Visit Nursing Homes

The Nursing Home Inspection
Quality of Life
Quality of Care
Nutrition and Hydration
The Nursing Home Check List    

The nursing home visit is a very important step in selecting the right nursing home for you. A visit gives you an opportunity to talk with nursing home staff and, more importantly, with the people who live and receive care at the nursing home.

When you visit the nursing home you will probably be given a formal tour. This is a useful introduction to the home, but it is important that you are not overly influenced by a guided tour. Use this time to evaluate the overall atmosphere of the home.

When the tour is over tell the nursing home staff you may want to return, but don't want another formal tour. Get some suggestions of different times of the week and day to visit. This should give you a complete picture of the services and activities available to residents. When you return make sure to check with nursing home staff before entering resident care areas. Respect resident privacy when walking around.

The Nursing Home Inspection
Near the end of your visit, ask to see a copy of the nursing home's most recent inspection. An inspection is a written report that says how well the nursing home meets federal health and safety requirements. This report is like a snapshot. It shows what deficiencies were found at the time of the inspection. Deficiencies are rated on scope and severity. Scope tells you how often a certain problem occurs. Severity tells you how seriously the problem impacts the health and safety of residents.

Nursing homes are inspected about every nine to fifteen months. Usually this is done by employees of the State where the nursing home is located. Nursing homes that do not meet State and Federal requirements are subject to fines and other penalties if their deficiencies are not corrected. By law, the nursing home inspection report must be posted in an area that is convenient for residents and their visitors to see.

Quality of Life
The law requires that residents receive the necessary care and services that will enable them to reach and maintain their highest practicable level of physical, mental, and social well-being. In the last decade, different laws and regulations also have been passed to raise the quality of life and standards of care for nursing home residents.

When considering a nursing home, it is important to remember that people who are admitted into nursing homes do not leave their personalities at the door. They keep life-long preferences and habits. They still have the basic human need for respect, encouragement, and friendship.

To maintain a good quality of life, nursing home residents:

• Need to keep as much control over the events in their daily lives as possible. People can become very depressed when these basic decisions are made by others or life-long patterns are changed.

• Should have the freedom and privacy to attend to their personal needs, to participate in their care planning, and to examine their medical records.

• May only be restrained to treat medical symptoms if using them is reflected in the resident's comprehensive assessment and care plan. Benefits from using restraints should outweigh the risks of harm to the resident.

When you visit a nursing home, keep these questions in mind.

• Does the interaction between residents and the staff seem warm and friendly?

• Most residents must share their room. Do residents have a reasonable choice of roommates? How are differences between roommates resolved?

• Even though space in nursing homes is limited, having a few cherished items can be very comforting. How does the home help protect resident's property and personal items?

• Does the nursing home provide a variety of activities that residents like and allow residents to choose the activities they want to attend? Are there activities for bed-bound patients?

• Are family members encouraged to visit, and are they encouraged to bring special ethnic or religious foods on special or holy days?

Quality of Care
By law, nursing homes must make a thorough assessment of every new resident within two weeks of admission. The assessment covers important issues like the resident's mobility, skin condition, nutritional and medical status, rehabilitation needs, and daily habits.

Based upon the assessment, the home also must complete a resident care plan that helps each resident reach or keep his or her highest level of well-being. Good care plans are put together by a variety of health-care providers as well as the resident, and family and friends. Care plans may change as a resident's needs change.

Unless you have a medical or social work background, it might be difficult to assess the quality of health care the nursing home provides to its residents. However, that does not mean you cannot trust your senses: does the home look and smell clean, is it pleasantly lit, do residents seem relaxed, and do staff seem to respond quickly to call lights for help?

Other ways to evaluate the home are:

• Check the most recent State inspection report. If the home was cited for deficient practices in any quality of care areas, ask staff how they were corrected.

• Learn if the home has written policies to prevent resident abuse and neglect.

• Does there seem to be enough staff to care for the number of residents.

• Find out how long the current staff have been working at the home.

• If you have special needs (dementia, permanent kidney disease, ventilator dependency), make sure the home has experience in working with people who have had the same condition.

Even if you have a trusted doctor, ask how often the nursing home's Medical Director visits the home. You should be confident that the home's Medical Director can take care of resident needs, because he or she might be called in emergencies.

Nutrition and Hydration
Lack of proper nutrition, or malnutrition, can be a serious health problem for older people. This problem is more than not getting enough to eat. It also can mean not getting enough vitamins and minerals in their food or not being able to process food after eating.

There are different reasons for malnutrition. Some people just cannot feed themselves and the nursing home does not have enough staff to help them eat. Poor dental health can make eating difficult. Another reason for malnutrition is that people begin to lose their sense of taste and smell around 60 years of age. If food doesn't taste or smell good, people may not feel like eating. Whatever the reason, the effects of malnutrition can lead to confused thinking, a reduced resistance to illness or the ability to recover from illness, and reduced physical ability.

Dehydration is another serious health problem for many older people who may take multiple prescription drugs that dry out their bodies. Also, older people may drink less because:

• They have a decreased sense of thirst and just do not feel thirsty;

• They want to avoid going to the bathroom as often if moving about is difficult for them; or

• They do not get help quickly enough to get to the bathroom and are afraid of incontinence.

Not getting enough fluids is dangerous. It can make people more vulnerable to illness and problems like low blood pressure, dizziness, and confusion. Dehydration can even lead to hospitalization.

The Nursing Home Check List
As you visit several homes, it might become difficult to keep all of your observations straight. In the back of this publication you will find a Nursing Home Check List. Make copies of this Check List and fill out a separate Check List for every nursing home that you visit. Do this during or right after the visit while your memory is fresh.

After visiting several homes and filling out the Check List, you should be ready to decide on some homes that might be a good choice for you or the person you are helping. When you narrow your list down to a small number, it is time to conduct follow-up visits.

Follow up visits

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