Visiting Nursing Homes: A Checklist

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A nursing-home visit is essential if you are deciding which facility is the best fit for you or your relative. Doctor and family recommendations are important, but nothing compares to what your own senses can tell you during a live visit.

The federal Centers for Medicare & Medicaid Services (CMS) sets minimum standards for nursing homes. States, however, are responsible for monitoring and ensuring that nursing homes provide the required level of care. Some states go beyond the federal requirement, but others are not so diligent.

Make sure you discuss the choices with your parent if at all possible. This may be difficult, but you can make a much better decision if you get as much information as possible about what's important to your parent: location, language spoken in the nursing home, meals, visits, activities, and so on.

If your parent is unable to participate because of cognitive impairments or a medical condition, think of what you know she values as you visit various facilities.

Just because a nursing home has a dementia or “memory care” unit is not a guarantee that it provides good quality dementia care. Many residents with dementia may not even be on the special unit, and the staff may not have special training or expertise in providing person-centered care for people with dementia. If this is a priority, you need to investigate further.

Don't rush through your nursing home visit, and make sure to visit more than once, preferably on a different time and day of the week. Evening and weekend visits are especially important, because staffing is likely to be lowest at these times. If you're using a checklist, remember that using your eyes, ears, and nose is more important than completing every item.

You can learn a lot just by observing how people talk to each other, whether there are smiles and touching, or whether the atmosphere is chilly and controlled. Often the person who takes you on a tour of the facility is a salesperson who will not be part of your daily experience after you or your parent is admitted.

Here are some categories to review during a nursing home visit, with a few specific examples:

  • Resident appearance:

    • Are the residents clean and well-groomed?

    • Are they appropriately dressed for the time of day and season?

  • Living spaces:

    • Is the nursing home clean, well-lit, and free of offensive odors? Note the use of sprays that cover up odors.

    • Is the temperature comfor`?

    • Is smoking allowed? If so, is it restricted to certain areas?

    • Are all common areas, resident rooms, and doorways designed for wheelchair use?

  • Staff:

    • Does the staff appear to be polite and respectful to the residents?

    • Does the staff wear name tags?

    • Does the management run background checks for abuse and neglect before hiring staff? Are these state or national checks?

    • Is there a full-time medical director on site? If not, how are physician services provided?

    • Is there a licensed nurse on duty 24 hours a day and a registered nurse present at least 8 hours a day?

    • How are physician services provided? Is there a medical director on site?

    • Do families ever hire private duty nurses or CNAs to supplement care?

  • Residents’ rooms:

    • Can residents have personal belongings and furniture in their rooms?

    • Is there adequate storage space?

    • What policies and procedures are in place to protect personal belongings and recover or compensate for their loss?

    • Do residents have access to a personal phone, TV, and computer? Is there access to cable TV and the Internet? What are the costs?

  • Menus and food:

    • Do residents get a choice of food at each meal?

    • Can the nursing home provide for special dietary needs (low-fat, kosher, halal)?

    • Are nutritious snacks available? How are they offered? Do residents have to request them?

    • How many staff will be in the dining room during mealtimes to assist residents?

  • Activities:

    • Ask to see a monthly activity calendar for three consecutive months, not including December (when holiday parties dominate).

    • How are residents who are unable to leave their room able to take part in activities?

    • How do staff encourage and facilitate residents’ use of outdoor areas?

    • Are trips to places outside the facility scheduled? What kind, how is transportation provided, and is there an additional cost?

    • How are residents’ views on the choice of activities solicited?

    • If your family member enjoys certain activities like reading, knitting, or attending religious services, how does staff make these available?

    • How does the facility provide opportunities to explore new activities, such as art, music, or writing?

  • Care:

    • Does the nursing home ask about someone's personal routines as soon as he is admitted? For example, someone should note what time the resident gets up in the morning, what time he goes to bed, and when he prefers to take a shower or bath. In a person-centered approach, residents have more choices about their schedule, and quality of life is the focus.

    • Is the same staff assigned to take care of the resident every day? Consistent assignment helps develop good relationships.

    • Is there transportation for doctor appointments or other reasons? Will an aide accompany the person if you or another family member can't?

    • Are there regularly scheduled care planning meetings with staff to discuss what is going well, what needs to be changed, and who will be responsible for carrying out the suggestions? If you cannot attend at the scheduled time, can the meeting be rescheduled or can you participate by conference call?

  • Safety:

    • Are exits clearly marked?

    • Are there smoke detectors and sprinklers?

    • Are handrails and grab bars appropriately placed?

    • Do you understand the details of the required emergency evacuation plan? Make sure you get a copy. What are the plans for notifying you in case of an evacuation?

  • Resident or family council — the 1987 Nursing Home Reform Law gives residents and family members the right to form independent councils to discuss issues related to care, safety, activities, or whatever else is appropriate:

    • What is the name of the head of the family council and how can you contact him or her? The person leading the family council should not be a nursing home employee. Staff may attend resident or family council meetings but only at the request of the council.

    • How does the nursing home inform family members of council meetings? Do notices appear in newswletters, bulletin boards, or in monthly billing?

    • How often does it meet?

    • What issues have been raised by the council?

    • How have these issues been addressed?

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