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How To Choose A Nursing Home

Overview

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It is preferable to find a nursing home that: 

  • You can afford (whether through your insurance, your own money, or a government program);
  • Is located where you want to be (such as an area that is close to family members and friends so it is easy for them to visit, and/or near community resources you hope to continue to see and use);
  • Combines good “nursing” care with an atmosphere that is acceptable to you; and
  • Takes care of your wants as well as your needs.  

The steps to take to find the best nursing home for you are as follows. 

Step 1. Locate the nursing homes in the area you want to live in

  • Two readily available sources for locating a nursing home are:
  • You can also find nursing homes through the following sources which may also be able to provide some insight about a particular home's reputation and what it is like to live there.
    • Your doctor
    • A hospital’s “discharge planner” 
    • Professionals in the long-term care field
    • Local non-profit organizations which relate to life threatening diseases. (Note: Feel free to call non-profit organizations that concern health conditions other than yours.)

Step 2. Narrow your list by checking existing data about the nursing home

For example, Medicare provides information about nursing homes and summarizes the information in ratings from one to five. Information is included about health inspections, staffing, fire safety and other quality measures. See: www.medicare.gov/NursingHomeCompare offsite link.

  • Once you find ratings for nursing homes of interest, you can look at more detailed information for up to three nursing homes at a time.
  • Keep in mind that the information on the site is reported by the nursing home. It is not generated by an independent inspection.

It may also be helpful to look at analyses of the federal data which can be found at:

The Joint Commission on Accreditation of Health Care Organizations, (JCAHO) provides accreditation to nursing homes and other health care facilities. To determine if a particular nursing home is accredited, see: www.qualitycheck.org offsite link

If you still have questions, you can contact your state's long-term-care ombudsman. The ombudsman advocates for nursing home residents. You can find your state's ombudsman at: www.ltcombudsman.org/ombudsman offsite link

Step 3. Call the nursing home and do a telephone evaluation

Once you have narrowed your search, it is time to start your own evaluation. If you start with a telephone call, you may eliminate the need to visit a particular home.  Some of the key questions to cover on the phone are:

  • Is the nursing home certified for participation in the Medicare or Medicaid programs? (This question is valid even if you are going to pay from private funds or via a long-term-care insurance policy.) 
  • Does the facility have vacancies or is there a waiting list? 
  • Is there space available for you under your payment plan?  Nursing homes are known to allocate beds between people paying full market rates and those on Medicare or Medicaid. 
  • What are the facility’s admission requirements for residents? Do you fit them? 
  • What is the typical profile of a resident?  For example, does the nursing home specialize in particular diseases? 
  • Does the facility follow Green Home principles? The Green House Project seeks to create a more homelike atmosphere in long-term-care facilities. In addition to a homier feeling, the movement calls for more patient centric care. To learn more about Green Houses, see: www.ncbcapitalimpact.org offsite link.  Then click on "Site Map", then click on "Community-Based Long-Term Care. 

NOTE: If payment is going to be through Medicare or Medicaid and there are no beds available for such payment methods: consider paying the market rate for several months and then switching to Medicare/Medicaid payment. It is difficult to move people out of a nursing home once they are in.

Step 4. Do at least one on site inspection - and preferably more.

Once you have narrowed your search, inspect the facility with a family member or friend to determine what life would be like living there. Ideally, visit the home several times. The concept is to get the idea of what a typical day is like. If you’re not up to it, ask a family member or friend to do it for you. Choosing the best home for your needs is too important a decision to leave to chance.

Preferably:

  • Do not announce your visits in advance so you see what things are like when staff is not on their best behavior.
  • Do not judge a facility by your first impression.

 If there isn’t time to do an inspection, be sure the information you receive about each home under consideration comes from a broad base of sources. Do not rely on any one source in making a decision about a nursing home.

Click here for a list of  questions to help you focus on things that will be important to you if you become a resident.  Feel free to print the list and take it with you or give it to whomever will visit the site for you. You can then write down your observations for each home visited so you can make a better comparison later.  

Bottom LineForm your own impressions. After you have done all of your research, your final judgment should include your “gut feeling.”

 Step 5. Ask a lawyer to review the contract.

If a nursing home facility uses contracts, have it reviewed by a laywer specializing in elder law. Look for terms that are important to you. For instance:

  • Can residents see their own doctor or are they restricted to doctors from the homey?
  • If your health condition gets worse, who makes the determination that it is time to move to a hospital?
  • If you have to pay money up front:
    • Is it refundable? 
    • If not fully refundable, is there at least a prorated refund in case you’re not happy there? If so, what are the terms?
  • If the contract is for a minimum term, what if you are not happy in the facility after living there for a while?
  • Who is responsible for scheduling and administering medication?
  • Does the home  permit you to use your own pharmacy or do you have to use theirs? Who is responsible for administering and coordinating your medications?
  • The place in which you will live:
    • Does the contract specify a specific unit you will live in? 
    • Can you bring your own furnishings? 
    • Is the same unit guaranteed on your return after a stay in a hospital?
  • Are there limitations on who can come to visit you?
  • Meals
    • Which meals are included?  
    • During what times?
    • Will the facility provide a special diet if you need one?
  • What does the contract provide about transportation? For example, to and from doctor appointments or for treatments. 

For :additional information see:

NOTE: Consider meeting with a geriatric care manager who can complete a clinical assessment and make a recommedation for an apropriate level of care and about particular nursing homes.


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