How to Choose a Nursing Facility

You are about to make a very complex decision. It is probably one of the most difficult decisions you will ever make. Throughout this book, we will discuss some of the most common questions and provide a checklist of issues to consider when you visit a nursing facility. The most important thing to remember is that you are looking for a home, a congregate living setting as much like home as possible. Someplace where you or your loved one will be spending a lot of time. Keep that in mind as you approach this decision.

WHAT ARE THE ADVANTAGES OF A NURSING FACILITY AS OPPOSED TO AT-HOME CARE?

You may already know the answer because you have been through the frustrating experience of trying to provide dependable, consistent care at home, on a 24-hour basis. Only nursing facilities offer comprehensive care and services to address a resident's full range of daily needs - professional and trained nursing, medical and medication monitoring, therapies, and nutritional management, as well as planned activities to meet social, religious and psychological needs, in a safe, secure setting staffed around the clock.

• AROUND-THE-CLOCK CARE: 24-hour nursing care planned by a team of concerned medical professionals.

• SAFETY AND SECURITY: greatly reduces the chance of accidents such as falls or fires; each facility provides a preventative safety management program.

• SUPERVISION: helps assure that medications are taken as prescribed, personal hygiene is attended to, meals are eaten and other daily needs are met.

• STRUCTURE: meals, medication, social activities and other daily events are scheduled giving organization and structure to the day.

• STIMULATION: the resident has the opportunity to interact with other people similar in age and to participate in a variety of activities designed to meet their special needs.

Your most immediate concern will probably be the level of medical attention needed by the resident. After talking with the resident's physician, you will have an idea of the type of care needed. Once you know the level of medical and personal service needed, you can ask for recommendations and referrals from the hospital social services staff, the rehabilitation staff, or physician.

HOW DO I FIND A NURSING FACILITY ?

Referrals are your best source. Talk to your physician, friends who have had experiences with local facilities, hospital social workers, and other health care professionals. You can also call the Texas Health Care Association at 800-380-2500 for a list of licensed facilities in your area. (The yellow pages can serve as another resource.) The next step is to pick two or three to visit. This way you can compare them and make a more knowledgeable choice.

WHAT ARE SOME IMPORTANT CONSIDERATIONS?

The most important thing is to be sure the facility is licensed as a nursing facility by the State of Texas. State regulators visit Texas facilities - unannounced - at least annually and ensure that state and federal standards are maintained. These inspection reports are available at the facility for you to review. Ask the administrator for details.

Of the many variables to consider, you must choose your particular priorities...

Accommodation Activities Cost Location

Rehabilitation programs Security & privacy for residents Therapeutic diets/special menus Visiting hours

ARE SOME CONSIDERATIONS MORE
IMPORTANT THAN OTHERS?

Fresh paint and new furniture may give a good impression, but do not tell the whole story. Nursing facilities are licensed and monitored for adherence to strict infection control standards, general cleanliness, medication administration, nursing care, and food service provisions. More important is the quality and attitude of the staff and management. By necessity, a nursing facility is a medical facility, but it should also have a warm and friendly atmosphere.

WHOM SHOULD I TALK WITH
AT A NURSING FACILITY?

Talk with everyone from the administrator to the director of admissions, nurses, visitors, volunteers, and family members of residents at the facility.

While you are observing the environment, notice whether there is good interaction between staff and residents; interaction among the staff; as well as the activity level of residents. Each facility has a social worker who serves as an advocate for the residents. You should feel comfortable visiting with the social worker, expressing concerns, and asking questions relating to your loved one's needs.

WHICH FACILITY IS BEST?

It depends on the situation of each individual resident or patient. Some facilities specialize in certain types of chronic disease care, while others may have specialized activities particularly suited to your loved one. Some facilities have religious sponsors or ethnic ties. Also, facilities offer varying levels of services.

Among the list of considerations, two criteria are obvious:

• Does the resident like the setting?
• Is the location convenient for you to visit as often as you would like?

WHEN SHOULD I VISIT?

At least one visit should be by appointment with the admissions director, social worker, or administrator so you can get a complete tour and have your questions answered. If you have the luxury of time, go during the week to talk with the administrator; then go on the weekend to observe the facility operating with less supervision. Visit during the noon or evening meal. Then visit again. Visit until you are comfortable.

WHAT ABOUT MEALS?

Talk to the dietary manager or consulting dietician. Ask for menus for the month. Also, ask how special diets are handled. Find out what the facility policy is for providing substitutions if meals are not satisfactory.

HOW ARE NURSING FACILITY
SERVICES PAID FOR?

Many people pay for their care from their own income or savings. Traditionally, medical insurance has not paid for nursing facility care. However, this is beginning to change. Check with your insurance provider or HMO to inquire about charges they will cover. Other sources sometimes available include Medicare, Medicaid, and the Veterans Administration.

• Medicare may be available for those going into a nursing facility after a hospital stay of at least three nights, as well as a skilled care diagnosis (at least one of the following therapies are needed: physical, occupational, speech, or respiratory).

• Medicaid may be available for those with modest incomes and assets of $2,000 for an individual and $3,000 for a couple or less.

• Long term care insurance is similar to other insurance in that it allows people to pay a known and affordable premium that offsets the risk of much larger out-of-pocket expenses. Although long term care insurance is relatively new, more than 100 companies now offer coverage. Several types of policies are available, but most are indemnity policies. This means that they pay a fixed dollar amount for each day you receive specified care either in a nursing facility or at home. No policy is guaranteed to cover all expenses fully.

Hospital social workers and nursing facility personnel can tell you the guidelines for these programs. Most nursing facilities have a set daily fee for a specific package of services. The facility staff should go over these fees with you upon your initial tour.

For more information on payment issues, see "Financing Long Term Care")

WILL I BE CHARGED FOR EXTRAS?

Yes. The daily or monthly fee will generally cover nursing care, room and board, meals and snacks, and activities. Other services are extra, including equipment, laundry services, medications, physician services, therapy services, and barber or beauty shop services. Some of these "ancillary" charges might be covered by your insurance provider, specific services not covered in the basic rate; some facilities have fee schedules covering these services.

WHAT ABOUT PRESCRIPTION MEDICINE ?

All nursing homes have arrangements with one or more pharmacies to meet resident prescription needs 24-hours a day.  Residents may, however, designate their own pharmacy, provided the pharmacy's services are provided on a 24-hour basis for emergency medications.

WHAT ABOUT A PERSONAL PHYSICIAN?

All nursing facility residents must have a primary physician who functions as the medical director. The resident may designate his/her own physician. However, realize the physician may choose to not make a facility visit. If this is the case, you may be faced with the option of transporting your loved one to his/her physician when such services are needed, or you can choose another physician who makes routine facility visits. The Medical Director is in the facility often, usually assuming the role of primary physician for those needing his or her care. You can also request from the nursing facility a list of physicians who practice in that facility.

WHAT IS A FAMILY COUNCIL?

Most facilities have a family council, which is a group of individuals who have friends or relatives in the facility. These councils serve as support groups for families, and suggest ideas, activities and changes for the facility to better serve its residents. If the facility you choose does not have a family council, you might talk to the administrator or social worker about starting one. Ask the administrator for a list of other types of support groups.

WILL THE NURSING FACILITY REQUIRE
A PHYSICAL EXAM FOR ADMISSION?

All residents must have a complete medical history and a physical exam by a physician at or near the time of admission. If the resident is coming straight from the hospital, hospital personnel will need to provide the records to the facility to prevent duplication of tests, expense, and stress to the resident. While at the nursing facility, the resident will have a physical exam at least once a year and at any other time the nursing facility staff believes it is necessary. Because nursing facilities are so extensively regulated - especially if you are relying on Medicare or Medicaid - you may run into some exasperating circumstances. Nursing facilities are required to get many, many forms filled out by either the resident or a responsible party. In addition, Medicare and Medicaid have extensive requirements and may not cover your particular situation. If you have questions concerning the admissions process, the Director of Admissions or other nursing facility staff will be happy to assist you.

HOW WILL THE STAFF CARE
FOR MY LOVED ONE?

Upon admission, the staff members will meet from various departments to formalize a plan of care for your loved one. If at all possible, you and the resident should attend and participate. The "care plan" is updated quarterly, or more frequently if needed. See if the staff is receptive to your loved one's special problems, such as a daily adjustment to a hearing aid, or making sure that the resident changes clothes each day. But be patient. Staff cannot be expected to learn all the special needs of a new resident overnight.

WHERE CAN I GET MORE INFORMATION?

Call the Texas Health Care Association (THCA) at 800-380-2500 or 512-458-1257.  THCA is an association of more than 750 licensed long term care facilities in Texas dedicated to providing quality care to their residents.

NURSING FACILITY CHECKLIST

CERTIFICATION AND QUALITY REVIEW______________________________

If Medicare and/or Medicaid coverage is needed, is the facility certified to provide it?

Does the facility have a formal quality assurance program?

LOCATION_______________________________________________________

Is the facility pleasing to the resident? Is the facility convenient for frequent visits of family and friends?

Does the facility have transfer arrangements with a cooperating hospital? Is the facility convenient for the resident's personal physician?

ACCIDENT PREVENTION_________________________________________

Is the facility well lighted inside and outside? Is the facility free of hazards? Are chairs sturdy, not easily tipped?

Are warning signs posted on freshly waxed or wet floors? Are there handrails in hallways and grab bars in bathrooms?

FIRE SAFETY____________________________________________________

Are exits clearly marked and unobstructed? Are exit doors unlocked on the inside?

Are written emergency evacuation floor plans posted throughout the facility? Are fire drills conducted?

CLEANLINESS______________________________________________________

Is the facility as clean as you set your personal standards? Is the facility free of unpleasant odors?

RESIDENT ROOMS___________________________________

Does each resident room have a window? Is there a privacy curtain for each bed? Is there a nurse call cord by each bed, accessible to the resident? Is fresh drinking water beside each bed? Is care used in selecting roommates?

Is at least one comfortable chair available per resident? Is there room for a wheelchair to maneuver? Is there a clothes closet or separate set of drawers for each resident? Is there easy access to each bed? Are residents allowed to decorate their rooms?

HALLWAYS_____________________________________________________

Are halls large enough for two wheelchairs to pass easily?

Do halls have hand grip railings? Are halls well lighted?

DINING ROOM___________________________________________________

Is the dining area attractive and inviting? Is food tasty and attractively served? Is there adequate time to eat meals?

Are tables convenient for those in wheelchairs? Do meals match the posted menu? Are those needing help receiving it?

FOOD_________________________________________________________

Does a dietician plan menus for residents on special diets? Does the menu vary from meal to meal? Are warm foods served warm?

Are snacks available? Are personal likes & dislikes taken into consideration? Is food delivered to residents who are unable or unwilling to eat in the dining room?

ACTIVITIES AREA_________________________________________

Are rooms or designated areas available for resident activities?

Is equipment (such as games, easels, yarn, kiln, etc.) available? Are residents using equipment?

ACTIVITIES PROGRAM__________________________________________

Are resident preferences observed? Are outside trips planned? Are residents urged to participate?

Are group and individual activities available? Do volunteers work with residents?

TOILET FACILITIES_____________________________________________

Are toilets convenient to bedrooms? Are there toilet facilities which are easily accessible to a wheelchair resident?

Are nurse call devices near each toilet? Do bathtubs and showers have non-slip surfaces and hand grips?

GROUNDS_____________________________________________________

Is there easy access for disabled residents? Are hazardous objects in walkways?

Is outdoor furniture available for residents and visitors? Is the overall appearance pleasant?

MEDICAL_______________________________________________________

Is a physician available in an emergency? Are personal physicians allowed? Are medical records and plans of care kept? Are residents involved in plans for treatment? Is confidentiality of medical records assured?

Is regular medical attention assured? Are other medical services (dentists, podiatrists, optometrists) available? Will the resident's personal physician be notified in an emergency? Does the facility report periodically to the resident's personal physician?

PHARMACY_____________________________________________________

Are routine and emergency drugs available? Does a pharmacist review resident drug regimens; how often?

Is a pharmacist available for staff and resident consultation?

GROOMING________________________________________________________

Is assistance in bathing and grooming available? How are bathing schedules developed? Are barbers and beauticians available? Are manicure/ pedicure services available?

STAFF ATTITUDES_______________________________________________

Is the administrator available to answer questions, hear complaints, or discuss problems? Does the staff show interest in and affection for individual residents? Is the staff courteous?

Does the staff respond quickly to resident calls for assistance? Do staff members know residents by name?

SOCIAL SERVICES________________________________________

• Is a social worker available to assist residents?

THERAPY PROGRAM______________________________________________

Is there a therapy program available under the direction of a qualified therapist? Is therapy available to meet special needs? Are the services of an occupational therapist, speech pathologist, physical therapist, or respiratory therapist available?

RESIDENT RIGHTS______________________________________________

Is staff trained to protect dignity and privacy? Does the facility have a resident council?

Does the facility have a written description of resident rights and responsibilities?

RELIGIOUS OBSERVANCES_______________________________

• Are religious arrangements made for residents to worship?

YOUR PART
If you are selecting a nursing facility for someone else, are you:

• Involving this person in the choice?
• Prepared to ease the resident's transition to the nursing facility by being with him/her on admission day and staying a few hours to get them settled in?
• Ready to visit the resident frequently and to make sure that other friends and family make similar visits?
• Willing to provide the resident with the same amount of love in the nursing facility as you would if he/she were at home?

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