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I found out very early on, that a smell of urine especially, is not a good sign. The feces smell however, should only be intermittant and if you revisit a place and the smell is still there, it's a sign as well. I would also, like someone said above, make sure about the staff to patient ratio. It's really very important in how your loved one is cared for. I had my mom in 3 different nursing homes before finding the right one. That wasn't good for my mom's mind and it was, as well, harder on me. I would think a place was okay and then, after a few weeks, I would see the problems. So much better if you can find them before admission. I don't think that visiting the NH only once or twice is enough. I would go at different times of the day and/or night and see what's going on. Talk to some of the patients as well. They will absolutely tell you if the staff, food or medical care isn't up to par. Ask them if you and mom can have lunch there one day with the patients but don't give them much of a heads up on which day. Decide what you think for yourself. The other thing that to me, was so important, was activities. Do you see people constantly sitting in the hallway looking bored to death? Some people HAVE to be by the nursing station like my mom was after her fall, but sometimes, it's just boredom. Make sure they have a great activities staff and also physical therapy. Most elderly people need PT at some point. I know all of this sounds expensive but my mom had NO money at all hardly and I just had to search well first. Also, I hope you know that if there is a medical reason that mom is sent for "rehab" from a hospital visit, medicare will pay for the first 90 days I believe. (some on here might know the exact amount of days better then I do). It does NOT have to be to an "indigent" type NH. It can be a very good one. While mom is in there, you will then be working on getting her on govnt assistance for the NH. The staff at any NH can help you with this process. I sincerely wish you well. My mom has passed away but by staying on here, I'm hoping that I can help other people going through this difficult time.
If mom has dementia, it's even harder to secure a great place. My mom was at the start of dementia when I started looking. The first place she was in, she told me that some man kept coming into her room at night staring at her. I was LIVID and really chided the staff to find out what it was all about. It was the dementia and sundowners but I didn't know. I removed mommy from there immediately when the staff kept denying this was happening. This was my fault for being uninformed about dementia I guess.
The food should be good- take the time to eat when you visit.
The rooms would have to be pretty large to accommodate 3 people. The norm seems to be 2 people in one room sharing a bathroom that is in their room. Or paying more for a private room.
Shower facilities tend to be down the hall.
Everything should be clean. Ask about staffing, how many RNs per shift, and especially, in my opinion, how many aides per shift - what are the ratios? For example a local nursing home here has 2 aides to 40 patients evenings, nights and weekends. Weekdays, daytime, there are lots of other staff present. To me aides are important because they do the bulk of the hands on care.
If an aide is a no- show for her shift everything backs up immediately until they get someone to cover.
I am sure there are plenty of RNs that get right in the trenches with the aides. Unfortunately at my MIL's SNF, the RN's will always refer anything icky to an aide. Lots of icky in this sphere so lots of aides are needed.