Eldercare Q & A: Choosing a Nursing Home

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Q: How can I find a good nursing home?

A: In Massachusetts, 80% of the people who enter a nursing home come from a hospital first. If a hospital discharge planner says your Mother must be out in 24 hours, and gives you a list of area nursing homes—-you are suddenly under pressure to make a decision. But the goal in our state is to make nursing home care a last resort, so be sure to ask for home care alternatives as your first resort. And then:

Extend your hospital stay: Use your appeal rights under Medicare to extend the hospital stay for two days. Ask for a “notice of non-coverage.” That will buy you additional time.

Check out alternatives: Call 1-800-Age-Info, press “3” to be connected to your local Aging Services Access Point (ASAP). Ask to speak with a nursing home screener. If your relative is on MassHealth, inquire about the “community choices” program as an alternative to nursing home care, or the personal care assistance program.

Get the names of local facilities: Your ASAP can give you a list of nursing homes and put you in touch with your local nursing home ombudsman. Ask that person about their experiences with area homes-good and bad.

Look for report cards: The federal government maintains a “Nursing Home Compare” website at www.medicare.gov that will give you info on local homes. Also go to www.consumerreports.org and look for their “Nursing Home Quality Monitor.”

Check the ownership: Look first at the independent, non-profit homes, rather than at a for-profit chain. Non-profits or religious groups usually have a mission to help people, not just their bottom line. Ask if the home has changed owners multiple times. If the facility is part of a large chain, you may have a harder time complaining about bad care.

Visit Several Times: If you’ve got one or two homes on your list, make unannounced visits. Stop by after breakfast to see how many people are still in bed. Visit at dinnertime and taste the food yourself. If residents are eating in their rooms, that’s not a good sign. Ask the nurse aides how many residents they each care for. The smaller the number, the better.

Read the Reports: Ask for the home’s Form 2567. That’s the state inspection survey. If you have difficulty obtaining it, that’s not good. A survey with lots of violations indicates problems. Ask if the administrator and the director of nursing have worked at a facility for several years, that’s a positive sign. Frequent turnover of key staff can indicate bad morale or mismanagement.

Talk to the administrator. What is his or her philosophy of care? Is this philosophy written down and given to families to read?

Do advance research: Nursing homes are an expensive investment. Do some research before a family member needs care. Ask your ASAP about what alternatives exist in the community for people who might need nursing home care, and learn those options first.