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TRENTON, N.J. - Finding the right nursing home for an elderly loved one is a daunting task. And it's one most of us will face, as two-thirds of people over 65 will need nursing home care, at least temporarily, according to AARP.
It's best if you can research facilities in advance, but that's not always possible. A sudden illness or injury may force you to confront these concerns sooner than you expect.
Either way, here are several key considerations:
The biggest influence on the quality of care nursing home patients receive is often the frequency of visits by friends and family. Make sure you'll be allowed to visit when you want — from early morning to late evening — to fit your schedule and enable you to monitor care at different times.
Once your loved one is in a nursing home, drop by frequently, sometimes without notice. In the afternoon, see whether residents are enjoying interesting activities together or watching TV alone. At meal times, note how much your mom or dad eats. Stay late sometimes. After your loved one has fallen asleep, remain until he or she wakes up to go to the bathroom. If no one responds quickly to a ring for assistance, that's a serious problem, says Amy Goyer, AARP's caregiving expert and blogger. Residents forced to get up and go by themselves risk serious injury.
There are several sources for referrals. Your local Area Agency on Aging or hospital discharge planners can provide listings of nearby nursing homes. Medicare caseworkers, at 1-800-MEDICARE, also can help.
Stick to facilities certified by Medicare. They're inspected every year, and any complaints are investigated. Read recent inspection reports, usually available through the state health department. One patient accident isn't a big deal, but frequent reports of patient falls, bed sores and the like are a red flag, says Edward Mortimore, director of nursing home evaluations at CMS, the Centers for Medicare and Medicaid Services.
The CMS website provides a tool to help users compare nursing homes. The site includes links to its five-star ratings system, complaints against nursing homes, links to local ombudsmen and other health advocates, a detailed guide to choosing a nursing home and much more; visit www.medicare.gov/quality-care-finder.
CHECK ON STAFFING
No matter how dedicated individual employees are, if there aren't enough, care suffers. Check the ratio of aides to patients. CMS requires each patient have a daily minimum of 2.8 hours of nursing aide time and 1.3 hours with an RN or licensed practical nurse.
Ask specific questions about care. Can your mom keep her current doctor? Who decides whether to change your dad's medicine and will you be notified first? What's the policy on handling patients who get agitated or aggressive, as can happen with Alzheimer's patients?
Also be sure to ask about how the staff will deal with the unexpected: a power loss, natural disaster or other situation that would require an evacuation. Some nursing homes aren't fully prepared.
SCOPE IT OUT
Visit each nursing home you're considering and take notes. Snoop around — and beware anyplace that objects. Check resident rooms for cheerfulness and safety. Use the bathroom to see if there's enough hot water. Inspect the kitchen for cleanliness.
Note the atmosphere. Are patients smiling? Is it peaceful? Does it smell pleasant and homey?
Stay for a meal with residents, usually for a nominal cost. Is the food appetizing? Are residents enjoying the meal? Ask how kitchen staff handles dietary restrictions and whether they will cut up food for those with difficulty swallowing.
Once you've narrowed your choice down to two or three facilities, bring along your loved one if he or she is physically and mentally up to it. If not, show pictures and discuss why you favor a particular home. Allow the person to feel they have some control so they'll "buy in."
For most families, cost is a key factor. Last year, a semi-private room ranged from an average $46,355 in Texas up to $222,285 in Alaska. For average costs by state, go to: www.aarp.org/relationships/caregiving/info-07-2011/nursing-home-care-cost.html.
To control costs, determine if it's possible to keep your loved one at home longer through a combination of family help, health aides and adult day care. If a move is years away, consider getting long-term care insurance.
Medicare will pay for a stay of up to 90 days; Medicaid covers costs for the poor. Many people must use up most of their assets to reach the point where Medicaid takes over ongoing costs. Check with your state's Medicaid program and this site about paying for care: www.aarp.org/relationships/caregiving/info-10-2009/women_planning_retirement.html.
Visit AARP's new site for caregivers, with a cost calculator for different types of care, checklist of questions and tips: www.aarp.org/home-family/caregiving/info-05-2012/caregiving-resource-center-asking-right-questions.2.html
SWEAT THE DETAILS
Ask about anything that could affect whether your loved one will be happy and well treated. Will special needs be accommodated? Are there organized outings or visits by young people and pets? What activities are listed on the bulletin board, and is there a full-time coordinator? Do they have a library, Internet access, exercise classes or other stimulating offerings?
"There's almost nothing in the care of your loved one that shouldn't be checked on," Goyer says. "And don't hesitate to move your loved one if they are not receiving the care they need and deserve."