Found a Good Nursing Home? Now Comes the Hard Part
Monitoring care requires a plan and many attentive visits
Choosing a nursing home for a loved one was never easy, and it became harder when some facilities were caught manipulating government ratings and reporting misleading data on how many patients have been injured or abused and how many nurses and nursing assistants they employ.
That requires the family to do more homework when picking a nursing home. And once the search ends, the oversight begins. Usually one family member shoulders responsibility for ensuring a loved one is safe, properly cared for and as socially engaged as circumstances allow.
Many factors can alter a nursing home’s performance. It can be a one-time event such as a change in ownership or a persistent industrywide problem like nursing staff turnover, which is near 100% annually, according to a recent study of 15,645 facilities by researchers at UCLA and Harvard Medical School.
Tips from experts:
Start by showing up
1. Visit often on an irregular schedule including mornings, evenings, weekends and holidays. This allows you to see different caregivers on different shifts and to determine if there are enough nurses and nursing assistants at all times. It also establishes that your elder adult has an active advocate.
“When an older adult doesn’t have any visitors or anyone to advocate for them, they’re less likely to get attention or have problems resolved quickly,” says Connie Chow, founder of the advice website DailyCaring.com.
This strategy is hard on people with inflexible work schedules. You can try a visitation calendar that includes family members and close friends. Or you can hire a geriatric care manager to visit. The Aging Life Care Association has an online search tool to find managers near you.
2. Pay close attention to your surroundings every visit. How is your elder spending his or her time? “Is your older adult clean, comfortable, well fed, and in good spirits?” Chow says. “Are there opportunities to socialize or participate in enjoyable activities? Does the facility and your older adult’s room look and smell clean and fresh?”
Wheelchair-bound residents left alone in front of a television or any resident dressed in mismatched, ill-fitting or stained clothes are red flags you should raise with the staff.
Ask a lot of questions
3. Ask your elder adult open-ended questions about specific topics. Instead of “How are you doing?” try “Do you get help when you need it?” “Do you like the food?” “Who do you eat with in the dining room?” and “What are your favorite activities?” Invite a narrative (in which surprising details may fall out) by saying, “Tell me about your day.”
To effectively advocate for older adults, you must know what they want. “Keep them at the center of every decision and don’t assume what they want,” says Mary Jo Saavedra, a gerontologist and author of “Eldercare 101: A Practical Guide to Later Life Planning, Care, and Wellbeing.”
4. Meet everyone who cares for your elder adult, learn their names and keep track of their titles, duties and the names of their replacements in this high-turnover field. Be respectful. Kind words will accomplish more than harsh demands.
“Too often, care work goes unnoticed or is taken for granted,” Chow says. “Most nurses and [nursing assistants] would love to receive grateful words or thoughtful cards showing their hard work is recognized. If it’s in your budget, it’s nice to show appreciation with a gift.”
5. As you get to know staff, tell them about small matters that can make a big difference. If your mother tends to misplace her glasses, that may help the staff understand why she is sometimes cranky or listless. If your father is an ex-Marine and has recently started asking to be addressed as “Colonel,” staff members can make him feel more at home by giving him that courtesy.
6. Some facilities allow families to do their older adult’s laundry or bring in special meals. Doing laundry at home can reduce the number of items that may go missing. It also knits families into the care network and helps them to better see how the nursing home works. Before bringing food, consult with the home’s dietician. Bring your own plates and utensils and take them home to wash. Try not to add to the staff’s workload.
7. If you have a concern and cannot get satisfaction from the staff, consider joining the nursing home’s family council or start one if none exists. Facilities that receive Medicare or Medicaid funds (nearly all) are required to help families form these councils, which provide mutual support for families and enable them to collaboratively monitor quality of care and to advocate.
8. Federal law also requires states to appoint long-term care ombudsmen to assist families in finding suitable facilities and to investigate complaints. The National Consumer Voice for Quality Long-Term Care has a directory of long-term care ombudsmen in every state.
9. If that’s not enough, be aware that nine states — Illinois, Kansas, Louisiana, Minnesota, New Mexico, Oklahoma, Texas, Utah and Washington — have laws permitting families to install video cameras in nursing home rooms. The laws limit how and when cameras are used in order to protect residents’ privacy as well as that of roommates, other visitors and sometimes nursing home staff.
A camera at a Seattle nursing home in 2019 recorded a nursing-home worker raping a resident with multiple sclerosis. The facility paid $8 million this month to settle the woman’s lawsuit. The worker is awaiting trial.
If all of this sounds like a burden, it is. So, Saavedra suggests friends and families remember to go out of their way to help the person primarily responsible for their loved one’s care. “A family advocate needs support as much as the older individual,” she says.