How did you go about picking a nursing home?

This is how I did it: Where my mom is right now is where my brother was last Fall, so I knew what the rehab was like. My mom is to stay in the same facility, but go to long term care there. I looked at the room, the window situation, peeked into some of the other rooms where residents were, observed the ones out in the hall in their wheelchairs as to how happy they were and how caregivers were responding to them. Then a woman in charge of events and activities called to ask what sorts of things my mom would like to do when she is a little better. Another place did the same, which I appreciate. The doctor who will see her twice a week gave me a call to go over his assessment. Where she is has all equipment needed for her care and I was uncertain the other place had enough staff. Where she is now is unfortunately the most expensive, but they can put her on medicaid if she ends up spending all her money. There are 2 other less expensive nursing homes close to me, but I've heard terrible things about them. This place she is in is only a few minutes away by car. I like that. I could walk, but there are 2 very busy streets to cross, so I will usually drive. Hope this helps.

* Interview staff (Ask about the 'horrible things' you hear/d) and ask how they handle specific situations.
- ask if they have cameras in room or if you could put one in (or perhaps you do not need to ask them)
* Call an elder care attorney or an attorney that specializes in elder care/trusts
- they might have recommendations, working with elder and/or their families
* Talk to residents, if you can (or their family); ask for references.
- Just sit around and observe what's going on. Then start talking to people.
* Do a search for any legal issues (you might need to call a library to figure out how to do this; if any infractions / law suits, they should be public record.
* There should be an accreditation for nursing homes. Call them and ask questions.

Gena / Touch Matters

Go to Medicare.com. There you can find ratings of nursing homes, hospices—wherever they pay out. There an overall rating of one to five stars. Then they break it down to several categories. In addition to the overall rating, my primary criteria was care of the residents. I didn’t have much choice over the first two places and they were busy earning their one star rating.

When I decided to place my brother into hospice care, I was adamant about moving him from the nightmare place. Even hospice nurses didn’t like that he place. I looked up facilities that looked good to me and the hospice social worker called around. He ended up going to one that had an overall three star rating and five star for resident care. He has Medicare and Medicaid and nursing homes like to limit the number of beds with this kind of payment because it’s less than what a pay out of pocket payment would be. He’s actually improved. I also found this hospice on the Medicare website. It was one out of two that all the various ratings were high and above the national average and they’ve been great. I wish more people knew about Medicare’s rating system. And of course tour these facilities.

SavannahTraci: There was only one Nursing Home in the town where my late mother resided. No choice there since EMS transported her from the hospital to the facility.

I knew there were probably better facilities in the nearby city but in the end I went with the one closest to me because when she was temporarily in one only 20 minutes away I saw that a commute would be really wearing - but then I was one of those people who visited every day so that was really important to me.

Thankfully I didn't have to choose a NH for my mother, but if I did, it would have been the same method I used for choosing the MC facility.

Start with checking online for NHs in the area, allowing a little extra range in case the closer ones are ruled out. From there, online checking can provide input from the facility (of course they will make it sound like the best!), and reviews from others. Brochures and online sites can show images to give you a vague idea of what it's like. Make a list including each place and bullet items under that regarding costs, room size/availability, staffing, hours it is open, including for visits. Call and ask many questions, including the answers into your list. Cost of the residence and what's covered for that cost. Ask about add-on and/or additional costs. For instance, my mother's "rent" covered up to one hour/day of personal care and 2 loads of laundry. Anything over that would incur additional costs. Deep cleaning the carpet happened a few times, when mom had "accidents." While cleaning her room was covered, this wasn't.

IF there might ever be a need for Medicaid in the future, make sure the place is certified for Medicare and ask how they handle existing residents who transition to Medicaid vs those who are on a list for a Medicaid bed.

The answers to these various questions can help rule out some on the list. For the remainder, try to schedule a tour/meal. Of course they may put out the red carpet for this, so as long as they allow visitors, go back at different times and on different days. Make observations using all 5 senses. As someone else posted, if it stinks this day and you go back and it still stinks, that likely isn't going to change! If possible, talk to residents, chat with family members visiting, etc. These are the real people associated with the place, so you'll likely get a better sense of how good the care is from them.

Compare those left on your list and choose the top 3. Perhaps another visit to each would help to make the final decision. Your profile doesn't mention dementia. Would your sister be capable of providing input? Could she be taken to see each of the final "contestants" and provide some feedback? After all, it will be she who is living there, so if she doesn't have cognitive issues it would be nice to include her thoughts/desires in the final decision.

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Unfortunately all but the newest nursing homes who follow the Eden concept are built with the majority of rooms being shared. Generally, the older the facility the smaller the room. Owners claim that is the only way they hit their expense line. The new hospitals are all single rooms to minimize the spread of infection and hopefully after having dealt with the covid 19, any new nursing homes will be built to give residents a bit more space and more protection against infections.

This takes a lot of work and things can change. A nursing home that was outstandingly excellent 5 years ago might not be now. That's why after you look at all the numbers and state ratings you need to talk to friends and families of current residents.

Good luck in your search.

Check your state health department rating cards for nursing homes (skilled nursing facilities). Medicare.gov also allows you to search their ratings on all certified nursing homes (your state site might send you there). It takes a bit of studying to figure out how to interpret their ratings - a five star overall rating may still show a three star rating in staffing. Also check the number and type of deficiencies rec'd during your states annual inspection and how long it took for the facility to rectify the issue (that's another long read in trying to learn which deficiencies are "worst" - get a cup of tea and settle in, lol). Ask for referrals from friends, associates and any groups of which you are a member. After you have a list of ten that interest you, put on your boots and start to visit. try to visit each facility at least twice (three times is better if possible). A morning visit is good. See how many residents are "up and about". Get a list of the monthly planned activities and check and see if they are really being held and attended. Check out the rehabilitation section to see if they are actively working with residents on doing rehab. Remember many of the residents are older and are in frail condition so don't expect rehab to look like the gym. Find out the average ratio of staff to resident during the three shift times - all facilities staff lower at night when, in theory at least, residents are in bed sleeping. If your loved one is transitioned out of PT for a walking problem, the PT may recommend "restorative walking" to keep the loved one at their current state. Restorative walking is almost always done by the CNAs not the PT staff due to payment restrictions. Good CNAs have always been hard to find but right now, it is just about impossible to get them. So a low number of CNAs will mean less restorative walking and a longer wait for bathroom issues.

Visit during meal time lunch or dinner. Now that restrictions are lifting there should be some people in the dining area; although many facilities are still not permitting outsiders into the dining area you should be able to peak in from the doorway. Some facilities only allow CNAs to assist residents who need help eating while others permit their activities personnel to assist in this area. Find out what the policy is because again..... if your loved one has to wait for the scare commodity of a CNA they aren't going to get much warm food. If possible, see if you can get a meal from the facility (this is hard to do in nursing homes; much easier in ALs because that is one of their marketing tools - restaurant quality meals ) and if you do get a meal at a nursing home don't be surprised that it may not taste special. The majority of residents in ALs are still independent and very aware of food. The bulk of residents in nursing homes have compromised health and as much as they would love to tuck into the salt and cheese laden lasagna, the kitchen will hit all sorts of state deficiencies if they cook like they would like.
So meals in nursing homes are usually gluten free, salt and pepper free, minimized sugar translation: kind of tasteless. Add to that the renal and respiratory diets and the need for thickened liquids, mechanical soft and pureed food..... you get it. But the hot food needs to be hot when it gets to the last resident so visit at meal times. See if their activities offered before and after meal times.
Nursing staff is the one who gives medications, handles emergencies and performs the skilled nursing tasks like wound suctioning, IV's, TPN. Find out how many RNs (not CNA) are on each work shift.

Therapy is so specialized these days that many facilities contract this service out. Find out who is doing the contracted PT, OT even if your loved one doesn't need it right now. Check out the size and layout of the rooms. Medicare pays for what is needed but Medicaid in most states will only pay for "shared quarters"
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Are you sure she/he NEEDS Skilled nursing? I was recommended to send my dad to one but I decided on doing hospice at a memory care facility instead. I liked that the memory care facility allowed hospice patients to have visitors 24x7 during Covid times whereas the nursing facility didn't. Also the memory care facility was able to do tours but the nursing facility wouldn't. Be alert for smells and also whether there are a lot of people always in bed (unless that's where your LO is at physically). I preferred the ones that got them out of bed and sat them out in common areas to keep an eye on things and possibly it makes him feel more a part of the community. Not everyone there is on hospice, of course. And there are varying levels of dementia too.

Ask friends, colleagues for personal referrals. Talk to a social worker. Visit during different times of the day to see for yourself, especially busy times like morning and evening. The place should feel and smell clean. There should be adequate staff to cover all the residents' needs at all times. Check the menus to see what the meals are like and visit during meal time to see how the process is done. Find out if there is a recreational director and planned activities. Look at the rooms to see how they are equipped and what size they are. Do the residents have access to privacy or are they all gathered out in the hallways or one main room. How safe is it? How are falls handled? How is laundry handled? What is the nursing staff? Is there a nurse on site on weekends? The more you visit and watch, the more you will know what to look for. Also talk to families visiting their loved ones to find out pros and cons. I think there is also a report card maintained by the state of health violations, outbreaks, etc.

Boots on the ground is the best way.

You'll get a rep from the NH who will show you beautiful pics of a 'resort'--and often a decision is made based on those pics.

My mother picked her own place and when she went there--well, although we'd warned her it was an absolute dump, she still went. I think you could hear her yelling miles away.

She was totally non-compliant (I don't blame her at all) and my OS stepped in and found a better place, not so filled with activities and stuff, but a quiet, clean place. She paid the difference in cost and physically moved mother there and left her. I know she never visited her, not once, but hey, she'd solved the problem.

I'd check out a facility pretty thoroughly before we do that again. I mean, wander the halls and see the 'long term residents' rooms. Mom's was so depressing and it stunk and there were 2-3 patients per room, when she had been guranteed a single. That's how we were able to break her contract--they'd actually written in her contract that she'd had a private room--and there weren't ANY. Nobody had a private room!

Visit as often as you can--and keep it to a couple hours and no more. No need to stay longer, no need to 'live' there.

You are giving up a lot of personal freedom of mom's to have her placed, but in the long run, it's probably for the better.

Your job is to make sure she's cared for in a caring, safe, clean environment. The idea of pop in visits at different times is a good one.

A big box of candy for the aide station doesn't go amiss. I'd do that on the reg.

Things will not be perfect, but they can be as good as they can be.

Good Luck!!

Check around and get onliine for more information, check reviews, make an appointment to tour the facility. Talk to other family members at the facility. Some facilities offer lunch with the tour.Good luck.

All I can add to the comments is this - visit your loved one in any facility you choose and visit often. Unpredictable times. You have to keep eyes on the patient as much as you can. Be there during med times and ask what she is about to take. Every couple of weeks ask for a copy of the medicines on her chart. Then compare to what she is actually getting.

Be prepared for her to be slapped into a diaper even if she doesn't use one now - if she requires any assistance whatsoever to get to the toilet. When she can't hold it while waiting on help a couple of times, the diaper will go on.

If she is mobile right now, your job with visits will be to keep her mobile. Get her involved in exercise classes and other activities that get her out of the bed, out of the room and moving. Your job is also to watch for changes in her behavior that might suggest urine infection. As common as it is, it often goes unnoticed by staff - probably because they don't know what normal behavior is for your person.

Find out if there are private care homes allowed in your state. We found a wonderful one for my Mom. She was in a nursing hone for 6 weeks. A “good” one. I wouldn’t put my worst enemy in a place like that. Best advice is to hire a private social worker to help you. Good luck.

https://www.health.ny.gov/facilities/nursing/select_nh/
you may find this website helpful.
Word of mouth, reading and visiting are all essential.
Check into Medicaid and what documentation you’ll need to begin to gather. Good Luck!

when my father started having major issues with dementia, my brother and I contacted several nursing homes in our area and arranged for a visit to walk thru, etc. (yes now that give them time to make sure things are good but you have to schedule this). We went thru at least 2...........one reminded me of a prison, they had a lock down unit. it was behind a large steel door with a little window, special code needed to get in and out. but the people could roam all over back there without worry. The next one was alot nicer, people could not get out due to having a buzzer on the front door so that when they got close, it automatically locked. So you have to check around, visit and ask around to other people you know about those places. We ended up going with the nicer place only because my father had fallen and could no longer be taken care of at home. The place we chose was good, they called anytime something was wrong, even a bruise on his finger. Check out online for their place and see reviews. I wish you luck

One such visit to a nursing home you are considering should be on a Sunday afternoon (or at least a Saturday afternoon). Although the place might be "spiffed up" a bit in anticipation of family visitors, the latter can provide an excellent and usually candid source of information about how their LOs are treated there. Of course other visits should be at ordinary times on weekdays to get a firsthand view of the usual condition of the place, paying attention to all the considerations other posters have mentioned.

I ended up hiring 24 7 Care for my 97 yr old Dad.

But, I'm considering a Live In since the cost would be at least half of hiring several Caregivers doing 12 hr shifts.
I did think about a Nursing Home and I wouldn't put a Love One in a Nursing Home unless I've stopped by a few different times unannounced and looked around and talked to a few of the residents.
Main't thing I decided was if the Nursing Home wouldn't allow a Camera in a Lived Ones Room then I wouldn't check my Lived One in that Nursing Home.

I use Nest Cameras at my Dad's house so I can watch him and see how the Caregivers are treating him any time I want 24 7.

Nest Cameras are easy to install and gave me Peace of Mind.

Prayers

When my mother suddenly required nursing home care, my dad used what he called his “ old people network” asking many of the older people he knew through the community and his church what they knew. This is an age group that often has reason to visit nursing homes and sees what they’re like firsthand. They also live in trepidation of needing one so their ears are tuned to listen and learn on the subject. They know where to go and where to avoid. This worked well for us

None of these places are a holiday inn. If you have to have one you need to visit them yourself. Talk to some of the residents and the people who may be there visiting the NH residents. Keep in mind if you chose a place you can always relocate a LO to another NH, but it may not be practical to do so.

The suggestions about dropping in, observing mealtimes, etc. are great and I initially thought the same thing, but with covid restrictions still in place to some degree, that's not necessarily an option (at least not in my area). So, I have been asking friends, acquaintances, home health people, etc. about which facilities to avoid. I found a place near my home I am currently checking into and made an inquiry call just to understand the process. It is all very stressful and the weight of the responsibility is great. I wish you the very best in your search.

Medicare has a rating for Nursing Homes, Skilled Nursing Facilities. This is a tool that you can use, it will indicate ratings of past inspections and if they found a particular area with deficiencies it will indicate what they were.
Tour any that you consider
Talk to other visitors.
Observe a lunch, see how residents that can not feed themselves are fed. In a general dining room or a “feeding room”. When my Husband was in rehab I observed one man eating his meals, they were what looked like pre made puréed food that looked like hockey pucks, no utensils and he just put his face into the plate and ate like my dog would! ( ok that was 1 person but I still can’t get over the fact that they could do that, where is the dignity?)
Ignore the fancy outside of the buildings.
Pay attention to staff, do they engage residents? Do they talk to them? This might be difficult to determine on a tour. Did a call bell bring staff to the room or did they ignore it or others? (Again not an indicator alone as some people ring for no reason, but did the staff look to see what room it was that was calling)

I just put my father in a skilled nursing facility based on his doctor's recommendation. I used his current health insurance company for a list of places in my area. I found one that is 5 minutes from my home so that I can drop in 2 or 3 days a week. I'm very friendly to the staff and residents that I come across during my visits. Nothing is ideal but making the best of the situation.

Here's a good link to find and compare nursing homes in your area: https://www.medicare.gov/care-compare/#search. It can help you weed out the really awful places.

In my case... I lived in a rural area where there few options to begin with, so I chose the closest after touring twice and observing the staff and residents (to the extent that they were visible from the hall). Fortunately, the facility was clean and odor-free, the residents looked content (even happy), the staff were pleasant and outgoing, and the aromas from the kitchen indicated a pleasant dining experience. I came away from both tours with a good feeling.

It contrasted sharply with another facility I had toured a few months earlier, which was dingy, seemed to be in ill repair and whose residents were aimlessly wandering the halls (I even witnessed a very loud verbal altercation between two residents, and the staff just rolled their eyes and walked on by). Moreover, the administrator advised me that my mother had too much money (i.e., her Social Security check was too large) and though she would not qualify financially for a "regular" room, they could place her in their memory care wing because the daily rate for those rooms was higher. That wasn't the level of care that my mother needed, and I was shocked that the administrator would even suggest it. Add that to the fact that their policy manual stated (in effect) that though "physical relationships" between residents weren't forbidden, they were okay as long as they were behind closed doors and the staff had no knowledge of them. That set off the alarm bells for sure. (And as it turned out, the home health aide I employed in the interim told me that she had worked there for six years, and it was a terrible environment for both residents and staff, and she only stayed that long because she needed the job.)

In short, do your homework, tour every available facility, and take careful notes of everything you're told - and everything you see. I was lucky - the best facility was indeed the closest one (a 10-minute drive), and that was a blessing when the lockdowns started shortly after Mama was admitted. I was able to do window visits every day, and keep close tabs on her care.

Good luck with your search, and God bless.

Make sure, BEFORE you pick a nursing home; show up UNEXPECTEDLY (don't let them know "ahead of time"). That way, you'll see how things REALLY are. If you let them know ahead of time that you're coming; everyone (caregivers and staff) will be on their 'BEST BEHAVIOR', they'll make sure everything is clean, etc. This way; if you show up "unexpectedly", you'll see what the home is really like. Good luck!!

We looked at the ones in our area and asked about the annual reports, staff continuity, management changes etc. If you chat long enough it is interesting what you find out!
We also asked locally and the one we picked had had good reviews amongst neighbours.
The smell and how the residents seem is also an indicator. I think the telling thing is how the staff behave when you wander around. Do they seem aware of you? Or do they seem more concerned with the people they are caring for? Do they seem to know the tesidents individually? Or are the older people all closed off looking?
Good luck! x

I relied on my feeling about each place. Was it what Mom would want? Some smelled so bad that I couldn't stay very long. One was small, very home-like, and perfect for Mom. I didn't enjoy going from place to place, listening to sales pitches, but it was worth it to find the right place.

Research, visit, visit, research. This web site have can help you tremendously as the advisors can assist you in identifying needs, financial position, location and assist you coordinating visits to the facilities. I would recommend you first visit with an advisor and then alone for a second visit, preferably unannounced and during mealtime (and if possible ask to eat a meal there). Also ask for activities schedule and a meal calendar (they should have a monthly schedule or at least a weekly one). Ask if possible to speak with outside relatives of the resident (1 or 2) and away from facility employees (this will allow for a frank and honest conversation).

Online reviews for these facilities are very unreliable and often times the reviewers can be paid to write them and negative review can be removed specially if management company or ownership changes.

Make sure to ask for move in incentives. :-)

Best wishes and good luck. .

I will place my husband in a MC facility run by the same organization that owned the AL facility where I placed my stepmother. I looked at 2 other places while trying to find someplace for respite care. I looked at two other facilities; one of which was a group home. It was a large house and he would have a large well lit room. But, there was only one bathroom and one shower room for 8 residents.
The thing that totally turned me off is when the owner told one of the residents to go wait on her room with the door closed while she gave me the tour. None of the other residents were visible. And all the bedroom doors were closed. It made me very uneasy about what kind of care or activities would be available.
The other MC facility was nice, but I didn't get a warm feeling. The residents that I saw were clean and neat and the facility was clean and odor free, but there was no joy.
The one I decided on was warm and inviting. The residents were all sitting in the living room playing as best they could, a trivia game. The building was spotless, odorless, and bright. There are activities scheduled every 30 to 60 minutes. What impressed me the most is the obvious love the staff showed to the residents. One lady was noticeably upset about something and the staff member knelt down, held her hand while listening to her, then hugged her. The lady sighed and settled down.
That is the care I want for my husband.

We were lucky in that we had a good discharge planner at the hospital. She looked at mom's financials and gave us the names 4 places that would accept Medicaid after 2 years of private pay (we thought that was very important).

We visited each place twice, once with an appointment and once just showing up.

The smell test is important. One place stank and the nurse said "oh, someone just had an accident". 2 days later, same smell. Nope.

Other than that, we based our decision on access to religious services and distance.