that they view this facility as one of
the best in our area
Mom's care has been phenomenol and they are on top of everything. The nurses give us updates whenever we go in. They even call me at home in the evening after the doctor has visited to tell me about changes in her meds, etc. The staffing ratio on days is 6 care givers for 14 patients, on evenings there are 5 staffers. We lucked out. It was a lot of time and energy spent in a short time. By the way, the facility is beautifully furnished, which I know can just be "window dressing". Many of the staff, (activities people, secretaries, hair dresser, house keeping) know my mom's name and address her personally when we pass them in the hall.
My advice is look as hard as you can, talk to others who have loved ones in facilities and ask their opinion, talk to the social worker at the hospital if your loved one is being transferred from a hospital. Do look at ratings, altho they can be misleading.
The best time to do this, of course, isn't when you are under the gun and have to make a quick decision. This whole experience has taught me that, altho we don't
want to admit it, you need to be prepared. WE knew mom was failing but didn't think things would happen so quickly.

Probably the best thing is to ask other people that have dealt with nursing homes. People at the dentist or doctor's office, church, grocery, anyone who may know something. My Mom was in the hospital for a broken arm and the social workers always push for seniors to go into nursing homes for a few weeks for "rehab". I checked the medicare site and found a facility with 5 stars.I regret believing the star ratings and falling for this suggestion..Once my Mom got there I sensed an unfriendly staff though the place was decked out with fancy decor, etc. She developed confusion due to a UTI which they didn't understand, implying she had dementia which she does not. The nursing home doctor happened to be checking on my Mom when she suffered delirium from the infection and he had her sent to the hospital. Upon admittance the nurse asked me if I had seen the wound on her back....I had never been told about this and was shocked to see a stage 4 decubitus ulcer on her back!! No one in this nursing home told me of this bedsore but the physical therapist at this nursing home did manage to howl about my Mom's lack of motivation for physical therapy and yet they just let her lie in the bed and this wound happened. Did they just think a stage 4 wound with bone exposed would go away on it's own if ignored??!!! Osteomyelitis later developed requiring 6 weeks of hospitalization and IV antibiotic. My Mom had started out with just a broken arm!! I don't believe any of those 5 star ratings one bit!!! I should have asked more people about their experiences with nursing homes had I had the time. Needless to say I never sent my Mom back there and she is at home with me.

you can't always say that if the patients are always sleeping, that depends on what time of day you go in and the advancement of their disease. sometimes I go in and my dad is sleeping, other times he is awake, sometimes after they eat they get drousy. my dad has good and bad days (whether on meds or not), he might be sleeping one day more compared to others. each person in these homes are different and react differently. there is a man where my dad is that is 102, most time he is awake when I see, but when I don't see him, he is probably in his room sleeping..........and apparently his disease is not as bad as my dad's or vice versa.

In my area there is a facility in my area that all dementia are admitted to skilled nursing care. Memory care is traditionally assisted living that is secured to prevent wandering. And as a nursing home the staff/resident ratio is high, but so are the fees which start at about 8K a month. I see several advantages in this approach. Their health will worsen most likely to needing nursing home care. When it does, they do not need to be moved to another location that mayy very well cause a significant decline. Those with dementia need more help and staffing ratios are commonly too high for me to be comfortable with. In my area it is common to find a 1:8, 9 or even 10 ratio. This is way too high IMHO. And memory care usually has add on fees based on level of care necessary. A friend has his wife in a memory care facility and he pays the base rate plus their highest level of care for 7k a month. However, the facility has asked him for an additional 700 a month so they can hire additional staff. Not right as far as I am concerned, this is a facility with a 1:9 ratio. Perhaps a nursing home would be more appropriate? Or a different memory care facility where staff ratios are 1:6. But those ratios are just a guideline. One person can come in that requires more assistance or is agitated and the staffing level may not be what it really seems to be because of some needing more staff time.

It is a situation that needs monitoring consistently and frequently because of new residents.

We are keeping my mom in her own home. My father and I are her main caregivers along with Hospice. We decided as a family not to use a NH because of the care issues involved with Alz. patients. They are not able to participate in their own care and cannot (in the later stages) let you know if something is wrong. That said, I agree with the prior posts, especially using your nose! If there is even a slight smell of urine or feces....just keep on walking! Notice if the aides and nurses are friendly as you walk by...if they don't even look at you and make eye contact ....keep walking. See how long call bells stay on before being answered and the energy with which the staff answers them. If they seem bored or 'put out' i.e. "What do you want now..." I'd suggest somewhere else. Some of them are just beautiful with professionally interior decorated lobbies etc....some have lots of glass, knick-knacks etc, but if the patients are just sitting staring at the walls when you visit and there are no activities going on, or stimulation of some sort I really would be wary of the place. I don't do art with mama but I do sit with her and hold her hand. I will listen to music with her or watch a movie or just chat with her....even if I am the only one talking....think if you would like to be there yourself before you make any decision.

Questions? You mean I got to give them a ride? They spent a lifetime driving everyone away. Thats a lot of extra driving.
I guess if I have to ask a question it's: "How do I keep my phone number out of your system?"

The staff matters much more than the surroundings.
....new Dr. doesn't even bother to come and meet and examine your loved one for 48hrs or so. They simply "rubber stamp" the incoming notes and meds. at admission....
if the clients are drugged if everyone is in wheelchair and falling asleep walk away. ask how many clients an aide has.........
Nursing homes order their own supply for economic reasons and there is almost always delays and substitutions. Be aware of those and what she is being given
....... Get a list of the activities provided, talk with the social worker, find out who the docs are and how often they come in
....ask the nurse question if he/she is to busy and rude most likely they will be to busy later when your loved one is there
.......... Some places don't seem to know how to handle dementia very well and it shows. ....my test question is to ask them how they handle confabulation.........
Some places don't seem to know how to handle dementia very well and it shows.
...Words that should be banned
All you need to do is ask;
Just ask ….
We have that up stairs ...
I'm not your ...
I'll get your ,,,, she's busy ..
Look for simple patient friendly actions
Does staff Introduce themselves every time
On serving food
    just putting food in front of person is not a friendly practice
  Do they     Ask if they need anything else
    Do they          ask if meal is OK while they are eating           
Do the staff say hello to visitors and patients
Is there a photo gallery along the entry way walls with every day carer's- Staff, all department heads and the administrators
Do managers have business cards and email addresses?

read the previous post they are very helpful

In addition to all the great responses already shared, I would add, dont bother getting on waiting lists, they only serve the interests of he facility you could spend a few thousand being on several such lists, each 100-200 people long and yet not be called at the time when YOU need a room---when you need a room, you need it NOW and you can't be waiting around. It's a gimmick designed by facilities to keep then operating all maximum capacity, encouraging people to move in earlier than really they need to move. It also creates paperwork for your family to answer the facility inquiries "are you ready to move in? We have a lovely 2BR" and also keep track of where you had placed Deposits so you can get them back after you die (or movd somewhere else). Also remember to read all the fine print in Rental Agreements, especially realizing is it a month-to-month lease, or is it yearly? And remember if you need to go to hospital for 3 weeks, you need to pay you rent if you want to keep the room. The only other thought is when you do move into a facility, don't bring anything of value, and what you do bring, put your name on it (even the eyeglasses and toothbrush). Everything is subject to getting lost borrowed stolen or otherwise disappeared. ....and you will have to replace it at your own expense.

While it is good to visit possible nursing homes for the future, I would try to come up with a long term care policy, the costs of home care, community adult day care programs, elder transportation and the possible family members who would be interested in grandmom avoiding the nursing home all together if home care is possible with paid help and family picking up the remaining hours each day , when it gets tough.

Many nursing homes have problems and the average person does not have the funds to pay their way in a nursing home for more than a year of so. At that point they will be placed in a Medicaid nursing home placement. Medicaid is not Medicare, but it is the health plan for the elderly who have no money left. Many nursing homes limit the beds for this funding.

In short, I found it best to keep my elderly father at home. Having a home health aide who we paid and who only cared for my father--worked. He got to stay in his home where he was very comfortable. He was happy with the arrangement. Having purchased him a long term care policy made it possible.

Good luck.

I can't remember all the questions I asked but I am sure some of the sites the people listed on here are good. But I don't know about asking the "residents/patients" what they think. They are there due to dementia/alzheimers do if they say they hate it, doesn't mean its not good. I see a lady each time I visit my dad, she says the nurses are mean, she hates but honestly I haven't seen one bad situation, so in this persons mind she just don't like it..........so don't base your findings on what the patients say. NOW not unless you actually see or hear one of the patients being treated badly.

I haven't read any of the answers but I looked on the Medicare website for the ratings which in the end didn't really mean all that much. You can see the complaints, the remedies, etc.

And remember, a nursing home is a business, so you can ask all the questions you wish, you'll get canned answers because they are selling a product.

The rehab where my mother is also serves as a 'nursing home' (I say this because very few nursing homes have nurses anymore). This particular one got a three star rating by Medicare but I think it's great, the CNA's are wonderful, helpful, and my mother loves the place. Lots of activities, clean, etc.

Quite frankly, I think it's a crap shoot, no pun intended.

I worked in many nursing home and things to do are check them out early in the morning about 7 am or weekends early. If you smell poop and pee walk out there are no need for q&a. look to see if the clients are drugged if everyone is in wheelchair and falling asleep walk away. ask how many clients an aide has. when was the last abuse like a bed sores or fall in their home was and how often does it happen with in the month then year. make sure you are able to came at all times. when you take the walk through make sure you look at the aide do they look over work are they nice to the clients and does the client interact well with them. ask the nurse question if he/she is to busy and rude most likely they will be to busy later when your loved one is there. Also if you see a client or two out side before coming in ask them how they like the place they know how it is when family is not there. good luck with this. just watch and go with your gut

The first thing to ask is if the NH is for profit or a non-profit. Steer clear of the for profit NH. I had my mother in a for profit NH and after her money ran out, they called to tell me they planned to discharge her. I took her home before their discharge date, but it was an extremely unpleasant experience to be hounded by them. They also had administrators walking around my mother's unit and having the patients sign their home over to the NH. Check out the activities available to the residents, and make sure the residents are taken to the activities. My mother was on a ventilator unit with a portable ventilator. They never took her downstairs to the dining room to participate in any activities as they did not have enough respiratory therapists to bring the vent patients downstairs. This also included physical therapy for her. She had physical therapy for 6 weeks and then it stopped. Even though there were activities posted for the vent patients, the events never took place, or if they did, it happened once in a blue moon. Find out when the doctors make rounds and when they are available for you to speak to them. Ask them what happens if there is an outbreak of an illness,and how it is handled. After visiting my mother, several of us noticed red bumps all over her stomach and arms. After my sister asked the nurse what the bumps were, the nurse and a wound nurse when to check my mother. They never told my sister what the diagnosis was. The next day, I was told by an aide that it was scabies, and there was an epidemic of it in the nursing home. She advised me to call the NH the next day and asked that they treat her for scabies. They never called me at home to tell me of this, but they called me several other times to say they were giving the patients antibiotics to prevent them contracting an illness that was going around the NH. As my mother was bedbound, she was put into a chair every day. The first NH I put her into, did not have a chair for each patient, the patients rotated when they went into the chair, and even then, the NH didn't follow the schedule. Go to the nursing home different times during the day. Don't keep a set schedule. Have other family members go, and ask them to report back to you if they see anything strange. Ask the nursing home how they handle when a patient needs to see an outside doctor or go to a hospital. Find out who the doctor is and what hospital they use. Make sure you know of any outside visits, and that you want to go with your parent. Before my mother came home, I had her go to a cardiologist as she had heart issues. If visiting doctors do visit the NH, find out what their specialties are. Ask if a Dentist visits or if the patient will be sent to the dentist's office. Ask about the meals served. How do they handle patients that don't like the food. Do they give them a meal replacement such as Boost, or Ensure? Are they given vitamins? Will the NH call you if they see mental changes in the patient? If the patient is in a double room, how does the NH deal with visitors? My mother had a roommate that had 8 family members visit her all at once. This included a newborn infant and the baby carriage. They were disruptive and treated the place as if they were at home. Ask how many staff are on the floor and how many shifts there are. When my mother was put in the chair, she always complained about her butt hurting, but there wasn't much as I could do about it because we had to wait until the next shift comes in to put her back into the bed. Good luck with everything.