50+ questions to ask a nursing home

Cost

• How much is assisted living? How much is the nursing home?
• Is the facility Medicare certified? (If they are, the facility will be listed on their official website and you can review them under Nursing Home Compare. www.medicare.gov/nursinghomecompare )
• Also, do they take Medicaid?
• Is the doctor at that facility covered by Medicare?
• What does medicare cover?  
• What costs extra?

Facility   

• Are they accepting new residents?
• Is there a waiting list? How long is it?
• How many rooms are there?

• How many are taken and available?
• What is the average time spent in assisted living?
• What daily things does assisted living help with?
• How often will they be checked in on?
• Will they be on a list assigned to an aide to be checked on?
• What are the eating arrangements? Where will they eat? Can they eat whenever they want or do they have to eat at a scheduled time? Can we see the menu?
• What factors determine when a person goes from assisted living to the nursing home?
• How homey are the rooms?
• In the nursing home, what is the aide to resident ratio? Day shift? Night shift?
• Is there an RN for each unit or is the RN responsible for the entire unit?
• Are you able to visit any time any day unannounced? What are visiting hours?
• I realize the health care field is a very hard career, but on average how long do your employees stay?
• Do you use a pool agency? What agency?
• What are the citations on the last 3 state visit reports?   
• What improvements have you made in the last 3 years?
• What improvements do you currently have planned?

Activities and community involvement

• What kind of involvement is there with the other residents for a mobile resident?
• What are some activities (s)he will be doing on a day to day basis?
• Is there a community room for socialization?  
• Is there a calendar of planned events for the month?
• Are there local activities they can go to outside the nursing home?
• What is the protocol for a resident leaving with a family member or friend? Who can sign them out? How long can they be gone?
• How often are there visitors? Do you allow church groups to come sing Christmas carols or do activities with the elderly?
• Do you allow pets to visit? There are documented therapeutic benefits to playing with animals.  

Medical Care

• Will the resident be able to leave to go see her regular doctor(s)?
• When they are no longer able to leave will their regular doctor have practicing rights at this nursing home?
• Who are the general practitioners for this nursing home?
• Can we have a consultation with them before (s)he starts living here?
• May we have a list of all the physicians who provide care?
• What happens if a new doctor comes in and they are not covered by Medicare?
• How often does the doctor see the residents face to face?
• How often are care plans done?
• Who has the say so of when the resident goes from assisted living to the nursing home?
• Who has the medical authority? It’s not the resident themselves. Is it the nursing home or the family?
• Will the family have to give permission for medication to be administered?
• If the resident needs to be transferred to a hospital, which hospital would that be?
• What type of physical therapy is available in facility? Does it cost extra?
• What is your protocol for infection control?

Legal rights

• Who is in charge of the resident’s money?
• How much money will the resident be given per month? Ex. $50
• What rights does the nursing home have to the person’s money and possessions?
• How far back can they go on possessions such as a house that has been put into their child’s name? What about a car that has been put in family member’s name?

Transferred care

• If you choose to remove them from the home, what is the procedure for that?

Alzheimer’s

• Do they allow a person diagnosed with alzheimer’s to live in assisted living?
• In the nursing home, do they have an alzheimer’s unit?  
• What are the differences between your alzheimer’s unit and regular units?
• What precautions are taken to prevent an advanced alzheimer’s patient from leaving the facility unsupervised?
• How often do they use chemical restraints?
• Who makes the decision to use physical restraints?
• How does the staff handle residents with behavioral problems?
• What kind of activities do they offer for alzheimer’s patients? Ex: Painting, art, music therapy, sensory play, puzzles, busy activities, etc…
• How do you encourage a resident to do activities they are still able to do on their own? What do the nurse’s aides do to make the residents feel like they are needed and still have a purpose? Ex: folding laundry, helping with things so they feel important, etc…

 
 
RED FLAGS WHEN VISITING A NURSING HOME
Before moving in

• It just doesn’t feel right.
• Residents not looking well groomed. They appear that their hair has not been brushed, etc..
• Residents not having sufficient clothing. Do they have warm socks on? Do they have a blanket if it is cold?
• Lack of cleanliness in the facility
• Avoiding answering your questions
• Refusal to share state reports
• Residents looking sedated. Of course, some residents are going to look groggy, but does it seem like people are sedated?
• A bad smell when walking the hallways. If residents are not having clean diapers and clean bedding often enough, there will be a stench.
• Try to pay attention to how many call lights are on and how long they stay on.
• Not being allowed to visit all the parts of the nursing home including the kitchen and bathrooms.
• Bad reputation

After moving in

• Not being allowed to just drop in
• Bedsores
• Unexplained bruises
• Suspicious accidents
• Seeing the staff treat the residents with disrespect and frustration rather than respect and loving care.  
• Your gut tells you to get them out of there.

 
WHAT TO DO BEFORE PUTTING YOUR LOVED ONE IN ASSISTED CARE OR A NURSING HOME

• Ask their doctor what point they think they are at. Should they be living on their own? Is assisted living suitable? Will they do okay living with you when you are gone for hours at work? Or do they need round the clock care/supervision in a nursing home?
• Visit multiple nursing homes even if they are out of your price range.
• When you think you have the right one, take your loved one to visit. How do they like the facility? How do they interact with the other residents?
• Assign power of attorney to one of their children.
• Update their will and final arrangements. File it with the court.
• Divide belongings. Any personal items that go into a nursing home may be stolen.
• Relocate any pets to be with family members. Hopefully they will be able to visit with their pet at least once a week or month.

 
Putting a loved one in a nursing home is hard. It’s never easy to do. Remember it’s about doing what is best for them. They’re not going to like it. They’re going to be mad at first, but they will adjust. If they need round the clock medical care or supervision, it’s better to make the move sooner rather than later.