What To Ask & Look For When Evaluating Nursing Homes

Stephen M. Garcia
The Garcia Law Firm

Recently a client called me in distress. She was compelled to move her 100-year-old grandmother to a new nursing home after the woman had been dropped by a caregiver when she was being transferred from her wheelchair to her bed.

The caregiver hid the incident. No one else noticed the pain the woman was in.

My client had been visiting long-term care facilities. After a day of walking corridors, she concluded she had no idea what questions to ask the nursing homes. She was calling me for help.

I realized then that “everyone” knows that if they have to place a loved one in a nursing home or long-term care facility it is imperative to visit the place. But few people know what to look for or what questions to ask. Here are some suggestions:

What to look for in a nursing home or long-term care facility:

  1. Who owns the nursing home? Research says residents typically receive better care at a nonprofit facility.
  2. Are a lot of the residents in bed or sitting in the hallways? Do they seem to be in stupors? This could be a sign of over-medication.
  3. Are the meals nutritionally balanced? Are the plates appetizing? Is there enough staff to assist those who need it? Ask to taste the food.
  4. Is water available at all times? Is it easily accessible to residents? Dehydration is a major health issue in nursing homes.
  5. Is the staff attentive and responsive to residents? Is there enough staff? If medical attention is necessary, how many nurses – and what types – are on each floor?
  6. Is the facility clean? Are there unpleasant odors?
  7. Does the staff have an activities director? Is a current activities schedule posted? Observe one or more activities. Are residents having fun and engaged?
  8. Are hallways accessible and public areas easy to navigate by wheelchairs and walkers? Are there handrails on the wall?
  9. Does there seem to be any language barriers between residents and staff?

Questions to ask:

  1. Ask the facility for two or three names and the contact information of former residents or family members to call as references. When you call, ask if they or their family member experienced any problems and how these problems were resolved.
  2. How long has the administrator, director of nurses, director of services, and activities director been at the facility? A long tenure by key players is a good sign.
  3. What percentage of permanent aides vs. aides from temporary agencies does the facility have? You are looking for a higher percentage of permanent aides.
  4. What kinds of activities are provided for residents? If a resident is bedridden, what sorts of activities can be brought to her room
  5. What is the ratio of staff to residents? One of the most important elements in a good nursing home or long-term care facility is the staff to resident ratio. The higher the better.
  6. What is the staff’s experience and training? How many hours of state certified training does each staff person have? Facilities that provide its staff continuous and ongoing training typically provide the best care to residents.
  7. How many staff people are available on each shift? What kind of assistance is available at night? Is there an extra charge for this?
  8. If your loved one has special needs – such as a ventilator for respiratory problems or supervision for Alzheimers or dementia – ask the facility detailed questions to make sure they can and are accustomed to providing the extra care.
  9. Ask what type of security is provided. Is there a guard at the door? Is the facility locked at night?
  10. Does the nursing home have an arrangement with a nearby hospital for emergencies? Can your loved ones usual doctor care for him or her in that hospital?
  11. Does the facility have a contract to accept Medi-Cal? Ask the facility if it will guarantee that your loved one can stay in the facility when their Medicare runs out. If you are told “yes,” GET THE GUARANTEE IN WRITING. Eviction when Medicare runs out is becoming more and more common.

Check the Nursing Homes’ Inspection History

Regardless of what answers you get or what you observe, make sure to check the nursing homes’ or long-term care facility’s inspection history.

Ask to see the nursing home’s or long-term care facility’s most recent state inspection report. If there are any deficiencies noted, ask if they have been corrected and ask to see the plan correction.

Don’t rely on the report the facility gives you. Do a little more checking. Some places to check include:

  • California Advocates for Nursing Home offers a free, online Nursing Home Guide with in-depth information on more than 1,300 Californianursing homes (www.nursinghomeguide.org).
  • Medicare.gov (www.medicare.gov)
  • California Department of Public Health lists nursing homes by county that have received AA citations (a violation that has been “determined to have been a direct proximate cause of death of a patient or resident of a long-term care facility). (http://www.cdph.ca.gov/programs/Pages/LnC.aspx)

Be an Advocate for Your Loved One

Once you have selected a nursing home or long-term care facility, visit often at different times of the day and evening. Keep your eyes and ears open. Ask questions. Make your presence and concern known to the staff. Be a “squeaky wheel.”

Being your loved one’s active and involved advocate is the best defense against nursing home neglect and elder abuse.

Free Consultation with an Elder Abuse Attorney

For more information, visit www.lawgarcia.com. If you think your loved one may be a victim of elder abuse or nursing home neglect, contact The Garcia Law Firm at (562) 216-5270 or at information@lawgarcia.com for a free, no-obligation consultation.