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Stressful but Vital: Picking a Nursing Home The decision is one of the hardest you will ever make. Your spouse, parent or another loved one needs care that assisted living or home health care simply cannot provide. You need to choose a nursing home. It’s a difficult and emotional task. The horror stories are well documented, and even in the best nursing homes the transition can be wrenching for the entire family. Finding a good nursing home takes research and perseverance. You want a safe, engaging and pleasant environment with caring staff and solid medical practices. “You can actually get all of that in a nursing home — if you know what to look for and how to search,” said Larry Minnix, chief executive of the American Association of Homes and Services for the Aging, a trade group for nonprofit nursing homes and other organizations for the elderly. Unfortunately, the typical search for a nursing home is made under duress. More than 60 percent of admissions come from hospitals. The patient may have broken a hip or had a stroke and now needs rehabilitative care. The hospital is in a hurry to discharge and may move quickly to get the patient moved to an available nursing home bed, regardless of the operator’s quality or reputation. In such situations, you have precious little time to do your research. What is more, these temporary stays often become permanent, depending on the individual case and sometimes on the quality of the temporary care received.
Paying for a nursing home is another huge source of stress. Medicare pays only for medically necessary care in a skilled nursing home, like physical therapy or intravenous medicine. It does not pay for what is called custodial care — help with walking, eating, bathing and other daily tasks. Instead, the majority of nursing home residents pay from personal money, long-term care insurance policies or, if they qualify, through Medicaid. The average cost of nursing home care is $200 a day, and that does not include additional fees for specialized services like care for patients with Alzeimers or dementia. . What Do You Need to Know? Every year the Centers for Medicare and Medicaid Services collect data on more than 15,000 nursing homes throughout the country. Health inspection data, staffing and quality measures are combined to come up with an overall ranking of one to five stars. To look up nursing homes in your area, go to medicare.gov and click on the nursing home compare tool. Health inspection data is only as good as the data itself. Many studies show that state inspections tend to underreport nursing home deficiencies and the seriousness of those deficiencies. Nothing substitutes for what you see, hear and smell when you visit a nursing home. Be sure to visit more than once and at different times of the day and different days of the week. Take the checklist from the Nursing Home Compare Web site with you. Trust your five senses. Does it smell like cleaning fluid and urine when you walk in or fried chicken and apple pie? You also want to see an ant farm of activity. Are the staff friendly and interacting with the residents?” Be sure to ask to speak with crucial leaders, including the executive director, lead physician and head nurse. If those people are not available, ask when you can meet with them. If you get the runaround, that could be a red flag. When you do meet with the staff, ask them if you may attend a resident council or family council meeting. These groups are usually run by family members to address concerns and improve the quality of care. You will get a good inside view of what is really going on at the nursing home from these meetings. After your visits, always ask your loved one’s doctor, clergy, friends and family what they know about the homes on your short list. State of Kentucky inspections can also be located on the website for the Office of the Inspector General. Several New Trends in Nursing Home Care Ask the nursing homes you visit if they engage in “person-centered care,” as well as “consistent assignment,” Nursing homes that provide person-centered care allow residents to wake up when they want to, eat when they want to and generally set their own schedules. Traditionally, many nursing homes have had residents wake, eat, bathe and go to bed at the same times. Consistent assignment, meanwhile, simply means that the same staff members — doctors, nurses, aides — treat the same patients each shift. The continuity of care reduces errors or problems and helps residents and staff members to develop a lasting relationship that can significantly improve a resident’s emotional well-being. Ask what the patient to nurse ratio is and how that ratio varies from shift to shift. Many facilities significantly decrease staffing on night shift when confusion in the geriatric population is noted to be worse. This can lead to falls and other injuries. Review all paperwork to insure that you are not entering into an arbitration agreement. Mandatory binding arbitration is a process by which parties “agree” to have a third party arbitrator (single arbitrator or a panel), instead of a jury or judge, resolve a dispute. Arbitrators are not required to have any legal training and they need not follow the law. Court rules of evidence and procedure, which tend to neutralize imbalances between the parties in court, do not apply. There is limited discovery making it is much more difficult for individuals to have access to important documents that may help their claim. Arbitration proceedings are secretive. There is no right to public access. Arbitrators do not write or publish detailed written opinions, so no legal precedent or rules for future conduct can be established. Their decisions are still enforceable with the full weight of the law even though they may be legally incorrect. This is especially disturbing since these decisions are binding so victims have virtually no right to appeal an arbitrator’s ruling. While arbitration clauses are said to be justified on the grounds that they are “voluntary,” this is hardly true. Arbitration clauses are usually outlined in tiny print, buried it documents and paragraphs and written in legalese that is incomprehensible to most people. Moreover, these clauses are mandatory, meaning that people are compelled to agree to arbitration even before a dispute arises (i.e., “pre-dispute.”). What To Do If Problems Arise If problems or concerns arise, especially injury or neglect, immediately notify the Director of Nursing and facility Social Worker. It is advisable that events are logged in a personal diary to help with trending of recurrent issues. Complaints can also be made to the Office of the Inspector General-Healthcare Division. These complaints can be made anonymously. If you have additional questions or request more information please email: director@kywatch.org
The Whole Truth
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