How to evaluate facilities?

[o_mom]

Does anyone have advice on how to evaluate nursing homes/assisted living, specifically memory care units?

We need to start looking, but have no idea what to really look for. Friends have said it is kind of like looking at preschools where the shiny bells and whistles don't necessarily mean good care and a lack of fancy amenities is not an indicator of bad care.

I do have a couple of RN friends who said they would go with us to look, but would like to have some idea of what I should expect.

[hillview]

Here is a good check list
http://canhr.org/factsheets/nh_fs/html/fs_evalchecklist.htm

Here is a rating system
http://www.carepathways.com/nhg-state.cfm

When we looked for a place for my grandmother we found a very knowledgeable social worker who was a godsend.

[NCGrandma]

Here is a good check list
http://canhr.org/factsheets/nh_fs/html/fs_evalchecklist.htm

Here is a rating system
http://www.carepathways.com/nhg-state.cfm

When we looked for a place for my grandmother we found a very knowledgeable social worker who was a godsend.

Both of these look very good. An additional resource that may have more details and/or more up-to-date info is:
https://www.medicare.gov/nursinghomecompare/search.html



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[NJ_Mom2011]

Unfortunately, patients' needs often can cause the pickings of nursing homes to be slim. Some memory care patients have specialized needs. Thus, unfortunately I had one family member who suffered Alzheimers in her early 60s, and unfortunately she was violent at the very end (and because she was still a relatively young senior, she was very strong). She was kicked out of the first nursing home that the family put her in, causing stress to her and the family.

I think having an honest assessment of the patient is thus necessary. If you think the patient will create specialized issues in the final stages and doesn't fit the standard mold (which in my biased opinion seems to be in the nursing home industry a weak female in her 80s and 90s who speaks English and will cause no problems), an important question to be asked is does the nursing home handle these difficult patients. For another family member with memory issues, I found the medicare.gov web site referred by NCGrandma the best resource, with caveats.

The caveat for using Medicare.gov is how fast the patient is deteriorating. Some nursing homes, especially the ones on the Medicare.gov site, are geared for end of life short stays. Others, which tend to be NOT listed on medicare.gov (as Medicare will not pay for them) are for long term care. Your relative's doctor probably already gave you an idea of what your relative's expected life expectancy. Grim, but necessary info in deciding what type of facility to place in.

My family has used care managers to guide us through this process. We used them in 3 different states, and was a mixed bag (2 of them terrible, 1 good). They are very expensive. Free care manager service is provided by Aplaceformom.com This is a commercial service, and the nursing home/assisted living facility pays their fee. They do tend to push the patients to use Sunrise Senior Living (which is ugh in my opinion, as they don't seem to handle difficult memory care patients like my relatives). But overall I found Aplaceformom advisors helpful.

I am so sorry about your family member. My prayers are with you and your loved one during this difficult time.

[lalasmama]

Does anyone have advice on how to evaluate nursing homes/assisted living, specifically memory care units?

We need to start looking, but have no idea what to really look for. Friends have said it is kind of like looking at preschools where the shiny bells and whistles don't necessarily mean good care and a lack of fancy amenities is not an indicator of bad care.

I do have a couple of RN friends who said they would go with us to look, but would like to have some idea of what I should expect.

Many many years ago, I was a nurses' aid at a memory care unit. Some things to look for/consider:

Ask about staff to patient ratios. Find out what your state requires, and make sure that the facilities are truly adhering to that (you'll be able to tell by the look on the CNA's faces!).

Expect locking doors. If they aren't locked, that's a bad sign--either they aren't used to true memory care issues/needs, or they cater to the patients that don't really need "memory care" (ie, "Mom's a bit forgetful, and left the stove on one too many times," versus "Dad's walked out of the house 5 times this week, the police were involved in 3 searches for him, and the next door neighbor was a bit freaked out when he walked right on in to her house").

Look at the residents. Smell the unit. Does it smell at least semi-fresh? Do the residents appear well-cared-for? Of course, it's still going to have a "nursing home" smell, but that doesn't mean the smell of incontinent people running around unchecked. Residents with food on their shirt isn't a huge deal, but residents with clothes that smell dirty is a bigger issue. Do the residents seem to have the same level of needed care that your family member will be provided (ie, do the residents appear to need more/less care than your family member, so that it isn't taking 4 aids to deal with Mr. Jones, leaving your family member with nursing care less time than needed)?

Ask to see the shower facilities. Are they on the unit? How "scary" do they look? (I had one resident who called it "the gas chamber;" it was a 13x13 foot tiled room with one shower head and a hand-held shower.) Is there a walk-in tub available on the unit?

How are physical therapy needs taken care of? Are they dealt with on the unit, or does the resident have to go somewhere else? (Ideally, it would be on the unit, so the patient stays where they are familiar, versus being led through locked doors to a place they don't normally go.

What does the unit sound like? What do the nurses and aids sound like? Quiet, soothing voices? Expect some occasional yelling from residents; that is normal. But, how do other residents and staff deal with it?

How are meal times done? Is there "family seating" at tables, instead of just being delivered to their room to eat?

How are doctor's appts dealt with? Will facility provide transportation and an aid for the visit? (Ideally, yes, an aid will go with the resident, as they are familiar with the resident's daily schedule and functioning.)

Good luck!

ETA to correct accidental emoji in the text.

[mytwosons]

Does anyone have advice on how to evaluate nursing homes/assisted living, specifically memory care units?

We need to start looking, but have no idea what to really look for. Friends have said it is kind of like looking at preschools where the shiny bells and whistles don't necessarily mean good care and a lack of fancy amenities is not an indicator of bad care.

I do have a couple of RN friends who said they would go with us to look, but would like to have some idea of what I should expect.

I haven't needed to look at memory care, but have done independent and assisted. I think it is helpful to visit as many as possible since you'll start to get a feel for either places that are understaffed and places where the people truly care. You might also consider asking local social workers. When my mom later went on hospice care, I found out their SW (and the hospice nurses) knew all about the different local facilities because hospice deals with all of them...This SW also had a side business working with families to find the appropriate placement.

[o_mom]

Thank you all - this is very helpful!

We are planning to visit as many as possible. It is likely that the transition will come after a hospitalization for other health issues, so we are trying to be prepared and not have to decide at the last minute. I have found a few people who have parents' in a local facilities as well as someone who is a service provider for many places in the area, so that is also a source we are tapping.

[NCGrandma]

Thank you all - this is very helpful!

We are planning to visit as many as possible. It is likely that the transition will come after a hospitalization for other health issues, so we are trying to be prepared and not have to decide at the last minute. I have found a few people who have parents' in a local facilities as well as someone who is a service provider for many places in the area, so that is also a source we are tapping.

If there is a possibility of being discharged from hospital to nursing home, keep in mind that hospitals typically have social workers or other discharge planning staff who often know a lot about local facilities. It may be a long shot, but you might be able to talk with one of these folks prior to a planned hospitalization.


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[NCGrandma]

Many many years ago, I was a nurses' aid at a memory care unit. Some things to look for/consider:

Ask about staff to patient ratios. Find out what your state requires, and make sure that the facilities are truly adhering to that (you'll be able to tell by the look on the CNA's faces!).

Expect locking doors. If they aren't locked, that's a bad sign--either they aren't used to true memory care issues/needs, or they cater to the patients that don't really need "memory care" (ie, "Mom's a bit forgetful, and left the stove on one too many times," versus "Dad's walked out of the house 5 times this week, the police were involved in 3 searches for him, and the next door neighbor was a bit freaked out when he walked right on in to her house").

Look at the residents. Smell the unit. Does it smell at least semi-fresh? Do the residents appear well-cared-for? Of course, it's still going to have a "nursing home" smell, but that doesn't mean the smell of incontinent people running around unchecked. Residents with food on their shirt isn't a huge deal, but residents with clothes that smell dirty is a bigger issue. Do the residents seem to have the same level of needed care that your family member will be provided (ie, do the residents appear to need more/less care than your family member, so that it isn't taking 4 aids to deal with Mr. Jones, leaving your family member with nursing care less time than needed)?

Ask to see the shower facilities. Are they on the unit? How "scary" do they look? (I had one resident who called it "the gas chamber;" it was a 13x13 foot tiled room with one shower head and a hand-held shower.) Is there a walk-in tub available on the unit?

How are physical therapy needs taken care of? Are they dealt with on the unit, or does the resident have to go somewhere else? (Ideally, it would be on the unit, so the patient stays where they are familiar, versus being led through locked doors to a place they don't normally go.

What does the unit sound like? What do the nurses and aids sound like? Quiet, soothing voices? Expect some occasional yelling from residents; that is normal. But, how do other residents and staff deal with it?

How are meal times done? Is there "family seating" at tables, instead of just being delivered to their room to eat?

How are doctor's appts dealt with? Will facility provide transportation and an aid for the visit? (Ideally, yes, an aid will go with the resident, as they are familiar with the resident's daily schedule and functioning.)

Good luck!

ETA to correct accidental emoji in the text.

All good points. I do disagree with one point, though. Some very good facilities are philosophically opposed to locked doors and other types of restraints. Instead, they use a variety of strategies including increased staffing,, personal alarms, etc. In those places, it is not a bad sign that there are no locked doors, but it will take more questioning to find out how they manage wandering, etc.


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[abh5e8]

Also ask about the waiting list. Especially if it is a hospital discharge to a nursing home, it will depend on what facility has a current opening. If you think the admission to the nursing home will happen soon, it might be worthwhile to see about putting that person on the waiting list.

Also, the facility has to accept the patient at the time of admission, so ask the facilities about their admission criteria, to get an idea of if your relative would be appropriate for the given facility.

[pharmjenn]

Look at the residents. Smell the unit. Does it smell at least semi-fresh? Do the residents appear well-cared-for? Of course, it's still going to have a "nursing home" smell, but that doesn't mean the smell of incontinent people running around unchecked. Residents with food on their shirt isn't a huge deal, but residents with clothes that smell dirty is a bigger issue. Do the residents seem to have the same level of needed care that your family member will be provided (ie, do the residents appear to need more/less care than your family member, so that it isn't taking 4 aids to deal with Mr. Jones, leaving your family member with nursing care less time than needed)?



I was going to respond with this, THE SMELL. I worked as an EMT after college, and some nursing homes were horrible with the poopy smell. Yes, patients are incontinent and there will always be smells. But a good facility will work to keep their patients clean as much as possible.

[maestramommy]

THere are several in town, and in the city next door. We started out by asking friends at church, because many of them already live there in some combo of independent living and assisted living or nursing care with their spouse. I found it's important to ask people to elaborate on why they like or dislike a place, because different people have different preferences, and cost is an issue as well.

[Percycat]

Check to see if your area has a local American Alzheimer Association chapter. We attended several free workshops that provide good information about facilities and services in our area and helped us prepare for future needs.

I'm sorry you are going through this. I hope you find some good options and receive good information so you and your family are at peace with the decision.