Looking For A Nursing Home: The Essential Search Protocol

Santo and his granddaughter Cece, June 2011

Santo and his granddaughter Cece, June 2011

by Karen Keller Capuciati

I often seek out my friend, Elaine, when someone I know is looking for a nursing home in our area. Elaine has done a lot of research on the topic, and I know she will have detailed answers for all the important questions that come up. Elaine also has a lot of handy tips to enhance a loved one’s nursing-home experience. For example, when I spoke with her on the phone this week, Elaine told me how she had made a special effort to get to know everyone — administrators, aides, nurses, etc. — at the nursing home where her father-in-law became a resident.

“I introduced myself and told them that Santo was my father-in-law. I made a point to ask them their first and last names, and then repeated each one back to them in order to get it right and to remember it well.”

“I find you get better care that way,” she explained. “Santo definitely got VIP attention, and that was because they saw how important he was to his family.”

Santo was suffering from Parkinson’s disease and dementia, and after first living with Elaine and her husband, John, for three years, he was moved to a private-pay assisted-living facility with a specialized dementia unit. As the diseases progressed, the facility required that Santo have round-the-clock aides to ensure his safety. “It was too much of a risk for the facility, so he had to be monitored 24/7,” Elaine said. “After three years, the cost of the private aides, on top of the monthly rate to live there, was untenable financially. He had already exhausted his funds with the costs of his care. Further, he needed access to around-the-clock medical attention, which could not be provided by the assisted-living facility. Sadly, he had to move, and a nursing home was the only viable option.”

So Elaine began the search for the perfect nursing home. Like everything else Elaine does, her approach was methodical and thorough, and her well-researched efforts paid off. “The home we chose served Santo well,” she said. “It wouldn’t be for everyone. The interiors needed updating, the neighborhood was a bit dodgy, but it was close by so we could visit frequently, and the staff knew we were only 20 minutes away. It was clean, safe and Santo was treated very well there.”

Elaine is passionate about the topic of choosing the right nursing home for our loved ones, in order to ensure their comfort, dignity and care. But it’s not as simple as just picking the home with the highest rankings, she cautioned. A facility that is good for one person might not be the best choice for another.

I asked Elaine to elaborate on her search protocol, and she graciously shared with In Care of Dad this thoughtful list that she recently compiled for a friend:

  1. First step: Check “Nursing Home Compare” at medicare.gov.
  2. Every nursing home should have a copy of its latest state inspections in its lobby, with all detailed information as to whether it has ever been the subject of sanctions or enforcement actions. Take the time to read these details. An enforcement action might only reference having dust above the grill in the kitchen, or, on the other hand, it might be about an aide striking a resident. These inspection reports are now also available on medicare.gov.
  3. Does the nursing home have an adequate rehabilitation/physical therapy area? One nursing home in our area had an insufficient rehab space with exercise equipment stacked in the corner. Unless your loved one is bedridden, don’t underestimate the value of a fully stocked and adequately staffed rehab program. The disuse of the rehab room told me that this particular nursing home was not suitable for Santo, since he was still cognizant and active, albeit confined to a wheelchair. Had Santo been bedridden, I might have placed him there, as their care for the bedridden was excellent.
  4. Does the nursing home place less active residents in the same area as the more capable residents who may have greater need for activity and rehab? For the latter residents, who are more cognizant and ambulatory, being integrated with, perhaps even surrounded by, the more inert long-term residents could be severely discouraging. Being placed in a separate hall or wing goes a long way towards maintaining a positive outlook and avoiding depression.
  5. Consider the smell. Does the nursing home smell clean? Is resident hygiene a prevailing concern of the staff? Are residents being cleaned and changed frequently enough? The facility that we chose for Santo could only have been described as shabby, but it was always clean. Bad smells occurred only two or three times in the 150 or so visits we made in one year. The furniture was threadbare but always clean, and the floors were always spotless. Medicare.gov rated the facility as better than average in the staff-to-resident ratio, and the care they provided confirmed this.
  6. Make an impromptu visit at dinnertime and take note of how many residents are sitting with full uneaten plates of food in front of them. At Santo’s facility, I walked in many times and always saw the staff feeding people. At a different nursing home in our area, I saw residents with full plates and blank stares. This tells me the facility was understaffed.
  7. Talk to the head nurse. Ask if the staff follows a plan where specific nurses and aides are interacting frequently with the same residents. Some nursing homes follow this model, believing that it helps foster productive bonds, while others believe it leads to frustration and the potential for abuse. I prefer the bonds idea. That is a personal choice.
  8. For breakfast, do the able-bodied eat in bed? That’s not a good sign — the staff should get these residents up and to the dining room. If they are eating in bed, this shows that the staff is not prepared in the morning. If a nursing home tells you they strive to have every able-bodied resident up and at the dining table in the morning, it’s an indication of quality care.
  9. Look at the visitor log. Do you see many visitors signing in? It does not necessarily reflect the quality of the nursing home, but the more “outside eyes” in the hallways, the better.
  10. What sort of activities are provided for residents? Is there a secure outdoor space for residents? Santo’s facility had a garden where residents could stroll in nice weather. Don’t underestimate this feature, as you will want to take your loved one outside when the weather permits.
  11. How many residents have bed and chair alarms? It’s annoying when they go off needlessly all day long. Where Santo lived, the facility had very few. They used other means, such as putting a low mattress on the floor for Santo and checking on him frequently. He had a restraint on his wheelchair, so they did not need an alarm. Ask how they handle these issues. Do they find creative solutions or simply use the easiest tool?
  12. Lastly, it is always a good idea to eavesdrop on staff-resident interactions. How do employees speak to the residents? This can tell you volumes about the quality of life in some nursing homes. One place I was visiting, I walked straight out the door when I heard the staff making fun of a resident. Conversely, the staff at Santo’s facility always referred to him as “Mr. Marino.” I liked that. No “honey” or “sweetie.” They were respectful rather than patronizing. They even asked for a list of his preferences, which he would not be able to communicate, simple things like the fact that he prefers cereal with milk for breakfast, or that he likes to wear socks to bed, or to be sure he is wearing his eyeglasses everyday because without them he gets disoriented. Each of these was a simple enough request, but the staff was very willing to comply, and altogether, they created a comfortable environment for my father-in-law.

What the staff may have lacked in infrastructure, they more than made up for with kindness, diligence and devotion to treating the elderly with respect. That was my sense about the nursing home when I investigated, and it proved to be true in all the time Santo lived there.


Karen Keller Capuciati is the Co-Founder of In Care of Dad.

3 Responses to “Looking For A Nursing Home: The Essential Search Protocol”

  1. Ann Shirley says:

    These are all some really great tips! I have seen many bad nursing homes from my experience with my grandparents. Some had bad rumors of abuse, others smelled weird, and then there were just a handful that seemed okay, but were a bit too expensive. I love how you point out the importance of rehab facilities. My grandfather wasn’t much interested in that, but despite being sick my grandmother loved to stay active so this was an important option for her to have.

    As my parents are now beginning to age I know that I need to consider senior care options. I have been looking into New Jersey Senior Care. I like that they offer many custom options including visiting angels. I feel like they would get good care on a personal level. Thanks to the great tips included in your blog I now know what to look for and what to ask!

  2. Jessie Parker says:

    Searching for a perfect facility that could provide you the long term care you need is hard, I also understand the feeling. There’s a lot of them, but only few will fit your needs. Choosing the right nursing home for the patient is a must, he needs to still enjoy comfort and dignity while receiving enough care.
    Thanks to you and your friend for sharing us your list of search protocol. This is a useful addition to what I already read from other pages like http://www.completelongtermcare.com/facilities and http://www.kiplinger.com/article/retirement/T066-C000-S001-how-to-choose-a-long-term-care-facility-for-a-love.html. This is a list of good advice from someone who can relate to those who are also in search of a good nursing home.

  3. I like how you mentioned that every nursing home should have a copy of it’s latest inspection in its lobby, and all of its detailed information and you should take the time to read it to make sure it is suitable for your loved one. My mother is getting super old and getting to the point where she can no longer move around very well, and can’t think efficiently, so she needs to but put in a nursing home. I will definitely keep all of your great tips and information in mind when looking for the best nursing home for my mom that will take great care of her.