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Looking For A Nursing Home? Here is a checklist

by Diane

At your request I have created this checklist

Choosing a Nursing Home Checklist

When it becomes necessary for nursing home placement, you need to be prepared. At the request of the forums I have developed a checklist.
The first thing to consider is to decide on a location. It is important that you are able to visit. Once you decide on an area that will allow family and friends to visit on a regular basis, then the checklist below will allow you to identify the most suitable nursing home for your needs.

As you narrow your prospects down, it is important to visit each facility that you are interested in, more than once. After the formal tour you should return on evenings, weekends when the staffing tends to be lower.

Initial Information

Is the nursing home Medicare certified?
Is the nursing home Medicaid certified?
What levels of care does this facility offer?
Skilled care and short term rehabilitation?
Dementia care?
Long term or custodial care?
Where are the results of the most recent state survey? Can you see the results of the state survey for the past 2 or 3 years? This is important to make sure that they have made the necessary corrections to any deficits. You do not want to see the same deficit reoccurring.
Has the facility ever had their license revoked?
Have they ever been closed to admissions?
Do they have specialty units such as a locked dementia unit, ventilator unit, hospice?
Are they able to be proactive and treat infections (if and when necessary) with IV antibiotics, with out an admission to the hospital?
Does the nursing home assign a doctor to the resident in the facility? Is the doctor accessible 24 hours a day?
Can we continue to use our own doctor?
Does the nursing home have a program in the facility that utilizes nurse practitioners?
What hospital to you send residents out when there is an emergency?

For dementia units:
Is there a geriatric psychiatrist on staff if behavior problems or depression occurs?
Does the facility initiate and promote a behavior modification program if necessary?
Is there specialized training for the staff for the specialty programs? Is it ongoing education?
What is the bed availability for your specific needs?

How long has the administrator and director of nursing been in charge of this building? You really would like all the administrative staff to have a least 1 year on the building. This can suggest problems.

How many administrators or directors of nursing have been in this building over the past 2 years?

During the private pay period, what added expenses can we expect? Can we bring in our own products to save on costs? Is there a system in place to notify or communicate to the family the products that will be needed?

What is the facility policy on mail order prescription plans? Will your pharmacy repackage into your system? What will be the charge for that service? Is it mandatory that we use your pharmacy services?
Does the home have an active family council?
What is the visiting policy?
Is transportation available to take the resident to doctor appointments?
Are care plan meetings held at convenient times for families to attend? Is a phone conference available if I am not able to attend in person?
Is there an emergency generator or back up energy source? How often is it tested?

Nursing Home Appearance

Observe for cleanliness: Are the floors clean, the bathrooms clean.
Are the wastepaper baskets emptied?
Are there paper towels and soap in the dispensers?
Are the residents groomed and appropriately dressed?
Is the home free of unpleasant odors?
Is the temperature comfortable for the residents?
Is there good lighting in all areas?
Are there water pitchers in all the residents’ rooms and are they easily accessible to the residents?
Are the noise levels comfortable in the areas where the residents congregate?
Is the furniture clean and sturdy?
What are rules about smoking in the building? If you have a family member that is a smoker, it is good to know the rules and see area where they will be able to smoke.
Are the exits clearly marked?
Are there rooms available for family visits or family dinners or celebrations?
Ask where smoke detectors location? Is there a sprinkler system?
Are there handrails in the hallways?
Grab bars in the bathrooms?
What is the shower schedule for residents? Is there a tub available for those that do not care for showers?
Is the room heated when there are showers given?
Does it feel homey? Is there an opportunity to personalize a room?
Are the rooms nicely painted? Is there paint chipping or plaster cracking?
Are the hallways cleared and uncluttered?
Is the home located in a safe neighborhood?

Observe the staff
It is important not to be pleased with how a facility looks. Do not judge a book by its cover. Staffing and staff interaction and the care provided is what really matters.

Does the interaction between the staff and residents appear caring, warm and respectful?
Does the staff wear name tags?
Does the nursing home do complete background checks on the entire staff in the building? Do they wait for the results of the background check before starting employment?
Observe and note that the individual knocks and introduces themselves as they enter a resident’s room.
Is there licensed nursing staff in the building 24 hours a day/ seven days a week?
Is there a registered nurse in the building at all times? If not, is there an RN at least 8 hours a day?
Are there consistent patient assignments of nurses and certified nursing assistants at least 4 – 5 days a week? Continuity of care is important.
What is the CNA (certified nursing assistant) to patient ratio? Do you make assignments based on the difficulty of care of each individual? When a CNA has a heavier assignment, does the culture here encourage team work? Are the licensed staff willing or able to pitch in to provide are when necessary?
What is the turnover rate for CNA’s in the building? For licensed staff? Lots of turnover suggests problems.
How often are care plan meetings? Is the staff that provides care for the resident (the CNA) included in the care plan meeting?
Is there a full time social worker on staff?
Are all areas wheelchair accessible?
Does the staff ensure privacy of the patients? Are doors closed when care is being provided?
Does the staff respond quickly to lights or calls for help or safety alarms that are going off?

Residents Room
May a resident bring in their own furniture?
What type of storage and closet space is available?
Do the residents have a choice of roommates?
What is the policy for making a room change if the roommates are incompatible?
Can the resident have their own TV and telephone?
What are the policy and procedures of the facility regarding protecting resident’s possessions?

Meal, Snacks and Nutrition
When arranging your tour, ask that you be able to sample the food that is served that day.
Ask to see the monthly menu for the home.
How often does the menu change?
If the resident doesn’t like what is on the menu, is it possible to order something else? What is the procedure to do that? Are alternative available for every meal?
Ask if your favorite food is available.
Are there nutritious snacks given out on a regular basis, or are they available upon request?
How often if the weight of each resident monitored? What do you consider a significant weight loss in a month?
Does the staff assist feeding patients? Does the administration assist with feeding when needed?
Can the family bring food in for the resident? Is there a place (refrigerator, freezer or shelf) to store this food? Do the residents have a microwave available to them?
Observe the trays and food served during meal time.
Can the kitchen accommodate special needs such as kosher, vegan, vegetarian?

Activities and Socialization
Ask to see the recreational therapy or activities calendar for the month.
Observe the residents. Do they appear to be sedated? Do they seem to interact and participate in the activities?
Is there a range of activities such as daily exercise and brain fitness classes available to all residents?
Are there areas where the residents can be free to go outside and enjoy without a staff member to be there at all times? (This will limit the times a person can go out)
Are the residents able to make choices to their daily routine, such as when they want to get up, when they want to go to bed, or when they want to eat?
Is there an active resident council? Do they keep resident council meeting notes? May you review them?
Ask to speak to several residents and their family members about the facility and quality of care. For example, are they happy with the care they are receiving? How do they feel about the staff? What are their concerns or complaints about the home?

Culture and Religion
Is the home sensitive to the cultural and religious needs of the residents? Are there other resident in the home that have the same ethnic or religious backgrounds?
Are there others that speak the language of the person being placed in the facility?
Are there systems in place to communicate to the resident when they do not speak English?
Does the home have a place where religious services are provided?

Finding the right home is only half the battle. Be prepared for the admission process to be exhausting. You will be required to provide medical, personal, financial and legal records.

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