Long-Term Care Facility Selection Guide

or, Tips for Selecting a Short-Term/Long-Term Care Facility (Nursing Home)

At some point in your life, you may need to select a care facility either for yourself or, more likely, for someone you love. It may be that the need for full-time care is brief following a hospitalization or injury. Or, the need may be long-term as your loved one may no longer be able to care for himself/herself as the result of dementia, other debilitating illness, or injury.
The process of selecting a short/long-term care facility can be a difficult one. Often the decision needs to be made quickly and occurs within the context of strong emotions such as quilt, fear, and doubt. Therefore, the tips provided below may serve to focus one's thoughts and enable the best decision to be made for all involved.
This checklist is reprinted from the U.S. Department of Health and Human Services except where otherwise noted.

General Guidelines
Look at Daily Life	Look at how the nursing home handles payment
Look at the Care Residents Receive	Look at the environment
Look at the Care Family Caregivers Receive	Other things to note
Your rights as a nursing home resident

General Guidelines

LIST SEVERAL PLACES: Organize a list of homes to inquire about and visit. It may be wise to place your name on as many waiting lists as you can as early as possible. Being on a waiting list does not obligate you to move into that particular home, but this advance planning will give you more options when the final decision is being made.

KNOW YOUR NEEDS: You or your loved one may require some special health services: physical, occupational or speech therapy; oxygen, IV therapy or tube feeding; Alzheimer or young adult services. If you need such services, find out if the home you're looking at provides them--not all homes do. Other issues to consider are the home's location, size and affiliation.

Nursing Home Selection Considerations - Nursing Home Info, Inc.
Selecting a care provider for a loved one is a difficult task. However, identifying the particular needs of your elderly loved one before beginning the search process will help you explore the available alternatives and make an informed decision. The following Needs Assessment Survey will assist you in your search and prepare you to answer the many questions that will be posed by a facility's staff. Once completed, a summary report may be generated to help you evaluate multiple facilities and expedite the selection process.
Needs Assessment Survey

PLAN TO VISIT: Plan to visit several nursing homes. This is one of the most important steps in the process; it gives you an opportunity to do some "comparison shopping." Check with the nursing home for scheduled tours, and then make an appointment with the social worker or staff who handles admissions. If you wish, return at a later time for an unannounced visit.

During your visit, USE YOUR FIVE SENSES and let your senses guide you. Trust your instincts. It is OK to do this. If something doesn't feel right to you, it probably isn't. Your senses can help you question such things as:

Are there unpleasant odors?
Are the residents well-groomed, dressed and out of bed?
Is the noise level unusual?
Does the facility look clean?
Are staff visible? Friendly?
Are residents involved in activities?
Does the home "feel" warm, or impersonal?

When you visit a nursing home, you should carry this checklist with you. It will help you to compare one facility with another, but remember to compare facilities certified in the same category, for example, a skilled nursing facility with another skilled nursing home. Because nursing homes may be licensed in more than one category, always compare similar types of service among facilities.

Look at Daily Life

Do residents seem to enjoy being with staff?
Are most residents dressed for the season and time of day?
Does staff know the residents by name?
Does staff respond quickly to resident calls for assistance?
Are activities tailored to residents' individual needs and interests?
Are residents involved in a variety of activities?
Does the home serve food attractively?
Does the home consider personal food likes and dislikes in planning meals?
Does the home use care in selecting roommates?
Does the nursing home have a resident's council? If it does, does the council influence decisions [about resident life?
Does the nursing home have a family council? If it does, does the council influence decisions about resident life?
Does the facility have contact with community groups, such as pet therapy programs and Scouts?

Look at the Care Residents Receive

Do various staff and professional experts participate in evaluating each resident's needs and interests?
Does the resident's family participate in developing the resident's care plan?
Does the home provide rehabilitation programs, such as physical, occupational, speech and language therapies?
Does the home have any special services that meet your needs? For example, special care units for residents with dementia or with respiratory problems?
What is the facility's policy on use of physical/chemical restraints?
What levels of nursing staff provide care?
What is the facility's policy on adherence to advanced directives?

Look at the Care Family Caregivers Receive

Are there programs for family members?
Are the social service and nursing staff responsive to family members' questions, concerns and needs?
Would you feel respected by this staff?
Would you feel like a partner in care with this staff?

Look at How the Nursing Home Handles Payment

Is the facility certified for Medicare?
Is the facility certified for Medical Assistance?
Is the resident or the resident's family informed when charges are increased?
What are the facility's case mix rates?

Look at the Environment

Is the outside of the nursing home clean and in good repair?
Are there outdoor areas accessible for residents to use?
Is the inside of the nursing home clean and in good repair?
Does the nursing home have handrails in hallways and grab bars in bathrooms?
When floors are being cleaned, are warning signs displayed, or are areas blocked off to prevent accidents?
Is the nursing home free from unpleasant odors?
Are toilets convenient to bedrooms?
Do noise levels fit the activities that are going on
Is it easy for residents in wheelchairs to move around the home?
Is the lighting appropriate for what residents are doing?
Are there private areas for residents to visit with family, visitors, or physicians?
Are residents' bedrooms furnished in a pleasant manner?
Do the residents have some personal items in their bedrooms (for example, family pictures, souvenirs, a chair)?
Do the residents' rooms have accessible storage areas for residents' personal items?

Other Things to Note

Does the nursing home have a good reputation in the community?
Is there a specific affiliation?
Does the nursing home have a list of references?
Is the nursing home convenient for family or friends to visit?
Do you have questions or concerns? If so, call the local or state Long-Term Care Ombudsman Program.
Does your family member's physician have a relationship with this facility?

Your Rights as a Nursing Home Resident

Published by Minneapolis/St. Paul Metropolitan Area Agency on Aging

Before you are admitted into a nursing home, or within your first five days of occupancy, you must be informed of your rights and responsibilities as a nursing home resident. You should receive a copy of the Nursing Home Residents Bill of Rights. You should also be told about the home's policy for handling complaints. Although most homes do have a policy for handling complaints, residents have the right to call on community agencies for assistance. The Long-Term Care Ombudsman Program (in St. Louis) at 314-298-9222 can assist you with any grievances. If complaints or problems that are brought to the ombudsman attention should be investigated by a unit of government, the ombudsman will work with you to assure that the appropriate agency is notified.

NURSING HOME BILL OF RIGHTS

The interests of all nursing home residents are protected by the Patients' and Residents' Bill of Rights. Every facility must post the Bill of Rights and how to make a complaint about a violation. If the Health Department finds a violation, the facility may receive an order to correct it. Whether or not the Health Department supports your claim, you may seek other solutions through social or legal services. The following list is a summary of the law:

As a resident, you have the right:

To receive information about your legal rights upon admission, with reasonable help if you have trouble reading, hearing or understanding English. Facility policies and public health inspection reports must also be available.
To be treated courteously and respectfully by facility staff, consultants and volunteers.
To receive health care which meets your individual needs and helps you attain your physical and mental potential.
To receive a written copy of the name, office and phone number of your physician.
To receive written information about businesses outside of your facility which provide services to you.
To receive information about your medical situation--diagnosis, treatment and alternatives, risks and the likely outcome--unless you choose not to know. You may have someone you choose be with you when you talk about these things.
To request and take part in care conferences or to ask someone to attend in your place.
To have staff who are regularly assigned to your care include familiar faces as much as possible.
To refuse treatment, drugs and diets, so long as the likely consequences are fully explained. There must be written justification if this choice is denied.
To refuse to be part of experimental research. Your decision must be written in your chart and your written consent obtained before the treatment or study begins if you chose to participate.
To be free from abuse, neglect, chemical, and physical restraints, except where restraints are needed for an emergency or a specific physician ordered and documented treatment.
To privacy in medical treatment and personal care.
To the privacy of your personal and medical records. Copies can be made available to you.
To receive complete cost information about your daily rate and other services and charges, as well as help in finding out about financial assistance programs.
To prompt responses to your questions and requests.
To personal privacy in religion and cultural expression, as well as the right to be free from people entering your room unless there is an emergency.
To express your opinions and recommendations.The facility's grievance procedure, the number of the Health Complaints Office and the Ombudsman's number should be posted.
To come and go, read and write, and be provided access to a reasonably private facility telephone. The rights to come and go can be limited only under the Commitment Law or in an abuse prevention plan.
To have personal clothing and possessions to the degree space permits. The facility must make some provision for locking up the valuables you want to protect.
To refuse to do work for the facility unless some kind of service is agreed to in your treatment record.
To buy or rent items or services from the supplier of your choice, as long as the purchase meets your needs and isn't limited by the Medical Assistance law.
To manage your own finances. You should get a report four times a year if the facility is handling your personal funds.
To meet with people from the community for any purpose: religion, business, politics, and nursing home improvements, as long as you don't infringe on other residents' rights.
To organize and meet in advisory councils. You can have staff assistance, private space to meet in, and the opportunity to make recommendations about policies in your home. Facility councils have these rights too.
To privacy in visits with your spouse. Married residents may share a room if both are residents, unless a doctor decides otherwise.
To seven days notice if you are to change rooms and 30 days notice if you are to leave the home, with information on how to challenge the decision. (Generally, you are entitled to a hearing if a nursing home wants to discharge you against your will.) This notice period may be shorter in situations which the home can't control, such as a medical emergency.
To protection and advocacy services, including the opportunity for private communication with a representative of a protection or advocacy service.

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