Step 4 - Visiting Nursing Homes

The nursing home visit is probably the most important step in selecting the right nursing home. A visit provides you with an opportunity to talk to nursing home staff, and, more importantly, with the people who live and receive care at the nursing home. When you visit the nursing home, you will probably be given a formal tour. While this may be a very useful introduction to the home, it is important that you are not overly influenced by a guided tour. When the tour is over, return to some of the places where staff are caring for residents. Be ready to ask the staff members who are caring for residents questions about their jobs and how they feel about caring for people with so many different needs. A checklist in the back of this booklet should give you some more ideas on what questions to ask. Near the beginning of your visit, spend, some time examining the nursing home's most recent survey report. By law, this report must be posted in the nursing home in an area that is accessible to visitors and residents. Surveyors compile a survey report that lists areas in which the nursing home is cited for deficient practices. Keep these deficiencies in mind as you visit the nursing home, and see whether the home has corrected the deficient practices listed on the survey report. 

What is a Survey?

All nursing homes that are certified to participate in the Medicare or Medicaid programs are visited by a team of trained State survey- ors approximately once a year. These surveyors (like inspectors) examine the home over several days and inspect the performance of the nursing home in numerous areas - including quality of life and quality of care. At the conclusion of the survey, the team reports its findings. Nursing homes with deficiencies are subject to fines and other penalties if they are not corrected. 

Over the last decade, different laws and regulations have been enacted to raise the standards of nursing home care, particularly with respect to quality of life. The law now requires that residents receive the necessary care and services that will en- able them to reach and maintain their highest practicable level of physical, mental and social well-being. In addition, civil rights law ensures equal access in all nursing homes regardless of race, color or national origin. Ask residents questions about the nursing home. Learn what they like and what their complaints are. Ask visitors or volunteers similar questions. The checklist in the back of this booklet will give you some additional ideas about what types of questions you should ask. 

Quality of Life 
When visiting nursing homes, pay special attention to quality of life issues. People who are admitted into nursing homes do not leave their personalities at the door. Nor do they lose their basic human needs for respect, encouragement, and friendliness. All individuals need to retain as much control over the events in their daily lives as possible. Nursing home residents should have the freedom and privacy to attend to their personal needs -- from managing their own finances (if mentally able) to decorating their rooms with favorite items. They should also be able to participate in their care planning and retain the right to examine their medical records. Residents may only be restrained when medically necessary (see the inside cover of this booklet for more information on restraint usage). Most importantly, staff must always respect the dignity of each individual resident. To check to see if the nursing home respects the dignity of each individual, look into these questions: 

Ľ Are staff members courteous to residents, and is the home's management responsive to concerns raised by residents? 
Ľ Does the nursing home provide a variety of activities and allow residents to choose the activities they want to attend? 
Ľ Does the nursing home provide menu choices or prepare special meals at the request of residents? (Sample the food if possible.) 
ĽAre family members encouraged to visit, and are they allowed to visit in privacy when requested? 

The checklist at the back of this booklet lists other topics you should consider when assessing whether the nursing home is sensitive to quality of life. Also, check step 6 of this booklet for additional information on the rights of residents and family members. 

Quality of Care 
Unless you have a medical or social work background, it might be difficult to assess how well the nursing home provides high quality health care to its residents. How- ever, there are still a number of actions you can take to evaluate whether the home is providing high quality health care. 

Ľ Check the survey report and see if the home was cited for deficient practices in any quality of care areas. 
Ľ Ask about the home's staffing, and ask residents if the staff are available when needed. Make sure that you are comfort- able with the number of residents assigned to each nurse and nurse aide. Be aware that there might be less staff at night or on the weekends. 
Ľ If you have any special care needs (e.g., dementia, ventilator dependency), it is generally a good idea to make sure that the home has experience in working with people who have had the same condition. 
Ľ Even if you have a trusted doctor, ask about the nursing home's physician and how of- ten he or she visits the home. Since the home's doctor may be called in case of emergencies, you should be confident that the home's doctor can take care of resident needs. 

By law, nursing homes must complete a comprehensive assessment for every new resident within two weeks of admission. The home also must complete a care plan that is designed to help each resident reach or maintain his or her highest level of well-being. Ask the home about its care planning process and make sure you agree with the home's philosophy. Remember that residents who have meaningful activities and are as independent as possible are generally better able to maintain their health. 

The Nursing Home Checklist 
On this site you will find a nursing home checklist. As you visit several homes, it might become difficult to keep all of your observations straight, so fill out the checklist shortly after every visit. Make copies of this checklist, so that you can fill out a separate checklist for every nursing home that you visit. Blank spaces have been left at the bottom of the page for you to add your own concerns to this list. If you have any gut feelings or additional observations, write them down also. 

After visiting several homes and filling out the checklist, you should be ready to decide on a short list of homes that might be a good choice for you or your relative. When you narrow your list down to a small number, it is time to conduct follow-up analysis.