Choosing a nursing home for a family member is the difficult job no one ever warned you about. You're tasked with securing a facility that will provide compassionate, high-level care to ensure your loved one's health, safety and well-being. How can you possibly find strangers who will care for your loved one as you would?
Asking for recommendations from friends and doctors is a good start. You'll get much further with information from both the U.S. News Best Nursing Homes tool and Medicare's Nursing Home Lookup to check ratings regarding:
-- The kind and amount of nurse staffing the home provides.
-- The home's diligence in meeting state health and safety standards.
-- The home's performance in key medical and behavioral measures, such as the percentage of residents receiving annual flu shots and whether residents get sufficient help with daily activities.
[RATINGS: Best Nursing Homes.]
But it takes more research to find the right fit. "I always encourage families to dig deeper and find anecdotal, informal information," says Nancy Avitable, an aging life care manager and owner of an aging life care practice in New York.
The coronavirus pandemic makes the deep dive challenging. In-person nursing home tours are either limited or simply not allowed, depending on your community and the nursing home's policies. As you use every means possible to glean information, be on the lookout for the following important qualities.
-- Proximity. The closer a facility to your home, the more likely you'll be able to go for a visit or to talk with staff. "Don't compromise on proximity to family and friends," Avitable advises.
-- Welcoming atmosphere. Don't settle on a nursing home based on the look of the building, courtyards, common spaces or rehabilitation units. "Ask for a glimpse of all the units. The sub-acute rooms (for short-term rehab stays) bring more money to the nursing home and they get renovated. You should see the rooms designated for long-term care," Avitable suggests. Consider whether the rooms are welcoming or if they look like sterile hospital rooms.
-- Safety. You want a facility that's well maintained, from the building to the furnishings and equipment. Note signs of wear and tear that can present hazards or discomfort, such as frayed carpets or worn linens or broken chairs. Also: Are fire extinguishers and exit doors handy? Ask about the plans for evacuating a facility in an emergency.
-- Adequate staffing. Sufficient staffing is crucial for your loved one's health. There should be plenty of professionals on the nursing home staff or frequently visiting the campus, including physicians, registered nurses, family counselors, certified nursing assistants and aides, physical therapists and wound care specialists.
-- Compassion. "In addition to taking a virtual tour and having conversations with administrative leaders of a facility, ask to connect and speak to nursing leaders or activity leaders to gain a feel for their communication and caring skills. I am interested in signs and signals of empathy and compassion. Ask if they are willing to share if they have family members in nursing facilities and how they made their decisions of placement. Ask them what do they enjoy the most about caring for their residents," says Dr. Frank Flowers, the senior physician adviser for Riverside University Health System, where he consults with more than 50 skilled nursing facilities.
-- Staff retention. Heavy turnover is an obvious indication of unhappy workers, whose dissatisfaction could mean worse care. "Some of best nursing homes I've worked with have high staff retention, and sometimes you'll even see generations of family members who've worked there," Avitable says. "You want staff who feel they're doing something meaningful. I like to know the longevity of the management and administrative teams as well. More continuity shows a more stable infrastructure."
-- Consistent assignment. Ask administrators and other staffers if caregivers work with the same residents every time the caregivers are on duty. This is called consistent assignment. It helps caregivers better understand residents' needs so they can provide better care. It also helps residents feel more secure and comfortable.
-- Good interaction with residents. You can pick up signs that staff members respect and care about residents in the small interactions between them. For example, do nurses knock before entering a room? Do staffers address residents casually and impersonally or politely and by name?
-- Flexible visitation. Before the pandemic, the best nursing homes offered open visiting hours. Since then, most nursing homes have tightened visitation due to COVID-19 risks. But there are other ways to see or communicate with your loved one, and that's extremely important since isolation is a serious health hazard. Look for a nursing home that makes an effort to allow residents to see their loved ones. Find out if you can schedule in-person visits, how often and under what circumstances. "Ask if window visits are available or if the recreation director will schedule video calls," Avitable says. "Will they supply an iPad or should you, and how will they keep it safe?"
-- Interesting activities for residents. Mindless games shouldn't dominate the schedule. Look for a nursing home offering many kinds of social, physical, interactive and educational activities. Also: Is an outdoor area available for walking, eating or visiting family or friends? Are activities offered for people with disabilities? Some homes offer yoga classes for those in wheelchairs, for example. Will a staff member take someone in a wheelchair outside? "Ask how the activity director would engage your family member," Avitable advises.
-- Meaningful tasks. Some nursing homes give capable residents opportunities to engage in the meaningful tasks they once did at home. For example, they could include deliver mail, bring water pitchers to residents or read to others.
-- Decision-making opportunities. Your loved one should have some say in his or her care, such as sleep and wake times, which activities to take part in, what to wear and what to eat. Ask if residents are permitted during the pandemic to socialize and eat together during meal times, and if they're allowed to eat in their room if they prefer eating alone.
Finding a nursing home with all of these qualities may be challenging, but it's possible. Once you've selected a facility, you should continue to ask questions and stay involved in your family member's care, especially if you notice any red flags such as a sudden change in policies, a noticeable change in your loved one's cognition or administrators who never seem to be around. "My most important advice is wherever you choose, keep connected with the facility," Flowers says. "Even though the connections with staff and administrators may not be in person, your demonstrations of care and concern for your loved one will only help to reinforce and enhance the attention given to your loved one."
Heidi Godman reports on health for U.S. News, with a focus on middle and older age. Her work has appeared in dozens of publications, including the Harvard Health Letter (where she serves as executive editor), the Chicago Tribune, Baltimore Sun, Orlando Sentinel and Cleveland Clinic Heart Advisor.
Heidi spent more than 20 years as a TV news anchor and health reporter at ABC affiliate WWSB and more than five years as the host of a daily health talk radio show on WSRQ-FM. Heidi has interviewed surgeons in operating rooms, scientists in laboratories and patients in all phases of treatment. She's earned numerous awards for outstanding health reporting and was the first TV broadcaster in the nation to be named a journalism fellow of the American Academy of Neurology. Heidi graduated from West Virginia University with a degree in journalism.
Connect with Heidi on Linkedin or email her at firstname.lastname@example.org.