Choosing a Nursing Home: Practical Advice for a Difficult and Important Decision

The selection of a nursing home is a crucial step in dealing with illness and disability. The decision to move to a nursing home is not one that should be taken lightly.

Options may exist. Other, less restrictive alternatives such as providing private care in one’s home, modification to the home, assisted living facilities and other options should be considered prior to deciding on moving into a skilled nursing facility. Once that decision is made, a nursing home should be chosen on the basis of preference, comprehensive physical inspection, location, recommendations, personnel and financial arrangements.

Although all nursing homes are regulated by state and federal agencies, not all nursing homes are equal. A report by the General Accounting Office in 1999 shows that over one-fourth of nursing homes have deficiencies so serious that residents are actually harmed or placed at risk of death or serious injury. Also, the General Accounting Office in 2002 prepared a report which concluded that abuse in nursing homes is a far-reaching problem and that the type of abuse is so serious as to cause major harm to resident’s health and well-being. Another report issued by the General Accounting Office that same year reached the obvious conclusion that there was a correlation between staffing levels and quality.

What follows is some practical advice about choosing a nursing home. The first step is to plan ahead. It is important to learn about the nursing homes in your local community, learn what kind of care each provides and the ratings of each facility, and eliminate those facilities with obvious problems. Also, consult with others including your physician and other professionals, friends and relatives who have placed someone in a nursing home. State quality ratings for nursing home facilities are maintained at the CMS web page at: https://www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcomplianc/fsqrs.html

In Massachusetts, the nursing home survey agency is the Department of Public Health, Division of Health Care Quality. This agency can be reached at 617-753-8000 or 800-462-5540. Visiting a prospective nursing home is important. When visiting, meet with key personnel including the Administrator or Director of Nursing and/or the Director of Social Services. Determine the ownership of the nursing home and whether it is run as a non-profit or a for profit corporation. Federal law requires the names of owners and board members be available to the public.

Tour the home in the company of the administrator or staff member. As you tour the home you should consider several criteria. Note the home’s general appearance and atmosphere. Is it pleasant and comfortable or are there unpleasant odors? Note individual rooms as to whether there are any personal belongings in their rooms. Are the rooms clean and comfortable? Ask about procedures used to ensure that roommates are compatible. Ask to review each resident’s activities, therapy sessions and schedules for the week. Inspect the kitchen, ask to see a menu for the week, observe food being prepared and served, and don’t be shy about asking for a sample. Also, note if the residents appear active and involved in activities. Note if you observe any residents who appear immobilized in chairs.

When speaking with nursing home personnel, ask for costs and other financial arrangements. Request a specific listing of extra charges not included in the basic monthly charge. It is likely that physician services, drugs and medication, physical therapy, diagnostic services and some personal services are not contained in the monthly bill. Ask for a copy of the admissions contract. The agreement should provide what the costs, services to be included, legal responsibilities and any other matters normally contained in a legal contract. Be observant for any clauses that would make another individual the responsible party for financial matters.

The selection of a nursing home is a highly important and individual decision to make. This decision should not be made lightly and needs to include the consideration of multiple factors. A reference guide checklist for use in choosing a nursing home is available upon request by contacting my office at 508-459-8059.