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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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Hi there... I recently came across this resource that could be helpful:

https://bit.ly/2uDRL6i

I wish you all the best and I hope this helps
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First of all I want to let all of you who try to take care of your elderly parent or relative are saints. Life is very difficult to lead on your own. It's exponentially tougher when you have to take care of your elderly relatives in your home. Especially if you are raising kids at the same time.

Everyone reaches a point where it becomes too much to take care of yourself and everyone else in your family. That's where assisted living can help.

I own 5 assisted living group homes and work my butt off to take care of my residents. So I'm sorry to see so many people think everyone one of our businesses are terrible. 80% of my staff have been with me for over 4 years. I try to take care of them as well.

Our rates are pretty affordable compared to the big facilities (I'm a small time operator). I drive a 13 year-old car with nearly 300K miles on it so I can invest back in our business, make it affordable, and take care of my staff. Many families come back to celebrate holidays at our parties even after their loved one has passed.

I just want to people to know there are people in this industry that really want to change the reputation surrounding assisted living. I put in many long days as an Air Force pilot before going into this industry. Yet I never put in the kind of hours in the AF that my managers and some employees do to cover when another employee is out or a family needs them.

Are there a lot of bad assisted living businesses out there? Certainly. It's like every other industry. But I've met a lot of other owners who are also passionate about taking care of the elderly.

Please understand that there are some good people in this industry.

To try to help people, I wrote a guide to finding the right assisted living home for your loved one. It's a huge decision and people are often overwhelmed when they arrive at that point.

I hope this helps:
http://wordpress-296287-1010367.cloudwaysapps.com/wp-content/uploads/2017/11/Right_Assisted_Living_Solution__Updated3.pdf
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LexiPexi Feb 2020
Thank you for what you provide and what you do - both for the residents and your employees.

I agree there are some very good homes and extremely good people, but in our city (Phoenix) - which is large, it is hard to find the good ones. For a first time person investigating or inquiring, it is difficult to know which one might be best. Every situation (both group home and resident) have different requirements.
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They suck, period
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As does your pin-head comment.
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I have something to add that I don't see mentioned previously. When I was looking at nursing homes for my dad, it was important to me to see that the residents were up and dressed and enjoying communal activities and eating in communal spaces. We visited some places and people were in bed - almost everyone in the middle of the day. If we didn't see activity or see people outside of their rooms, it was a definite NO. I believe that the staff need to put forth the effort to get people dressed and engaged. They need activities to keep some level of stimulation, even if they may not participate. We could definitely tell the difference within a few steps on the hallway. It was also important for us to see spaces where you could visit with your loved one outside of their room - so as not to disturb the roommate. It's certainly a difficult decision for sure. Best of luck.
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Do they put them all in a line in front of nurses station! ACTIVITIES- important for anyone it helps socialize instead of isolate. Is this a for profit facility- I found the ones that do not we’re happy to have volunteer program which adds more stimulation and help at the bingo or other activities. And do you feel “ the love”? In my husbands place it was evident. In my moms- it appears like a fancy four star hotel- night and day difference. Beautiful but nothing like I addressed above. Try and talk to a few family members while you are on tour. Ask them .
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I would first look up each nursing home’s ratings through DADS (Department of Aging and Disability). This would give you an idea of any issues. The questions I would ask the facility are: 1) the ratio of staff to patients during the day, evening, and weekends. 2) Does the staff receive heath benefits and the turnover rate. I know this may sound weird but if the nursing home company/owner is not taking care of their staff, then that reflects on the care that your love one receives.
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Review as many sites as you can about the Nursing Home that you choose. A nursing home told my mother that she was too well to stay there and less than 48 hours later, she had a stroke and did not survive.
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Before interviewing, I would suggest visiting medicare.gov and review the facilities state surveys. I would also review thestate department of health survey for the facilities as well. The Medicare website also has a checklist you can download and make copies for touring the facility. It is fine to schedule a visit but I would also advise an unscheduled visit to see how the facilityoperates especially during the off shifts (evenings,nights,weekends). Observe how the staff interacts with residents. Take a big breath as you enter the building to check for odors. Take note if the facility has the survey results posted for review. If possible speak with other family members. Don't rule out the least up to date with decor. The care, cleanliness, and concern for residents is what's most important. Crystal chandeliers in the dining room or mahogany tables not so much. It should have some pleasant atmosphere but not at the expense of resident care. For some people for profit versus non profit is a consideration as well. It is a big decision. Good luck.
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If your mom will be private pay & has roughly $ 250/ 275k to pay for average 2.5 year stay in a NH (8-9k a mo) then you have lots of options and can take your time to visit several. & more than once.

But if mom will likely outlive her $ and Medicaid is on the horizon, to me, you have got to take a hard look at to whether mom can actually transition from private pay to Medicaid and whether the facility will more than probably have a Medicaid bed available for her.

Does her needs assessment right now clearly document she needs 24/7 skilled nursing care? For Medicaid, that will be looked at. Just having dementia or needing medication management may not be enough. If she’s private pay, they don’t have to show medical need. NH likely love having a resident who is easy care. But Medicaid can find that type of resident not “at need” medically so ineligible for LTC NH Medicaid.

If she’ll be needing Medicaid, when you look at places ask how many dedicated beds are for Medicaid residents & ask how many are open & available that day. If none & a waiting list exists, ask how many are on the list for Medicaid beds & what the wait list time tends to be.

Hopefully there’s $ and Medicaid not ever an issue. But if might be, look into this now. You really don’t want to have to move her again in another few months.

If mom should be hospitalized, ask what bed hold policy is.
Some have it as long as monthly rent is paid in full, bed held forever.
Some places have waiting list so bed hold could be 30 days. Others may want fresh assessment on her or her hospitalization chart reviewed by them before she’s able to return.
If she should find herself returning as posthospitalization MediCARE rehab resident, are they set up to do all types of rehab? If NH is just about long term residential care, there may not be rehab unit or staff.

One you’ve narrowed down choices, if you can, I’d suggest you look at what activities scheduled & go to see if fits your mom’s personality. If mom could do what other residents can do. And if this NH idea of activities can work. Like if moms crafty but activities are watching movies, not ideal.

Take a peek into bathing room. A better NH will have bins or shelves with residents stuff clearly delineated. Shows attention to small details.

Also when you move her, if she has medications at old NH you need to take them. If her meds are being paid by Medicare, they won’t pay for duplicates. Drugs usually come in 90 day blister packs & held in secure part of nurses station.

Some NH do a internal needs assessment on transfers. My moms NH#2 did this. I filled out a request & allowed visit as her MPOA for a RN / SW duet from new NH to visit my mom at old NH. They called me from moms bedside and let me know all ok. New NH let me set up her room day before too; so morning of move it was very minimal chaos. Mom was ambulatory so could get herself in & out of my car. If she had needed ambulance that would have been a separate charge & not covered by MediCARE or Medicaid. She was on Medicaid, so move was timed to be right after she got her income for the month. Each NH got a to the penny copay for their # of days. No 30 day notice either as Medicaid allows for lateral transfers without penalty. I did give old place notice tho’.

Look at the current NH contract to see how notice must be done. Then clearly ask future NH if they can hold her space for that period of time.
She may end up having to double pay if timing doesn’t work out. Moving them really is a bit of a ballet to accomplish.
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The more places you look, the better you get at evaluating them. I started out looking for cleanliness, maintenance and appetizing food. If the place smelled odd or things appeared broken, it was a turn-off. Every place we looked at, we ate the food to see if it was nutritionally prepared and tasty. We looked at menus for the week. Then proximity (within 20 minutes of me), personal space and light was important to us. I looked for a place that was cheerful and had windows/outdoor space. I did ask about staff ratios, but I think a better measurement is visiting at different times/days to determine how staff is used and the attrition. I wanted my father to be able to get away from noise and have some privacy vs being put in a high traffic central location and being left there. But I also wanted a staff that was conscientious enough to come get him for social activities but would respect his wishes if he said no. It was important that he be handled like an individual. If he wanted to sleep in a little longer, they let him and kept his breakfast warm for him. They did every resident's laundry separately, so there was minimal mixing up of clothing. I think it is very important to be close by so you can drop in frequently and get to know the environment. We moved into a new small memory care as one of the first residents, but I made an effort to get to know the others and their families. He initially had a lot of attention that decreased as the facility filled up. It was important to me know how falls would be handled - whether there was nursing staff on-site to evaluate him or he would be automatically shipped off to a hospital. The one thing I forgot to check for was whether they had a lift for transfers. I did not think we would need one but eventually we did and then the facility could no longer support him. The other question was whether to turn over all his medical care to the facility doctor/nursing staff. I do not think residents of long term care facilities get enough of the doctor's time. You want to remain in the loop of medical treatment so they don't medicate without your consent. Aids are supposed to carry medicine to only one patient at a time. I found someone else's pills in my father's room once, which posed a danger to him. But in general, I feel he was safe and well cared for.
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"Every place we looked at, we ate the food to see if it was nutritionally prepared and tasty. " While this is important to consider, keep in mind that what you are served might be very different from what residents are served (you sign up for tour, so they know you are coming and can prepare a "nice" meal for you!) It is difficult to determine what the residents really get (or if they get their proper dietary needs met) until they live there. I have attended special meals at mom's MC and have also eaten spur of the moment (no way to prepare something 'special' for me!), plus everyone sits in the dining area, so you can see that you get what they get!
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If you know anyone at all in one of the NH you are considering, go and spend a day with that person so you can see how it really works.

When you go interview, you will see the 'show' rooms and be told all of the great things about the place. Mostly what you will hear is the 'expectation' of their home. They 'expect/hope' to have 4 people working each hall at all times, but that is probably not the norm. They 'expect/hope' your mom gets a bath every other night, but common short staffing issues will change that on the day of move in. How quickly do they answer calls from a patient who needs bathroom assistance?? The answer will be close to 10 minutes, however if the employee stops by the room, turns off the call light and says I'll be right back - please know that the employees call response will show under 10 minutes when, in fact, she didn't return for another 45 minutes--- much too long for an older person to wait when they need to go potty. Make it very clear you want mom to be taken to bathroom every so many hours and no diapers to be used as a convenience for staff (so they don't have to take her to potty so often). If you're mom already in diaper, this might not be an issue, however it is VERY common to start the diaper thing immediately so calls do not require response. It also means mom is not getting up/down to go to the bathroom and decline will begin right away. Whatever she is capable of doing right now - you expect it to continue.

The interview is lovely - problems are NOT brought up. Have your list with you so they understand what you expect. When you decide, arrange visitors on a regular basis to observe what is really going on. If it's a private room, you might also invest in a camera.

Best advice is to spend 2 days visiting someone just to observe. Day 1 should be early morning to afternoon. And day 2 afternoon to late evening. That's how you see how many people work a hall/how many patients on the hall. No point in hearing a fluffed up version of how great the place is from someone who wants your money when you've already see the behind the scenes.
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Invisible Feb 2020
I think 10 minutes is too long to expect someone to wait when they have to go to the bathroom. People in Memory Care can't anticipate.
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You’ve gotten some great ideas already. Beware the “there are no good nursing homes anywhere ever” responses, they are here to discourage and make you feel guilty at a time when you deserve support and positive help. More than what questions you ask, take time to observe and talk to both residents and families. You’ll soon get a sense of what’s good. You’ll see if workers are engaged, residents are content and cared for, families have a positive impression during what’s everyone’s tough season, the food looks appealing, the environment is bright and clean. I wish you the best in this, trust your judgment, and always be your loved ones advocate
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my2cents Feb 2020
I have real issues with people who get a job at a NH knowing exactly what the work entails and then figure out ways to lighten their load by way of not properly taking care of the patients. And, yes, that is common. Owners of the facilities make a great deal of money and should be investing more in ensuring they have enough employees to do the job and the staff are treating patients like they live at home.

With that said, none of the comments I make about what goes on in a NH are intended to make someone feel guilty. It it to encourage them to visit often and pay attention to what is going on. Someone has to speak up for the people who may not be able to. If you put someone there and never return to check on the care being received....then yes....I would hope there would be lots and lots of guilt.

If you've never had a relative in a NH, you have no idea what can go on there. Too many people find out when things go south. If NH becomes the best place for a person to live, it does not erase the responsibility of the family to visit and observe first hand what is really going on.
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There is not enough information in your post. I think you need to start from what needs you have and how they can meet them. I agree that they are all bad, including the 5 star facilities, and I received the same feedback from doctors I regularly visit. The facilities are intentionally understaffed. The more your loved one can communicate and make his or her needs known, the less you will need to be involved. In the long run though, you should pick a facility close by so you can follow up on the care often and at irregular times. The number one problem I saw were families transferring their loved one because of medication mix-ups. So they moved them close to home so they could be on top of it. If he or she has a need for a drug for a psychiatric condition, that will probably the one that they fail to provide.

Beware of people giving opinions on nursing homes because many of them never visit. I spoke to a personal doctor who gave glowing reviews on nursing homes. She gave facts about what nursing homes did that were clearly wrong from my experience and that of others, so I ignored her.
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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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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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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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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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Add this to your personal checklist: the time it takes to drive to the facility from your home. If you plan to visit often, an extra 15 or 20 min each way can really add up. Noise level might be a consideration too.
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Hi..
Just my 2 cents.. They are all bad.
The least are the ones that do Rehab & have a wing for live-ins.
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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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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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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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Sorry - Had issues posting, hence the multiple posts!
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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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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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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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Sharonvee, there are some articles I found on Aging Care, see if any of the articles can give you some ideas.

https://www.agingcare.com/topics/173/senior-housing
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