Choosing a Skilled Nursing Facility
An Informed Decision
If you are considering a move to a long-term care facility for yourself, or for your spouse, parent, other family member or friend, you will feel more confident in your choice if you know about your options and what you and your family can expect after the move.
Whether you are considering just one long term care facility, or are trying to choose from among several facilities, your decision should be an informed one. This means understanding what level of care is needed in your particular situation and making sure the facility you are considering is a good fit. Being informed includes becoming acquainted with the facility itself, its typical resident rooms, dining room, and spaces used for social activities and aspects of care, such as physical therapy. It also means getting a good feel for its residents and staff.
Taking the time to visit, observe, and ask questions not only lets you make the best selection, but also prepares you and your family to take full advantage of everything the care facility you select has to offer.
Level of Care
The level or levels of care a facility offers is the first thing to ask about. A person about to be discharged from a hospital and admitted to a nursing facility for a short period of recovery before returning home has one set of medical, therapy, and social needs. A frail or chronically ill person who requires ongoing, around the clock nursing and personal care has another set of needs. Someone with severe dementia has yet another.
These days, terms like “nursing home,” “extended care facility,” and “convalescent center” refer to facilities that provide a wider range of health care services than ever before. The facility you are looking at may offer or specialize in certain types of care. In fact, it may operate programs or units (groups of rooms on the same floor or wing) for particular categories of residents, such as a special unit for Medicare (short stay) residents, or one for residents with Alzheimer’s disease or other forms of dementia.
Ask whether the facility you’re looking into offers the right level of care for your situation . . . and whether it does so in any special way that might affect your decision.
Paying for Care
Another thing to check on is cost and who will pay. The rates facilities charge their residents vary, and it may be important for you to know which services are covered in a basic daily or monthly rate, and which ones have to be paid for as extras.
Not all facilities participate in Medicare and Medicaid, so if one of these programs covers you or the person you are helping, it is important to verify that the facility you have in mind is certified to receive that type of payment. Medicare is the federal government program for persons age 65 and over that pays for a limited period of time in a nursing facility after certain types of hospital stays. Medicaid, a program funded jointly by the state and federal governments and administered by the state, pays for extended care for persons who meet eligibility requirements tied to income and assets.
Similarly, a growing number of managed care plans, like HMOs, have payment contracts with particular long term care facilities. It is worth asking about this, as well.
Things to Look For
Visiting the facility you are considering is always a good idea. While you’re there, these are some of the important things to look for:
Residents
Do the residents appear comfortable and well cared for? Are they appropriately dressed and well groomed?
Staff
Do the facility’s employees seem knowledgeable and well organized in the tasks they are performing? Are they courteous and attentive to the residents (for example, knowing and using a resident’s name, and knocking before entering a resident’s room)? Are they wearing name tags to let residents and visitors know who they are? Are they groomed appropriately? Do they seem happy and engaged in what they are doing?
Resident Rooms
Are the residents’ rooms clean and comfortable? Do lighting, ventilation, and space seem adequate? Are the bathrooms equipped with non-skid surfaces and grab bars? If rooms are shared by two or more people, is privacy respected as much as possible?
Meals
What is the dining room like as a meal is being served? Do things seem calm and organized? Is the food appealing? Is it served hot?
Social Activities
Does the facility offer a variety of activities and outings? Does it keep residents informed and personally active as much as possible? Are calendars, posters, and photographs displayed?
Building and Grounds
Is the facility well maintained? Are there walkways or a courtyard for outdoor visits in good weather? Do stairways and hallways have safety rails?
More Questions to Ask
Many important characteristics of a facility are not visible on the surface. So you shouldn’t be reluctant about asking more questions. For example, you might ask about:
Choice of Doctor
Does your regular doctor see patients at this facility? If not, which doctors do?
Admission Agreement
What sort of written contract does the facility ask new residents to sign? Ask to see a copy.
Family Involvement
What are the opportunities for family involvement? Find out about visits, availability of support groups, and participation in care conferences and care planning.
Survey Results
All long-term care facilities are regularly inspected (“surveyed”) as part of their license renewal or in conjunction with their certification as a participant in Medicare or Medicaid. The results of the state’s most recent survey are always available for you to look over. Were there any major problems?
Facility Policies and Procedures
What does the facility ask of each resident . . . what are its “rules and regulations”? What is the policy on smoking? On loud noise? On protection of resident belongings?
Helpful Resources
Additional information about selecting a long-term care facility is usually available from:
- Hospital discharge planning staff
- Physicians and their physician assistants or nurses
- Senior Information and Assistance
- Long-Term Care Ombudsman
- Local, County, or State Office on Aging.
Copyright IlluminAge, 206-625-9128. Reprinted exclusively for individual use by long term care residents and their families. All other use, reproduction, distribution or adaptation is prohibited.