How to Choose a Nursing Home

What is a nursing home?

A nursing home is a long term care facility. Nursing homes provide care for people with illnesses and disabilities that make it impossible for them to stay in their own homes. Nursing homes are not hospitals. Because the facility is the person's home, people who live there are called residents.

The idea of living in a nursing home does not appeal to most older adults. It is also a difficult decision for most of their families. Nursing homes can, however, be a good choice for both the resident and the family if they know what to expect.

What types of care do nursing homes offer?

People are in nursing homes for many different reasons. Nursing homes may provide:

short-term comfort care for the terminally ill
a short rehabilitation stay after surgery, stroke, or other illness
respite care for the caregiver
long-term care
minimal care when the person is no longer able to live alone.

Nursing homes offer several types of services:

Nursing services. This includes giving medicines, taking care of people after they get out of the hospital, caring for wounds, giving tube feedings, and advising the person's health care provider of health concerns.
Personal care. This includes help with walking, moving from bed to chair, eating, going to the bathroom, bathing, and dressing.
Rehabilitation services. These services are provided by speech therapists, occupational therapists, and physical therapists. Several conditions need to be met for Medicare to pay for these services.
Residential services. This includes a safe setting, room and board, and planned programs for social and spiritual needs.
Medical care: A health care provider visits each resident at least every 2 months or more often if needed.

How do I select a nursing home?

Begin by researching several homes close to friends and family. Get lists of nursing homes from a hospital discharge planner, social worker, or the Area Agency on Aging.

State or local ombudsmen are officials who work on behalf of nursing home residents. They may be able to steer you toward good homes and away from bad ones. The Area Agency on Aging or your state's Department on Aging can help you find the ombudsmen in your area.

Phone each nursing home you are considering. Ask about waiting lists and admission requirements. Then visit each home, even if it does not have a bed currently available. There is no substitute for on-site visits. Pay attention to how the facility treats your request for a visit and how much they allow you to see. This will tell you a lot about their attitude toward residents and their families.

Where available, check out 3 or 4 nursing homes. The family should make a visit to each with the prospective resident, if possible.

Visit the facilities you are most seriously considering at various times of the day. Be there during meals and activities. Consider the size of residents' rooms, privacy, quality of furniture, and closet space. Look at the kitchen and laundry facilities, the recreation area, therapy rooms, and all other areas of the home. Speak to other residents and families to learn how satisfied they are with the care at that facility. Observe the home's physical aspects. Does it seem cheerful or depressing? Does it smell? Observe how staff members behave with residents. Do they seem overworked? Ask the staff if they like working there, and if so why.

What should I look for during my visit?

A good nursing home should:

Provide a safe, comfortable setting.
Maximize the remaining strengths of the older person.
Compensate for the residents' weaknesses and disabilities.
Monitor residents' health status.
Help the residents adjust emotionally and socially to the new setting.
Promote independence and individual preferences.
Meet individual care and dietary needs.

When visiting the nursing home, observe the nursing home and answer for yourself the following questions about the facility, staff, and services.

Facility

What is the condition of the building and grounds? Is it clean? Are odors present?
Are there possible safety problems, such as obstacles in the hallways, poor lighting, or inactive alarm systems on exits?
Do they have safety equipment, such as fire doors, sprinklers, privacy curtains, handrails in hallways, and grab bars in bath and toilet rooms?
What are bedroom sizes and condition of furnishings? Is there enough space for personal belongings?
Is there adequate lighting, ventilation, heating, and cooling in bedrooms?
Where are bath and toilet facilities located?
Do they have wheelchair-accessible showers and sinks?
Are common living areas accessible, adequate, and nearby?
Is the dining room attractive?
Are there safe areas to wander?

Staff and services

Is the staff visible and busy? Are they watching TV?
Are call lights answered promptly?
Are residents treated with consideration and spoken to with respect?
Are residents clean, well-groomed, and appropriately dressed in clean clothing?
Are residents wearing their dentures and eyeglasses?
Do the residents appear content?
Do the residents speak with each other?
Are many of the residents restrained?
Do the residents appear listless or appear to be over-medicated?
Do the residents have too many bruises?
Are activities going on that would be of interest to the future resident?
Does the staff offer assistance to residents who need help walking, getting in and out of bed, and dressing?
Is the food adequate and appealing? Do they provide alternative meal menus?

It may be quicker and easier for the staff to do things for the residents. However, most older adults are happier and healthier if allowed to do as much for themselves as possible. Notice whether the staff encourages residents who want to walk, dress, and feed themselves.

It is also a good idea to find out how the facility deals with residents who have problems with bladder and bower control. Do they encourage frequent trips to the bathroom and the use of adult diapers only when necessary? Or do they often use urinary catheters?

What should I ask the nursing home administrator?

The family and the future resident should meet with the administrator of the nursing home. This gives you a chance to get answers to questions about activities, social work services, available therapies, and the purchase of medicine.

Does the home employ both a full-time activities director and a full-time social worker? Generally, the better nursing homes do.
Ask to meet the Medical Director and the Director of Nursing. How much experience do they have in long term care? Do they work well together? Are they responsive to residents and nursing staff?
Are there enough nurses to meet resident needs? If the home uses a temporary agency to provide nurses, there will be less consistent care.
Are podiatry, dental, physical and occupational therapy services readily available?
Will a bed be held if the resident is hospitalized? If so, for how long, and what will it cost?
Is the facility Medicaid certified? If not, the resident will have to move when he or she runs out of private funds.
Is the facility Medicare certified? Medicare certification is very important since those facilities can offer more services to a resident coming back from a hospital.
Are the administrator and director of nursing available and accessible to patients and families? How are complaints handled?
Do residents fall often? What is their procedure regarding falls?
Do the residents have pressure ulcers (bedsores)? What skin care programs are used?
Is there a support group for families?
Is there a volunteer program for residents?
Is there a resident's council to meet with staff and plan activities?
Is special equipment available for patient needs (wheel-chairs, special beds or mattresses, walkers)?
How are emergencies handled? Is a doctor always available by phone?
Who will be informed about changes in the resident's health?
Does the home allow residents to bring some furniture from home? Does it provide adequate space and safety for clothes and personal possessions? Do personal possessions get stolen?
Who will pay for the loss of dentures, hearing aids, or glasses?
What telephone access do residents have?
Can the facility manage very complex residents with special needs?

In addition:

Ask to have all rates and charges fully explained. Ask for a list of the services and supplies that are included in the basic rate and what costs extra.

Ask for a copy of the admission contract. Ask them to explain anything that you do not fully understand. A private attorney or one from legal services at the Area Agency on Aging can provide advice if there are terms you do not understand or that seem unreasonable. It should be possible to modify the contract.

Ask for a copy of the most recent state inspection report (also called the state survey) on the facility. According to federal guidelines, nursing homes are required to provide their latest inspection report to residents and the public. The family is entitled to take a copy home. There may be a small charge for the copy. If you cannot get a copy, there may be a problem in the way the facility operates.

Most inspections identify some problems. Many of these are minor and may not affect the quality of care. You should be concerned if there are any major problems cited. Find out if the problems have been corrected and what is being done to keep them from happening again.

You must feel confident that the administrator is qualified, competent, and responsive to residents, their families, and staff. This individual is responsible for everything that happens in the home and is the person to contact when problems are encountered.

How is nursing home care paid for?

Nursing home care is paid for by personal funds, long-term care insurance, Medicaid, or Medicare. Sometimes several of these payment methods are used.

Living in a nursing facility is expensive. Nursing home care costs $50,000 to $75,000 per year. The amount you pay depends on where you live and if you have private room. Most people cannot afford these costs for very long. When they have spent all their money, many need government help to pay for nursing facility costs. The Medicaid program pays for most of the nursing facility costs in the US.

Some nursing homes will accept only private-pay residents. Although most homes will also take residents paying with Medicaid. Medicaid covers care in nursing facilities, if the resident qualifies by financial need.

To get Medicaid, you must prove that you have few assets. If you are single, you must have little or no assets. The exact amount varies by state. If you are married, the spouse at home is allowed to have about $60,000 in assets, not counting a house. Even with Medicaid, part of your income will go toward the cost of nursing facility care.

Medicare is a federal insurance program for people age 65 and older and for those who have been disabled for at least 2 years. About 2% of nursing home patients are covered by Medicare. It pays only for skilled care after at least 3 days of hospitalization, not counting the day of discharge. It covers room and board, nursing care, medicines, and all therapies. There is a 100-day limit. Only the first 20 days are covered at 100%. There are many restrictions and few people qualify for the entire 100 days at one time.

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

HIA File AGI3019F.HTM Release 9.0/2006