9 things to consider before choosing a facility
En español | When you buy a house, you first hire a professional inspector to give it a thorough, top-to-bottom review. But usually you have no such resource when shopping for a nursing home. Here’s how to use your multihour visit (yes, give yourself lots of time) like a pro to make sure it is the best facility for your loved one.
1. Check the grounds
Are there nice sitting areas for residents, and are they being used? Are the garbage dumpsters reasonably clean and well concealed? Is road noise troublesome? Do you get a sense of security and safety? Imagine your loved one sitting outside the place: Would he or she be content there?
2. Schmooze with residents
Try to speak with people already living there when they’re alone, or socializing with others. Ask about living conditions and interactions with fellow residents and staff. See if they like the food and whether they’re engaged rather than warehoused. Find out what a typical day is like. Ask if there are regular events for family members. “Everyone tends to look at how pretty a place is. But pay attention to how well the residents are cared for, and cared about,’’ says Charlotte Yeh, M.D., chief medical officer for AARP Services.
3. Talk with family members
See if visitors are willing to talk for a few minutes, and get their unvarnished opinions and observations. Ask about why they chose the facility, if they have any regrets, and also if they have any tips for getting the best care and arrangements. They may also know how accommodating staff is to out-of-the-box requests, such as off-hour visiting, and if there are any quirky regulations.
4. Ask tough questions
Don’t be timid. Ask staff about their jobs, how they are managed, if they know residents by name. “You don’t want to anger anyone, but you do want to get a real sense of the place and feeling for the culture,’’ says Jennie Chin Hansen, former CEO of the American Geriatrics Society and past president of AARP. “How does staff interact with patients, and are they invested in them?”
5. Check turnover
The work is taxing, and the wages can be low, so it’s not uncommon for care operators to experience turnover among the frontline staff who interact with residents. Good organizations work to minimize this. “Heavy turnover is an indicator that the culture supporting the care workers isn’t strong,’’ Hansen says. Ask management and staff members about turnover, as well as residents. Also try to get a sense of the camaraderie of the staff; do they work as a team and appreciate each other?
6. Have a meal
Nursing homes are not restaurants, but the food should still be fresh, appetizing and healthy. The best way to tell is to have a routine lunch or dinner with the residents.
7. Give a smell and sound test
A few times during your visit, pause for a moment and engage your other senses. Are the sounds of the place calm and reassuring (be it music, laughter, conversation or activity), or are they worrisome (silence or patients in distress)? Then do the smell test: Is it clean, fresh, well-ventilated? Or do you smell urine, mustiness or overpowering cleaners?
8. Make a safety check
Start with the everyday needs: Are there handrails and nonskid floors? Are the walkways clear of wheelchairs and other equipment that could cause a fall? Then ask questions about disaster planning. What will the nursing home do if a catastrophic natural disaster hits? What is the backup plan if the disaster plan fails? How much food, water and power is available in case of an extended emergency? “These are all things you want to know,’’ says David Marcozzi, an emergency physician and former director of the National Healthcare Preparedness Programs.
9. Visit again, during off-hours
A scheduled, guided weekday visit likely will reveal the facility at its best. The real test is whether all your positive observations hold up in the off-hours. See if staffing levels seem adequate and whether the same sense of calm and positivity remains when the staff is no longer on alert.