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I am going to interview 4 local nursing homes and need to know how to select the best one.

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The tour will probably take you to a floor and may show you a few rooms. Keep an eye out for anyone sitting in the hallway unattended. Check for smells, which are unavoidable sometimes but need to be handled quickly. Does it look clean and well maintained? CNAs shouldn’t be congregating, but there should be good noticeable rapport between them. They should address the residents pleasantly and kindly. Ask what the org chart look like for the floor. How many cnas, lpns? Is there a charge nurse, and is she accessible. Admin assistant? Is there a rehab facility attached where they can get PT and OT. Check the menu. Check the activity calendar, talk to the activity person if possible. Does everyone have to go to the dining room for meals? How often are showers? (Moms was only once a week, but it was better than nothing because she hated showers so I was happy they at least managed that). If there will be a roommate, how do they try to match them up?
Dont be too dazzled with fancy appearance or all the bells and whistles. Caring and loving staff to me was the most important aspect of Moms NH, which certainly wasn’t fancy like a hotel, but was clean and well maintained, and she was matched perfectly with a roommate. That’s why I think it’s very important to observe the staff and their interactions. Loving kind staff is a principle that comes from the top down and to me shows a good management. The fancy stuff is more to impress the kids...the residents really don’t care.
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Riverdale Feb 2020
The smell issue is so pertinent. A few years ago I visited someone in a nursing home. The place had a nice location and would have seemed to possibly be a good choice. When one went to the wing where she was located the smell of urine was overpowering. I recall thinking how could anybody stand to work there. I had visited my grandparents in facilities in the past and never experienced that overwhelming smell. Some years later when a friend had to find a facility for her husband after a serious stroke I told her about this and suggested she not consider this facility. I went with her on tours of others and never found this same issue with them.
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Usually the marketing staff are the most personable, the most vivacious. And it is the marketing staff who will show you around and answer your questions. If you ask questions you will always get rosy answers: we meet all state requirements for staffing levels. We provide person-centered care. We will treat your parent like our own! Try to speak to the head of the unit your familiy member will be living in. Sometimes this is a nurse. Ask the frequency of care-plan meetings, and whether you can ask for additional meetings.

Trust me, you must spend as much time as possible OBSERVING, and ideally without having a minder with you the whole time. Peek in resident rooms. You'll be told it isn't possible because of privacy rights. Knock on the door, smile and ask the resident if you can come in and say hello. They will unfailingly welcome you! Notice if there are towels and face clothes in the bathroom; these are in notorious short supply in nursing homes. Run the tap to see if the water gets warm quickly. Are the bathrooms warm? Often they aren't all that warm and comfortable, making residents resistant to showering. The most important element: Notice if the aides are truly engaging with residents or are they socializing among themselves, or spending their time at the computer kiosks entering data. Are the wheelchair footrests clean? At mealtimes, is food served bite-sized so residents can easily chew it? Are normal condiments like salt, pepper, ketchup, etc. on the tables where residents can use them? Talk to residents about the food, how mealtimes are. (If you are in a memory care unit, this may be a little harder to assess.) What are the noise levels like: are aides shouting down the hall to each other, are doors banged, are call bells still being used? Try to get their philosophy on the use of meds. Often elderly residents are on a list of meds, many of which might be antipsychotics, that frankly don't help their mental state. Same with common meds for things like cardiac issues. Enlightened care homes try to minimize meds as much as possible.

Do they have the staff to ensure that residents are given regular exercise every day? Even residents in wheelchairs need this. And they need to get out into the fresh air regularly. Do they have a family council? Virtually all nursing homes now have resident councils with monthly meetings, but they don't like to facilitate meetings among families, and this is so important to ensure good care.

Ask what training their staff has had and whose training models they follow. If they can't give you an answer, it's not a good sign.

Once you choose a nursing home, remember that your job is just beginning. You need to be a regular presence and advocate for your family member's interests. Best of luck. You are embarking on a labor of love.
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A nursing home employee once told me to look around. Select a place where all the employees are actively caring for patients. I was told by this staff member that if employees are standing in the halls chatting away with each other then the residents are being neglected and to move onto the next facility.
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My brother and I have recently placed 3 people in AL. We toured over 15 homes together, I let my eyes and my nose guide me. With 2 of the homes, we walked in the lobby and then walked out, the smell was terrible. We looked closely at the hall ways, the common areas and then the rooms themselves, the layouts. We talked to the residents, and had lunch at each facility and toured the kitchens. We checked out their reviews and the reviews of the doctors on staff. We checked the state accreditation site to see if there had been any violations, and if so, how they were handled.

Since we were looking for AL, we made sure that the facility we chose had a step up program, so that when needed they could be moved within the same facility.

When we sat down with the directors we wanted to know:

What has been the average rent increase over the last 5 years?
How long has this director been in place?
What is the average turnover of the staff?
How many patients does each CNA take care of?
Every detail on when the doctors come in to see patients, how the meds are
distributed and so on.
What is their emergency evacuation plan? We are in Florida.
Questions about bathing, cleaning, laundry and more.

Be prepared, have a list of questions with you. Take your time.

Good Luck!
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LexiPexi Feb 2020
Great ideas.
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Stop relatives of patients and ask them if they are happy with the care their loved one is getting.
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I did that before I chose a rehab facility.
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Ask about the staffing. Ask about the mission and the care of the people, their attitude. As you go through the facilities the questions will come to you. Observe the patients. Ask if you can interview patients at all (my aunt who was many years at John Knox in Missouri used to speak with people thinking of coming into the facility; she thrived there). Wishing you good luck. Ask about activities. Ask about their attitudes to visits, mealtimes, and etc. You will soon see how open or not open they are to questions.
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There are lots of checklists questions that are listed on websites about nursing home care. I also realized things that would matter to me-decor floor plan do not matter to my sister. But bright clean cheerful helps me when I walk in the door. Dull and sad do not.
We are looking to move my sister for the 4th time this year-due to her declining dementia condition-started at assisted and now needs LTC or memory care.
I did have a check list printed out that I tried to ask the same questions each time for each place. The most current situation was chosen under duress. Sister was due to be released from hospitalization for anger and combative behavior at assisted which they would not tolerate under any circumstance. Many places will not take residents with difficult "behaviors". Thankfully medication changes helped to address bad behavior so wasn't really a problem for my sister after release, but we did not have any assurance that bad behavior was not coming back. But others have this problem at current place, and were actually kind of scary to me when they got upset when I asked them to leave my sister's room-they were confused and/or just curious. Staff were not doing much to keep an eye on problem cases.
I asked about staff ratio, care plan, how much can my sister bring with her, shower schedule, who the visiting doctor is. activity schedule is worthless-nothing on the weekend even though calendar says something it supposed to happen. Residents are plopped in front of TV and or wander as no one is keeping them engaged. I tried to get a "feel" for the place-which was not a good one-when we were signing contract I ask about requirements to get out at some point. but really had no choice bad behavior is almost like a felony-will follow us where ever we apply.
Due to behaviors in the hospital we were concerned about bringing her home with us-too many practical concerns about safety etc.-crossed our fingers that maybe new place would work out in spite of my gut feeling it would not be good. Turns out it wasn't good. 4 injuries, scabies, person defecated in my sister room messing on her furniture which was not cleaned up the same day. it is hard to assess the level of care and concern the care givers will actually provide.-sorry to say don't believe the sales pitch-they are not the caregivers they are not the ones your person will be needing care from every single day.
In our case minimal attention, turn over, and too much time on their cell phones, horrible food, unlocked doors, missing and damaged clothing, in house dr. ordering RX without telling me, nurses angry with me because I would not approve more meds to further diminish my sister's ability.
Use the medicare website and look up places in your area. Due to bad care received to this point, I would not consider anything below 4-5 star rating. 150 places in a 50 mile radius only 15 met my criteria. No one has a bed and we do not have enough for left for 1 year of self pay at 10,000 a month in my area. the best place here has a 2 year wait. We are on several wait list but no promise we will ever get a spot I have exhausted myself emotionally during this impossible search for better care. A new place has opened near us-daughter of a neighbor has FIL there and says she is comfortable with the arrangement-although is a learning process for staff as more people are brought in to live there. I am giving one more shot at maybe they will take my sister-i have called over 20 places in total. if you have someone to go with you-seems to help me with a second pair of eyes might see something important you would want to know-don't settle for less than what you need or want if you can afford to wait for the right place to come along.
If not we are going to bring her home with us and pray pray and pray we can do 24-7 care without loosing our minds in the process-while knowing I have not located good day care or good home care to assist me in caring for my sister.
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GAinPA Feb 2020
My heart goes out to you. I hope you have found the care your sister needs.
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Visit during the week and on the weekend. Staffing is different from week and weekend staff. Ask family of residents about their experiences. Also observe the residents - clean, appropriately dressed, not too many bandages (older skin is fragile), people participating in activities. I have an abiding love of outdoors and appreciate places that have beautiful, open garden areas that residents can visit.
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Don't sign anything without having an elder law attorney review the paperwork. Watch out for arbitration clauses.
Check with your local office on aging and the long term care ombudsman for what they know about the places you are considering. Sometimes the most beautiful/new/ lovely facilities have dreadful staffing ratios. Do not forget they want to fill beds; once the bed is filled they may not care any longer and they may make promises that are not kept. The lowest paid workers are the ones that provide the most care. Ask about turnover (if they answer honestly).
Even if you are not a support group kind of person, you might want to check in with your local Alzheimer's Assn and go to a few meetings so you can talk to people who have dealt with this and know the inside poop...they can speak freely and know what really goes on. Beware that sometimes the closest place is not always the best either.
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I am assuming you are talking about a Memory Care facility and not about a Nursing Home.
Ask how the fees are scaled.
Will there be an increase for every little decline or will you pay a bit more up front and have no increases for a while?
What are the safeguards in place to prevent wandering?
What is done to get residents engaged?
Is mom going to have a shared or private room? If shared how are conflicts resolved if there is a problem with roommate?
Will they permit cameras in the room? If not why not.

While on your tour also inspect the kitchen area if they will allow it. If there is a resident kitchen area that the residents in Memory Care have access to check that out as well. If there are juice dispensers look to see if they have been cleaned around the nozzles, look to see how the ice scoop is stored. (If these areas are not clean it is very easy to transmit bacteria to a population that has poor immune systems)

Does the facility restrict visitors when there is an outbreak of Norovirus or any other virus?
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