The Decision

Nursing home checklist: Questions to ask

• Visit the nursing home. Then visit it again. Visit during midday when most residents are up and about, having meals, interacting with staff and taking part in activities.

• Determine what is important to you and your family. For some it is amenities; for others, proximity to home and work for regular visits.

• Talk to staff, residents and their family members if you can. Ask them if they are satisfied with the nursing home and its services.

Quality of life

• During your visits, are you treated in a respectful way?

• Is the place homey and resident-directed, meaning focused on the residents and their needs and comfort, or more institutional?

• Do the residents look happy and well-cared for? Do they talk openly and freely?

• Is the facility clean? What does it look like? What does it smell like?

• Can you take part in social, recreational, religious or cultural activities that are important to you? Can you choose whether to participate?

• Do you get to choose what time to get up, go to sleep and bathe? Can you get food and drinks that you like at any time? What if you don’t like the food that is served?

• Can you have visitors any time?

• Is transportation provided to community activities?

• Can you decorate your living space any way you want?

• Will you have privacy for visits or personal care?

Quality of care

• Will you be included in planning your care? Will your interests and preferences be included in the care plan? Will you be able to change the plan if you feel there is a need? Will you be able to choose which of your family members or friends will be involved in the planning process? Will you get a copy of your care plan?

•  Does the nursing home’s inspection report show quality of care problems (deficiencies)?

Location

• Is the nursing home close to your family and friends so they can visit often?

Availability

• Is a bed available now, or can you add your name to a waiting list? Nursing homes don’t have to accept all applicants, but they must comply with civil rights laws that prohibit discrimination based on race, color, national origin, disability, age, or religion under certain conditions.

Staffing

• Ask the staff to show you the information they are required to post about the number of licensed and unlicensed nursing staff.

• How many residents does each certified nursing assistant care for on each shift?

• What is the staff annual turnover rate? Very high rates such as 40 percent to 50 percent, with half the staff new each year, could be cause for deep concern regarding morale, management or continuity of care.

• Do staff members knock on the door before entering a resident’s room and refer to residents by name?

• Do all staff members wear name tags?

• Does the nursing home perform a background check on all staff?

• Does the guide on your tour know the residents by name and is he or she recognized by them?

• Is there a registered nurse present at least eight hours per day, seven days a week?

• Does the same team of nurses and certified nursing assistants work with the same residents four or five days a week?

• Are the certified nursing assistants involved in care-planning meetings?

• How long has the nursing home’s management team, such as the director of nursing and administrator, been working together? At least a year?

• Is there a doctor, therapy staff and social worker available to meet?

Security

• Does the nursing home provide a safe environment?

• Is there a guard at the door? Does this make you feel better or worse about a nursing home?

• Are appropriate areas locked at night and/or day?

• Are there special personal monitoring devices to alert staff if a resident becomes confused and wanders in the facility?

• Is there an emergency evacuation plan? Does the facility hold regular fire drills (bed-bound residents included)?

• Does the nursing home have smoke detectors and sprinklers?

• Are there handrails in the hallways and grab bars in the bathrooms?

• Are exits clearly marked?

Residents’ rooms

• Are residents allowed to have personal belongings and/or furniture in their rooms?

• Does each resident have storage space (closet and drawers) in his or her room?

• Does each resident have a window in his or her bedroom?

• Do residents have access to a personal telephone and television?

• Do residents have a choice of roommates?

• Are there policies and procedures to protect residents’ possessions?

• Are there quiet areas where residents can visit with friends and family?

Food

• Do residents have a choice of food items at each meal?

• What is the menu like?

• Are nutritious snacks available upon request?

• Do residents all have to eat at a certain time?

• Do staff members help residents eat and drink at mealtimes if help is needed?

Activities

• Can residents, including those who are unable to leave their rooms, choose to take part in a variety of activities?

• Do the residents go on outings? Where? How regularly?

• Does the nursing home have outdoor areas for resident to use? Do staff members help residents go outside?

• Does the home have an active volunteer program?

Preventive care

• Does the nursing home make sure residents get preventive care, like yearly flu shots, to help keep them healthy?

• Does the nursing home have an arrangement with a nearby hospital for emergencies?

• Are care-plan meetings held with residents and family members at times that are convenient?

• Can you still see your personal doctor?

• Can your doctor care for you at that hospital?

Source: Centers for Medicare Medicaid Services

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