Nursing homes (also known as “skilled nursing facilities”) have changed over the years. The institutional, hospital-like setting of the “traditional” nursing home can still be found, but a more home-like setting is the norm in an increasing number of facilities. A nursing home provides registered or licensed nurses, available 24-hours a day, for residents who require ongoing medical attention, in addition to assistance with ADLs (activities of daily living, such as bathing, feeding and dressing). There are generally two types of nursing home placements: Temporary and Permanent.
Temporary placement in a skilled nursing facility is sometimes necessary following an accident, injury or illness that requires hospitalization. When an elderly loved one is discharged from a hospital, but still requires medical attention, finding a nursing home becomes an emergency priority. Often the hospital discharge planner, social services department or doctor can recommend a nursing home or even facilitate acceptance. This kind of placement is meant to be short-term, perhaps only several weeks to several months when skilled nursing care and rehabilitation services are needed to prepare the parent for a return home and more independent living.
When physical and/or behavioral conditions can no longer be handled in an intermediate care or assisted living type facility, or by a family member or in-home caregiver, then the move to a nursing home and the need for skilled nursing care is likely to be long-term and probably permanent. You will have more time to do research and to find the skilled nursing facility that best suits your needs and the needs of your elderly loved one.
There are a number of important factors to consider when searching for and choosing a nursing home for an elderly family member. Carefully consider and prioritize which factors are the most important and discuss these with your loved one and other family members as needed:
Structured Setting vs. Relaxed Setting
Structured nursing home settings are facilities that are run much like a hospital ward. Residents are awakened early every morning to take vitals, there are set times for meals and activities, and generally a more structured daily routine. These structured settings have been the norm for many years. However, more and more facilities are moving to a more relaxed and home-like approach to care, while still retaining their skilled nursing and rehabilitative services. In these settings residents can stay up to watch TV, sleep in if they want, even use the kitchen to prepare their own meals if they are able.
Think About It: Would your family member feel happier and more at home in a relaxed environment where there is more choice, or would she feel safer and more comfortable in a structured environment where choices are more limited? If possible discuss these options with her and involve her in the decision.
Location is especially important for family members and friends who wish to be close enough for regular visits. Also important is the proximity of the resident’s regular physician, dentist, optometrist, pharmacist, and any other specialists important to his ongoing care. If religious affiliation is important, that, too, should be considered.
Think About It: Who are the most important people in your loved one’s life? The people who keep him mentally, physically, and emotionally healthy outside of the facility he will be living in? Proximity to as many of these individuals as possible will be an important factor in deciding which facility is the best fit.
Size of Facility
A sociable, outgoing person who enjoys people and group activities may be happier in a larger facility with many scheduled activities, while someone who values quiet and solitude may thrive in a smaller nursing home.
Think About It: Would your loved one prefer the relative hustle and bustle of a larger place, or would she feel more comfortable in a small-group setting?
Does your family member need physical, occupational, vocational, speech or respiratory therapies and are they available at the facility? What kind of entertainment and recreational opportunities are provided? Do they have wide appeal and are they planned on a regular basis? Is there space to walk outside or some other way to exercise and enjoy the outdoors?
Think About It: What specific types of services does your loved one need? Would he enjoy and/or otherwise benefit from recreational and social activities organized and provided by the facility?
Cost is an obvious factor to consider. For detailed information about the cost of nursing home care, see How Much Does Nursing Home Care Cost? Some nursing homes are part of a for-profit chain, others are non-profit, perhaps run by religious or community organizations. Consider the cost differential between these two different types of facilities and how those differences may impact costs and fees over time.
Think About It: How will you and/or your loved one pay for a skilled nursing facility? What resources are available, both private and government, to pay for these services, and for how long?
A loved one who needs this level of care is vulnerable. A nursing home’s reputation is a vital piece of information to consider when choosing a safe place to live. Check reputations with sources like the Better Business Bureau. See if any serious complaints have been filed. Check ProPublica’s Nursing Home Inspect online tool, which compares nursing homes by state using data from the U.S. Centers for Medicare and Medicaid Services, including data on deficiencies and penalties imposed by regulators on specific facilities. Ask friends, family, doctors, clergy, and anyone you know who has experience with nursing homes for recommendations and, maybe more importantly, for places to avoid.
Think About It: Do you know anyone (or someone who knows someone else) who has a loved one in a nursing home or skilled nursing facility? Do you or does a family member belong to a community group or email list where you can get a glowing recommendation for nursing homes in the right location?
Use your eyes. Is the place clean, friendly, orderly, and active? Or are there residents lined up in wheelchairs watching TV? Use your nose. Does the place reek of urine or a strong disinfectant odor to cover up problems? Use your ears. Do you hear people conversing naturally, or do you hear residents frequently calling out for help or is there an unnatural silence? How is the food? Is it nutritious and appetizing? Are there choices? If you are on-site, take the opportunity, if possible, to speak to residents and/or their families to get their assessment of the home, what works well and what could be improved, and to try a meal. Ask questions and trust your instincts.
Think About It: Would you be comfortable living and eating there? Would your loved one be comfortable living and eating there?
Caregiving Policies and Culture
What is the staff turnover rate and how much and how often are they trained? What is the caregiving philosophy – for instance, is staff rotated regularly or do they stay with the same residents to develop a relationship? Are there scheduled activities–do residents go on outings if they are able? How is medical care provided? Is a physician always on call? How do they handle emergencies? How is pain treated? Is end of life care available?
Think About It: It’s the people that make a great care facility what it is. Who are these people and how are they cared for by their employers? Happy caregivers will give the best care for the one you love.
If this is to be a long-term or permanent residential placement, you need to do more research. To start, compile a list of local nursing homes. Your local Administration on Aging (AOA) office can help provide such a list, or you can start with the Internet and expand your list as you learn more about what facilities are available.
In addition to your local AOA, you will find a number of nursing home directories on the Internet. Some of them list only facilities that pay to be included or are sponsored, but others are more comprehensive and list facilities by state and location. Several sites you might try are A Place for Mom, Senior Advisor, Senior Living, and Caring.
Once you’ve compiled your list, using every resource you can find, you can start your search, maybe weeding out those that don’t seem to meet your location, cost and services requirements so the task doesn’t seem so daunting. With perseverance, and luck, you should be able to locate a nursing home that meets you and your loved one’s needs.