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Finding Quality Nursing Home Care

Tools and Tips

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Nearly 1.6 million older Americans live in nursing homes in the United States.

While many are receiving quality care, the move to a nursing home can still be difficult for older adults and their family members alike. Among other things, family caregivers may feel guilty because they’re unable to personally meet their older loved one’s complex care needs. Caregivers may also worry that their older loved one may not receive quality care at a nursing facility. If you’re considering moving a loved one to a nursing home, experts with the American Geriatrics Society Foundation for Health in Aging (FHA) offer the following advice for ensuring the best possible care:

Before you choose a nursing facility

Check licensure, certifications, qualifications and care When touring a prospective nursing home, ask to see the nursing home’s license if it’s not displayed in a public area. Is the nursing home Medicare and/or Medicaid certified? Inquire about the services the nursing home offers. Does it provide services your loved one needs or might need, such as wound management for seniors who develop bedsores, physical rehabilitation services, or a specialized unit for those suffering from Alzheimer’s disease or other forms of dementia?

Get to know the staff When visiting a nursing home, evaluate your comfort with staffers. Are they approachable? Do they answer questions from both residents and family members? What policies are relatives supposed to follow if they have concerns
about their loved one’s care? Are routine care planning meetings held at convenient times for family? It’s important to get to know the staff and create a “partnership relationship” with those who will be caring for your loved one. The better the communication and interaction between staff and relatives, the better residents will fare. If possible meet with and assess the personal qualities of the nursing home administrator and nursing director. These two leadership positions are central to maintaining quality care in the nursing home.

Make sure residents with special nutritional needs are well nourished Find out how staff
accommodate residents who have dietary restrictions, or are unable to feed themselves. Ask such questions as:

• Does the staff make every effort to feed seniors out of bed? What strategies do they use to do so?
• Does the nursing home accommodate special dietary needs by, for example, preparing pureed foods, and carefully monitoring meals for residents with diabetes and food allergies?
• Does the nursing home provide supplemental vitamins and minerals in residents’ diets when necessary?

After you’ve placed your loved one in a facility

Keep visiting! Family interaction is crucial for your loved one’s well-being. So make frequent social visits. Not only will your loved one feel happier and comforted by your presence, he or she will also feel more settled in his or her new home. If you make regular visits you’re also more likely to notice signs of new health problems or injuries or other changes in your loved one that may be overlooked by staff. Additionally, you’re more likely to notice changes in the nursing home staff – changes in staff and administration that could affect quality of care.

Be on the lookout for signs of neglect or abuse If you see an older adult – your loved one or any other resident – who is wearing soiled clothing, is dirty, looks malnourished, or appears to have untreated health problems, investigate immediately. Pressure or “bed” sores – a painful breakdown of the skin that results in mild redness and swelling or, in extreme cases, in deep wounds and infection – can be evidence of serious neglect. Bruises may be signs of abuse.

Scrutinize facility cleanliness and safety:

• Are there handrails in the bathing areas and hallways? 
• Are there sprinkler systems and are fire extinguishers easily accessible? 
• Are there plenty of secured walking areas inside and out? 
• Are the floors difficult to walk on (are they slippery, for example, or covered with too-thick carpeting?)
• Are the doors operated by electronically equipped devices to reduce wandering? 
• How many staffers are working at a given time during different shifts? And are there policies stipulating minimum staffing levels for specified numbers of residents?
• Are there emergency preparedness and evacuation plans in place in case of fires, floods and other hazards? Are staff trained to evacuate residents if necessary?
• Are the bed rails or guard rails on nursing home beds raised up? Raised guard rails on beds pose a serious injury risk for older adults, and should rarely be used to restrain patients. Likewise, residents sitting in chairs should not be restrained with seat belts or trays.

Evaluate routines and activities Residents who don’t have dementia or other cognitive problems should be able to make choices about their daily routines, such as when to go to bed, and when to bathe. In special care units for residents with dementia, however, it should be apparent that the nursing home follows a consistent routine. This is especially important for residents with dementia. Consider the range of activities offered. These may include arts and craft classes, chair exercise programs, religious services, discussion groups, entertainment such as musical and dance performances or “movie nights.” If your loved one has difficulty participating in the activities the nursing home offers ask what other activities it can provide to help him or her become engaged and stimulated.

Visit the nursing station often You should stop at the nursing station each time you visit, not only to monitor your loved one’s daily activities – which staff should record in his or her medical chart – but also to review the services provided by the staff and inquire about any changes in medications, diet, behavior, sleep or exercise. Ask about your loved one’s mood, his or her interest in food, participation in activities, and his or her health. You or another family member should be contacted immediately if a problem occurs – if your loved one falls, for example, or begins wandering. As a caregiver, you have the right to be informed.

Get more information about nursing homes from:

• Nursing Home Compare

Last Updated April 2010