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Nursing Home Considerations - Bureau of Health Workforce

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What to Consider When Choosing a Nursing Home
Wedeveloped this module under a contract from the U.S. Department of Health and Human Services, Health Resources and Services Administration. The Department of Health and Human Services, Office of Women’s Health, funded this work.Disclaimer: Some of the views expressed in this presentation module are solely the opinions of the author(s) and do not necessarily reflect the official policies of the U.S. Department of Health and Human Services or the Health Resources and Services Administration, nor does mention of the department or agency names imply endorsement by the U.S. Government.
Overview
Overarching questions:Would I want this place to be my new home?Can I see the person I am caring for living here?Adapted from Bet Tzedek Legal Services and National Senior Law Center, Nursing Home Companion (2003), and Kane R.L. and Ouellette J. (2011).The Good Caregiver. New York, New York. Penguin Press.
Location
Can the resident’s caregivers, family members, partners, neighbors and friends easily navigate to the facility?Is it close to the resident’s former home?Is it close to the resident's religious institution?
Residents
Are the residents’ clothes clean?Appropriate for the time of day?For the season of the year?Are they clean shaven?Hair combed?Nails clipped?Do they appear happy and content?Does it appear that their needs for durable medical equipment (e.g. wheelchairs, walkers) is being appropriately met?What do current residents say about the nursing home?
Residents’ Rooms
Are rooms clean and quiet?Do they have windows that open?Air conditioning? Individual thermostats?Do they have a locked space for personal items?Are rooms decorated by the residents?Are call buttons easily reached from the bed?Is there enough closet space?Is there a private phone available?Is there a television available?How many beds are in one room?
Bathrooms
Do residents have private baths and showers?If there is a communal/shared shower, are there areas for privacy?Do bathrooms have grab bars near toilets and bathtubs?Are there working call buttons?Are doors wide enough to accommodate wheelchairs?Are bathrooms clean?Do they have adequate sanitary supplies?
Food
Are the dining room and kitchen clean?Do staff assist residents who cannot feed themselves?Does the food taste, smell, and look good?Can residents choose their food?Are choices consistent with cultural and other preferences?Do they provide food that adheres to special diets?Can residents bring their own food?Will the facility store it?How is food made available between mealtimes?Are drinks, including water, always available?
Cultural Environment
Does the facility pay attention to customs and traditions such as special foods, holiday celebrations, or special festivals?How do they share and support differences in customs and traditions?Is there a specific emphasis on a given culture?Do most of the residents come from one group?Do they organize programs around specific cultures and related practices or events?Do any staff speak the native language of the potential resident?
Staff
Do employees know residents by name and address them respectfully?Do they have enough time to care for residents?Are staff regularly assigned to the same residents?Do staff smile at one another and the residents?Is the person in charge of the facility open to your questions and requests?Do they welcome the involvement of caregivers, family, partners, friends, and other visitors?
Staff (continued)
How long have staff members worked for the facility?Are they responsive to resident requests?Can residents pick their own roommate?How do staff treat married residents?How many hours/day is a registered nurse present?How many hours/day is a licensed practical nurse present?How many times/week does the facility's doctor visit?
Services and Programs
Does a licensed social worker perform social work services?Does the home have a resident council or family council?Do they offer religious services?Do community-based organizations and groups visit?Does the facility have technology available for resident use?Is web-based monitoring used or permitted?Are there quiet areas for residents?
Services and Programs (continued)
Is wheelchair-accessible transportation available for residents who want to participate in activities outside the facility?Does the facility organize activities and field trips that take into account residents’ interests and preferences?Are there private areas for residents to meet visitors or doctors?Is it safe for residents to go outside?Can they have a garden?Does the facility provide therapy in a separate room?
Dementia Care
Are there special care units/separate areas for those with late stage dementia?What are the criteria for entry into these areas?What training do staff in these units receive?What is different about the care given in these units?Do staff treat residents respectfully?Are staff able to describe the person's interests and abilities over time?Do residents look clean and appropriately dressed?
Dementia Care (continued)
Are residents restrained or secluded in other ways?Are residents permitted to leave the unit or area? If they are locked in, how is that handled?Are bed alarms used?Do the residents seem overmedicated?Are residents required to eat, sleep, drink and take medications at the same times?Is their speech slurred or do residents seem tired?
Opinions of Others
What do caregivers, family members, partners, neighbors and friends say?Does the potential resident’s doctor have an opinion about the facility?Is the doctor willing to visit the resident at the facility?
Payment
How many of the residents are covered by Medicare or by Medicaid?What changes will occur if the resident transitions to Medicaid?Does the facility work with the resident’s health care organization?What is the daily rate?What “extra charges” are not included in the daily rate, e.g., laundry?Is a deposit required? (A deposit cannot be required if the resident’s care will be covered by Medicare and/or Medicaid.)
Public Record
What does the report say onNursing Home Compare?Can you view inspection reports at the facility?What violations, if any, have been found by the local licensing and certification agency?Federal Nursing Home Regulations & State LawsNursing Home Certification & ComplianceHas the facility lost its license or federal certification?Have any lawsuits been filed against the facility?
Additional Resources
Resources
TheAlzheimer’s Association – In My Community:provides information and checklists about nursing homes in your area.Aging and Disability Resource Centers: offered by many states.Nursing home report cards: check to see if your state provides them.

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Nursing Home Considerations - Bureau of Health Workforce