| Step 4 - Visiting Nursing Homes |
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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.
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