Even if you only have a few hours to decide, don’t be discouraged; this article provides a great deal of information, in a small period of time. Scroll down and follow this step by step plan that will quickly lead you through the decision-making process.
Five key steps to locating a high quality skilled nursing home in your area:
Step 1: What are my needs?
First of all, are you sure a skilled nursing home is what you need? Your health care provider or social worker is the best one to help you with this decision, but the following list will help you understand the facility or agency that would most likely meet your needs. (scroll down)
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Assistance Available for the following needs: |
Community Services |
Home Health Agencies |
Independent Living Facilities (ILF) |
Assisted Living Facilities (ALF) |
Custodial Care in Nursing Homes |
Skilled Nursing Facilities (SNF) |
| Meals | Yes | Yes | varies | Yes | Yes | Yes |
| Transportation for shopping | Yes | varies | varies | varies | varies | varies |
| Transportation to appointments | Yes | varies | varies | varies | varies | varies |
| Housework and laundry | Yes | Yes | varies | Yes | Yes | Yes |
| Medication assistance | Yes | Yes | Yes | Yes | Yes | |
| Dressing, bathing, | Yes | varies | Yes | Yes | ||
| Getting to the bathroom or onto a bedside commode, as well as assistance with transferring into and out of chairs and the bed. | Yes | varies | Yes | Yes | ||
| Total care of bedridden patients | Yes | Yes | Yes | |||
| 24 hr supervision and safety management of people with severe thought disorders such as Alzherimers | Yes | varies | varies | |||
| Physical Therapy |
Yes |
varies |
Yes |
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| Occupational Therapy | varies | varies | Yes | |||
| Speech Therapy | varies | varies | Yes | |||
| Social Services | varies | varies | Yes | |||
| Respiratory Therapy | varies | varies | varies | |||
| Skilled Nurse Visits | Yes | Yes | Yes | |||
| IV therapy | Yes | varies | Yes | |||
| Oxygen therapy | Yes | varies | Yes | Yes | ||
| Appliance care (foley catheters, colostomies, etc) | Yes | Yes | Yes | |||
| Routine Wound care | Yes | Yes | Yes | |||
| Diabetes monitoring |
Yes |
varies |
Yes |
Yes |
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| Complete Laboratory Blood Work | Yes | Yes | ||||
| EKG, Radiology & Ultrasound Services | Yes | Yes | ||||
| Physician visits in house | varies | Yes | Yes | |||
| Complex wound care | varies | Yes | ||||
| Minor suturing | rare | |||||
| Ventilators | varies | |||||
| Renal Dialysis | varies | |||||
Step 2: Locate high quality nursing homes in your area
All skilled nursing facilities are not alike. The costs, services, environment and quality of care can vary considerably from facility to facility, so it’s important to do your research before making the decision about where to place your loved one. This is a very important decision and often an overwhelming one. Ideally, you should plan ahead and think about long-term care before you need care or before a crisis occurs. Often however, unexpected illness and disability does occur, and families are frequently faced with the need to make a sudden decision.
The following guides will give you a wealth of information about the skilled nursing facilities in your area.
- State of Florida: Nursing Home Guide The Nursing Home Guide from Florida’s Agency for Health Care Administration
- United States: Nursing Home Compare Nursing Home Compare is an extremely informative section of the Medicare website which compares all skilled nursing facilities in the United States. This is very useful and gives specific information about each nursing home including the most recent State Survey for each facility. The nursing home’s corresponding plan of correction to address the deficiencies found during the inspection are available from the nursing home or from the state survey agency at 1-888-419-3456. Be aware, however, that this is only one measure of quality, and it does not by any means tell the whole story. (Tampa Bay nursing homes are included in the North Florida section.)
Per-patient staffing levels: Avoid nursing homes with abnormally low staffing levels. High staffing levels can be a sign of good care, but not necessarily. This ratio can be distorted when poorly run nursing homes have a low occupancy of residents because they have been unhappy and left, yet the facility still has the larger staff meant for full occupancy.
Inspection details: Look over several years of inspections to see whether good or bad inspection results are a pattern. One borderline inspection might be a random anomaly.
Occupancy: Check to see if the nursing home is running close to capacity. Good facilities tend to be full. Occupancy less than 80 percent is a bad sign.
Quality measures: These numbers are meant to measure quality of care, but these numbers can easily be distorted. Staff at good homes will catch and document early signs of skin breakdown which will then reflect badly on their comparison to a more poorly run facility where these early signs are overlooked altogether. It will appear that the good facility has more skin breakdown (bed sores) than the poor one, which is not the case. In any event, this measure may not reflect quality of care.
Step 3: Ask around
Consult your doctor, and any other available health care professionals such as nurses, nurse practitioners, case managers and social workers for further guidance. There are many professionals in the community who know the best facilities in town, and the worst ones.
Step 4: Visit the facility
—This is very important, don’t skip this step
Meet the administrator, talk to the nurses, the aids, the therapists, the activities person, the residents, and look around:
- Request copies of their most recent inspection results. Inspection reports are available online, on the sites above, but there is a significant lag time before they are published online.
- Does the facility meet your specific needs such as specific oxygen delivery systems, air mattresses for wounds or fragile skin, or specialized beds for safety measures?
- Is the nursing home clean and well maintained?
- Are there odors that linger? In even the best facilities, odors do occur, but they are eliminated quickly.
- Are the furnishings appealing and comfortable?
- Is the atmosphere pleasant and warm?
- Are the hallways wide enough for ease of movement, or are they cluttered with laundry carts, dirty laundry, and equipment?
- Do the nurses appear pleasant and caring or stressed and impersonal?
- Are the patients cleaned up and ready for the day by midmorning, or are many of them sitting around in pajamas with uncombed hair in the afternoon?
- Ask the residents about the food and social activities. Do they look clean and well-groomed?
- How often do they get showers?
- Are there single rooms available? The majority of rooms are usually doubles, but single rooms are essential when patients have special needs.
- Do all rooms have private bathrooms? Do the bathrooms look and smell clean? Can you move around freely in the bathroom or is it cramped and cluttered with equipment?
- Are there hand gel sanitizer dispensers mounted in the hallways outside of each patient’s room?
- Do all beds have electric controls?
- Are meals healthy and appetizing?
- Is the kitchen clean and organized?
- Is there a registered dietician? How often available?
- Is there an activities person. How often available?
- Are there individual and group activities and a monthly calendar? Is there at least one activities room with evidence of regular use?
- Is transportation to shopping, doctors visits, and other outings available?
- What are the visiting hours. Are non Medicare patients allowed to visit home?
- Is physical therapy available? How often are the staff in the facility. Is there a physical therapy gym?
- Is speech therapy available? How often is the speech therapist in the facility?
- Is occupational therapy available? How often are the staff in the facility?
- Are the therapists licensed?
Step 5: Visit often and communicate with the staff constructively
This is also a very important factor in how well your loved one adjusts to their new home. Unfortunately, even the best skilled nursing facilities will at some point fall short of your expectations and the needs of your loved one. You will need to visit often (at least weekly), not necessarily at the same time, and be willing to communicate and work agreeably with the staff. There are two sayings that come to my mind when I think of families who have successfully communicated with the staff: “The squeaky wheel gets the grease” but also, and very importantly, “You can catch more flys with honey than vinegar”. Remember that the staff is busy and has a very hard job to do but tend to respond well and do their best for families who visit regularly, have reasonable expectations, and who are kind and considerate to them.
If family or friends are unable to visit, you might want to consider hiring a guardian to visit weekly. A patient who has no visitors and unable to speak for themselves are the most likely to be neglected when the staff gets overly busy.
Also, remember that clothing, shoes and other personal items will still be needed from time to time. All personal items should be clearly labeled with the patient’s name. Special foods are always greatly appreciated by someone who eats cafeteria food day in and day out. Planned outings, if possible, are extremely helpful in lifting the spirits of of someone confined to a nursing home. So just because you have been successful in finding the right skilled nursing facility, your job is far from over in caring for your loved one.
More useful references:
- Paying for Nursing Home Care from Medicare
