Finding and Choosing a Nursing Home

When you’re looking for a nursing home for a parent or a spouse, it is a difficult job. No one wants their loved one to live in a nursing home. But sometimes it is necessary, when the care needed is more than can be provided at home or in assisted living.

Unfortunately, choosing a nursing home happens under tremendous time pressure, generally under one of three circumstances. Maybe one of these describes you.

From the Hospital to Rehabilitation

First, when your loved one is leaving the hospital for rehabilitation. Often that hospital stay is a whirlwind of activity and uncertainty, and then all of sudden you hear that your loved one will be discharged that afternoon. Don’t let that happen to you. Understand that if there is any chance that your loved one will not come straight home, start looking for a nursing home for rehabilitation immediately. At some point the discharge planner at the hospital will ask you if you have a preference between nursing homes, and you should have an answer ready. In addition, you should ask your discharge planner to find out whether the nursing home is likely to have a bed available for long-term care if care will be needed there after rehab stops. This is further discussed in the next paragraph.

After Rehab Stops

When rehab starts at the nursing home for your loved one after his/her hospital treatment, the goal will be to get your loved one better to return home. However, when the resident is no longer rehabilitating, or when Medicare stops, then the nursing home will discharge your loved one from rehabilitation and you need to locate long-term care. It may be that the nursing home will have a long-term care bed available. However, since Medicare will not be paying you will need to find another way to pay for this care, perhaps private pay, long-term care insurance or Medicaid. You may want to pay privately if this will be a short one or two month nursing home stay, but for longer stays many people explore Medicaid options. Especially for a married couple, be sure to find out if the nursing home will have a Medicaid available quickly. Generally for a married couple, it is possible to obtain assistance from Medicaid fairly quickly, while preserving most of the couple’s assets.

Entering a Nursing Home Directly from Home

Sometimes a loved one goes straight from home to a nursing home, because it’s no longer possible for him or her to live at home. In that situation, there is no hospital stay. Again, if you see this as a likelihood, start making plans early for the nursing home you want to use.

For most people finding a nursing home for a parent or spouse is something they never have done before. Here are some helpful tips that can help you:

  • Look Close-by. The single most important factor for better care an quality of life for a nursing home resident is frequent visits by family members. You need to come by frequently to visit, provide companionship, see how your loved one is doing. The care will improve based on the family’s attentiveness and advocacy. Plus, staff often reacts better knowing that the resident will have regular visits, and they appreciate your own efforts. For your loved one, your visits can brighten the day or week. So, location is important: make it convenient for family and friends to visit.
  • Talk with Others. When you visit the facility, talk with family members and residents there about the facility. You can also ask the facility to provide names of people to talk to. Ask about the care provided in the facility. Also ask whether the administration and staff respond quickly to concerns raised by the resident or relatives.
  • Check the Ratings. Look online at Medicare’s Nursing Home Compare . It is a free site for comparing the quality of nursing homes, using Five-Star Quality Ratings. You can view health inspection results, nursing home staff data, quality measures, and fire safety inspection results. You can also talk with your area’s nursing home ombudsman, at the local Area Agency on Aging.
  • Ask about the Care. You should talk with more than the admissions person at the facility. In particular, meet with the nursing home administrator and director of nursing. Ask about how care plans are developed for residents. Also ask how they respond to concerns expressed by family members.
  • Visit and Tour the Nursing Home. This is extremely important, but look beyond first impressions. Don’t be too impressed by fancy decorations. Similarly, don’t write off the nursing home because it is older and more worn. You should be more concerned about quality of care and interactions between staff and residents. Cleanliness is key. Moreover, when you visit are the CNA’s working with residents. Or are several of the CNA’s grouped together, talking to each other? Watch to see how the staff talks to and assists the residents in the hallways, and if residents are treated with respect. Also, check on the food service, for the types of food, presentation and whether it is served on time. Good food can be one of the few pleasures that can be enjoyed for some people who have little else that is enjoyable. You should also tour the facility, and you should be concerned if it does not smell clean, or if it appears that housekeeping is disorganized or neglected.

For more pointers on evaluating nursing homes, see the checklist. This checklist is also available here.

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