older people’s health issues
Nursing Homes
Selection
Even though nursing homes are monitored and regulated by government, they vary considerably in quality, personality, and cost. So people or family members who are interested in a nursing home should try to get as much information as possible. They can ask the administrator of the nursing home to see the state’s evaluation of the home. Medicare's nursing home comparison toolalso provides detailed information about every Medicare- and Medicaid-certified nursing home. The Centers for Medicare and Medicaid Services created theFive-Star Quality Rating Systemto help people needing care, their families, and caregivers compare nursing homes more easily. This rating system includes information regarding how well nursing homes are caring for their residents’ physical and clinical needs, including looking at problems that commonly develop or worsen in residents of nursing homes, including the following: A decline in the ability to do daily activities Undernutrition Weight loss Pressure sores Incontinence Pain management Constipation Infections Depression Use of too many medications Whether these rating systems are valid is debated. Nonetheless, they provide information that can help people better compare nursing homes. Other important questions to ask the administrator include Whether the nursing home is certified to provide Medicare and Medicaid coverage How often care of residents is reviewed What type of medical care is available Whether residents and family members are included in the review of care Whether there is a family and/or resident council For some questions, the administrator may direct people to the nursing home’s medical director or director of nursing. Talking to other people who are familiar with the home is helpful. Such people include long-term care ombudsmen (who visit nursing homes and investigate complaints), doctors, clergy, family members of residents, residents, and employees of the nursing home. Some homes have resident council organizations, consisting of family members and friends of residents who meet to discuss issues that come up in the nursing home. These organizations can provide family members of prospective residents with helpful information. However, making an unscheduled visit to a home for several hours is usually the best way to determine whether the quality of services is good and whether the home will be a good place for a loved one. Philosophy of Care Does the home simply provide custodial care (such as bathing, feeding, and dressing), or does it try to optimize residents' ability to care for themselves? Environment Is the nursing home attractive, friendly, homelike, and relaxed? Are there any unpleasant odors? Is the nursing home clean and well maintained? Are the dining room and other common areas bright, cheery, and pleasant? How is the noise level in common areas monitored to prevent it from disturbing residents whose rooms are nearby? Are there safe, accessible walking paths on the grounds? Is there a garden or patio? Does the nursing home have appropriate safety devices, such as fire alarms and sprinklers? What are the plans for emergencies, such as fires? Residents Is the nursing home accepting new residents? Do the residents seem reasonably happy and active, or are they wandering aimlessly or sitting and doing nothing? Are the residents clean and appropriately dressed? Are any of the residents restrained? Staff Members Do the staff members treat the residents with respect, patience, and friendliness? Are staff members experienced and qualified? Do the residents see the same staff members on a daily basis? Is there a high turnover in staff members? Do staff members respond to requests for help in a reasonable amount of time? What is the ratio of staff members to residents? Rooms Is there enough storage or closet space? Are the residents’ rooms bright and cheery? Are private rooms available? How are roommates selected? How are private items stored or secured? Can residents have their own telephone, television, and internet access? Is water available and within reach for residents who need it? Can residents decorate their rooms with personal items? Are there safety features, such as grab bars and pull cords (to call for help)? Meals What time are meals served? Are meals served hot? Are snacks available between meals? Can residents get from their room to the dining area easily? Can meals be provided in a resident’s room if needed? Are the meals tasty and nutritious? How are special dining or menu requests handled? Are choices available at meals? Can the nursing home provide special diets when needed? Is there an additional cost? Are staff members available to help with feeding during meals? Is there a registered dietitian on staff? Health Care Can residents keep their own doctor rather than use the nursing home’s doctor? How often is the nursing home’s doctor available, and where? Does the nursing home have an arrangement with a nearby hospital? If residents have to be hospitalized, will a bed be available afterward? Are other health care practitioners (such as dentists, podiatrists, physical therapists, optometrists, counselors, and social workers) available? Are therapy programs (such as physical, occupational, or speech therapy) provided? Does the nursing home have special programs for people who have disorders such as Alzheimer disease or HIV infection? What services does the nursing home provide for residents with a terminal disorder? How are prescription medications ordered and given to residents? How is the use of medications monitored? What is the policy on residents keeping nonprescription medications? Are residents and family members encouraged to participate in developing a plan for care? Services Is help with daily dental care provided? How is personal laundry done? Is reading material available? Visiting Is the nursing home conveniently located for frequent visits by family members and friends? Can family members visit any time? Activities What activities are offered? Are residents encouraged to participate? How are the residents informed of the activities? Is there an activity director? Does participation in activities cost extra? Are there rooms for other activities, such as a TV or game room? Are religious services held on the premises? Costs Are all the services that residents need covered in the basic charge? What services (such as hair salons or laundry) cost extra, and what is the cost? Residents’ Rights and Privacy Does the nursing home have an active resident or family council or both? Are residents allowed to go in and out as they please? Are restraints used? When and why? Is there a lock on the door to private rooms? Do staff members knock before entering? Can married couples live together? Are they given privacy? Are the sexual needs of residents respected? How often are residents bathed? Can residents have a bath or shower whenever they want? Are bath and shower areas kept warm enough? How much privacy is provided in these areas? Are pets allowed? Can visitors bring pets? Can residents keep food or alcohol in their rooms? What is the nursing home’s policy on lost or missing valuables? Who contacts family members in case of an emergency? If residents wish to leave, what are the policies on giving notice or refunds? 