Nursing Home Questions

mimi427August 28, 2005

Since I will be visiting my first nursing home next week, to "check out" the facility and possibly put mom's name on their waiting list, I was wondering if those of you with experience could give me an idea of what to look for and questions to ask...I would certainly appreciate it...

Warmest wishes,


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Visit at different times, first of all. If you can walk through on your own at least once, without the director of admissions giving you the marketing spiel, it will be helpful. There are the obvious things to watch for, like the 'odors.' It's normal to smell urine or feces occasionally, if someone has an accident, but if it's every time you visit, that would raise a red flag with me.

Watch how the patients interact with the staff. You'll probably find many patients sitting outside their rooms in the hallway. Do staff know them by name? Do they say hello? How do the patients respond (those who can respond)? Do they smile? Do they seem comfortable? How does the staff treat them? Do they playfully joke with them? Are they paying attention to the patients or are they too busy talking amongst themselves?

Do administration members greet any of the patients by name? Watch for this when you get the formal tour.

Ask if there is an impaired-memory unit. Your mother might not need that now, but if there is a unit there, she would not have to be moved to another facility if the need arises.

Ask to see an activities sheet, to get an idea of what kinds of things they have. Do they have occasional events like family barbecues or teas? Is there a gathering room or living room where the patient can visit with family?

CLEANLINESS -- look at the floors, bathroom, furniture in patients' rooms. They usually keep the public areas sparkling clean. My mother's nursing home did not do a good job of cleaning the floors and bathrooms in patients' rooms.

Are patients given flu shots every year?

If you go on the Medicare website, you will probably find a nursing home checklist, also.

    Bookmark   August 28, 2005 at 10:50PM
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While you check for odors and cleanliness, keep in mind that most NH and Hospitals work with a half-staff on weekends. Saturdays will not be as good as the rest of the week. It should be reasonably clean by Sunday afternoon. Also expect some urine odor if you go early in the morning. Ask about laundry.

    Bookmark   August 29, 2005 at 8:58AM
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What do you mean, "ask about laundry?"

    Bookmark   August 29, 2005 at 9:12AM
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Some homes do the personal laundry for the patients. Others may do only sheets and towels, leaving the families to take care of clothing. Or they may do personal laundry and charge a small fee for it. It's also nice if they have a beauty shop or barber shop. Large homes usually have dentists and doctors on call for regular or emergency care.

    Bookmark   August 29, 2005 at 10:01AM
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The reason that you want facility with a doctor that makes regular calls, is that while most patients seldom need anything that the RNs can't take care of, occasionally they need a doctor to check things out. It can be very difficult to take a patient out in a car and into a doctor's office. Especially if the patient is frail, hard to handle or in a wheelchair. The same thing holds for dental care.

    Bookmark   August 29, 2005 at 10:07AM
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Be aware that if you have the nursing home do the patient's laundry, you run a high risk of things disappearing or getting lost. I don't care WHAT kind of facility it is or how good it is. I did all of my mother's laundry, had a sign on her hamper AND above it, saying "Family does laundry" and somehow things still disappeared. I would empty the basket nearly every night.

They will label the clothes, but again -- there is the risk of things getting lost from the time you send it down to be labelled to the time you get it back.

Label everything (even things like radios). You can't be too careful. Sometimes patients steal from other patients and it's not necessarily done out of maliciousness, it's just that sometimes they do not know what they are doing.

    Bookmark   August 29, 2005 at 10:36AM
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That's correct, the patients don't seem to think about things in terms of what belongs to who. My mother was very bad about this. She loved to go into the other patients rooms and if something caught her eye, she took it. If you told her that she was stealing, she would be horribly insulted and tell you very quickly that she was "not stealing." A few(thankfully a very few) of the patients are like small children when it comes to property and personal things. Buy inexpensive items.

    Bookmark   August 29, 2005 at 11:04AM
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first- look at them as if you were planning on moving in yourself. is the place clean? do the blinds work? Central A/C or individual units? if the latter, are they relatively new? (a 10 year old unit uses the cost of its replacement every summer in added power consumption)

single rooms, or roomates? (some people crave privacy, some companionship) and do they have people roomed up slap-dash, or is there some kind of thought given to it? (at one point, my father was in a room with a semi-comatose old war vet who watched John Wayne movies day and night- not much fun for my talkative father who loves broadway)

ask about the laundry. ask about social events. and outings. and physical therapy/exercise offered (this is often neglected, which I think is a crying shame, since I've SEEN patients regain mobility in a matter of weeks with daily work)

ask about the menu. if at all possible, see the kitchen as well as the dinig hall.

meet the staff on as many shifts as you can. the RN's are important- but it's the aides who are going to have the hand's on time with your mom. exhausted is standard- sullen is unacceptable.

and definatley double check their policies about bringing stuff from home- some places allow 'dorm' sized refrigerators, video games, furniture, the's was cramped, but that was mostly because of his bed, and the respirator took up so much room...but I did buy nice new drapes for his room, and left them for the next tenant.

    Bookmark   August 29, 2005 at 11:37AM
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Oh yes, Chinacat makes a good point about giving some thought to roommates. I was grateful that they did this in my mother's nursing home. When she was going from rehab into long term care, the admissions officer called me and said there was a room available with two lovely women who could converse with her. At this time, Mom was still coherent. She said she would strongly suggest I take the room, if I liked it when I saw it.

Later on, one of the roommates died and they put another woman in there, who was alert and lovely. She eventually transferred across the hall to a larger room, and a third lady came in. She, too, was lovely and alert. The remaining lady in the room was sharp as a tack and gave me a full report every day. ;-) She also watched my mother like a hawk and called for someone if my mother just seemed vaguely uncomfortable (by this point, Mom didn't talk much). So although the room was crowded, thankfully Mom always had good roommates who watched out for her.

    Bookmark   August 29, 2005 at 12:05PM
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Roommates can be a blessing. The alert ones watch out for the ones that need a little extra watching. There will be a lot of people that can't care for themselves because of wheelchairs and health conditions. They will be fully alert and can help keep any eye on things. there was one woman across the hall from mother that I kept supplied with extra money so that mother could get an extra snack and a drink every afternoon. Mother could not have managed money on her own.

    Bookmark   August 29, 2005 at 12:22PM
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After a while, Mom could no longer feed herself and the aides had to feed her. I'd rush up there after work so I could feed her her dinner, and sometimes it would take over an hour, but that was part of our visit. You know darn well no aide is going to take an hour to feed a patient. The "original" roommate in Mom's room was so funny -- she would say, "I don't LIKE the way they feed her!" and wag her finger.

I would like to go back to visit this lady, but I simply cannot go into that place. It will soon be a year since Mom passed. I sent a card to her daily aide a few weeks ago, thanking her for the wonderful care she took of Mom (and she did do a fabulous job).

    Bookmark   August 29, 2005 at 12:30PM
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Another (can be important) thing. When you talk to the staff ask how long they have been there. If you hear 15, 20, 30 yrs. you have a very contented staff. Chances are pretty good the administration respects staff and patient/residents well. If you hear a lot of 2 mo, 6 mo etc it would send up a red flag to me. Also no matter where you choose stay involved!!! Even the best places are only better with involved family.

    Bookmark   August 29, 2005 at 12:56PM
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Thanks always, you are extremely helpful. I have been gathering information off the internet and from "The 36 Hour Day", but nothing's as good as first-hand experience and I appreciate all of you.
The place I am looking at this weekend was recommended by a social worker that works with mom's doctor - he is on staff at the facility, so I'm very hopeful that this is the right place for mom; and, it's only 15 minutes from my house. On the other hand, it's about 40 mins from one sister and an hour from the other, but I've come to realize I can't please everyone. Keep your fingers crossed for me please!!! I realize that just looking at one NH, my chances are not great that this will be the right place, but because it's been recommended by her doctor's office and him being on staff there, I am very hopeful. They do have an entire section devoted to Alzheimer's too....thanks again, Mimi

    Bookmark   August 29, 2005 at 1:23PM
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I'm sure this goes without saying, Mimi, and since you are so devoted to your mother it's probably not even worth mentioning, but visit often and at different times. Statistics show that patients who have active family members get better treatment. Visiting at different times ensures that they never know when you might show up. And the best thing you can do for your mother once she is in there is to be her fierce advocate. I tried going up the food chain when I had objections to things, but by the last few weeks I had HAD it and I went right to the nursing supervisor when I had issues. There was that time when they left Mom alone with her dinner tray, knowing she needed assistance, and I came in and found her covered with food because she couldn't do it herself. The supervisor heard about that from me, and apologized profusely. It never happened again.

You have to watch for everything. Watch her skin, to make sure it isn't breaking down. Make sure she doesn't smell (most of the time, Mom didn't, but occasionally a replacement aide would not clean her sufficiently and she was incontinent).

    Bookmark   August 29, 2005 at 2:52PM
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All good advice...but I do have to strongly disagree with one suggestion (actually, more like two). First of all, going into a nursing home and touring it by yourself is an invasion of privacy. It is these people's home...and we wouldn't want to someone coming into OUR home without an invitation/escort and having strangers just looking around at our rooms or watching us eat, etc. Think about it.

Also, the idea of "popping in" for a tour is just obnoxious if you ask me. By doing so you are demanding a tour/assistance right away. In any other profession/business one wouldn't just pop in without an appointment and expect immediate service...why in a nursing home? Admissions staff have committments too and sometimes can't just drop everything to do a tour. It's merely a wives tale to believe that by doing so (popping in, that is) you will see the true going ons...but the fact of the matter that nursing home staff are exceptionally busy all of the time...they certainly don't have the time nor the inclination to say, "oh...admissions has a tour coming at 1:00 p.m. so make sure everything looks perfect!". The staff don't even KNOW when a tour is scheduled and frankly don't care. Staging COULD POSSIBLY happen in a smaller, adult home or assisted living setting I suppose but certainly not in a SNF with 100 beds or so. Typically nursing homes are what they are...and not trying to hide their imperfections from tours.

Otherwise, like I said...good advice. Good luck!

    Bookmark   September 17, 2005 at 10:51PM
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With all due respect, the discharge nurse at the hospital told me to do exactly what you claim is not good.... He called several of the facilities that I wanted to see and he told them that I would stop by sometime during business (9-5) hours. Period. They all said, fine. One home I vsited was 200 beds, and the other was 49 beds. Both had no trouble finding time for me. In one case, I was shown around by the in-take person, and in another, by the nursing director.

In the 6 weeks that Mother was in the SNF, I wandered the halls at all times. Several staff members took on the duties of tours at different times, and it was just part of the job.

And I think I can now walk into a facility and say hello to residents and walk the halls and not be an invasion of their personal homes. I don't go into private rooms unless invited, of course, but from my experience, the residents are all pleased to have a smile and a friendly hello, how are you today. And I don't think the staff cares either.

But you are right, nothing is staged. It's all real.

    Bookmark   September 18, 2005 at 12:55AM
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I didn't meant to sound harsh and in re-reading my post and I can see where I I'm sorry. In my nursing home..yes...we all accommodate tours at all times...pop-ins and all...but I also can't tell you how many times people have dropped in and demanded a tour right away...sometimes this does a dis-service to the tour-ee. In other words, if a member of the admissions department or social work department aren't available they are accommodated by members of different departments who often aren't able to answer the questions they may have nor give them any advice. They can end up walking away with incomplete information which can be quite frustrating. It is a fact of life, however, and we (meanng Nursing Home staff) are used to it but it can be a bit frustrating for us sometimes. In a perfect world everyone would make an appointment...but it certainly isn't a perfect world so that's ok.

As for the discharge planner giving you that's common practice. And again, that's ok, says to do that in all of the literature on "how to pick a nursing home", etc. but it's still, in my opinion, not necessarily the best way to go.

And although you raise very good points, Fairegold I still strongly disagree about having individuals tour independently without escort. It's a HIPPA issue...a security issue...and a dignity issue. If your loved one was living in a nursing home would you want some crazy person wandering around un-escorted? You never know who can wander in looking around. And although I agree residents LOVE visitors it is the nursing home's responsibility to maintain their safety, privacy, and dignity. A tour can say hello and even stop and chat all they want...they just better have a staff member with them! I stand firm on that issue.


    Bookmark   September 18, 2005 at 9:01AM
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I failed to mention that if you have a loved one in a nursing home and visit with the other residents...or if you did have someone in one and go back to visit with those residents who you got to know...that's wonderful! You could even become an official volunteer...all nursing home are always on the look out for devoted volunteers.

But if someone from the street just walks in and starts wandering around on their own...that's a big no-no.

    Bookmark   September 18, 2005 at 9:07AM
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I agree, I'm not walking in off the street. I was visiting my Mother and saying hello to other people. I note that official visiting hours are 12-8, so by then the showers and busy work are pretty well done. And there is a sign-in sheet for visitors.

Thanks for the clarifications.

    Bookmark   September 18, 2005 at 11:09AM
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