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How to choose a Nursing Home: An insiders guide to choosing a quality long term care facility

Choosing a nursing home for a loved one can be a difficult decision for a number of reasons. There are many financial, medical
and legal issues that can pop-up without any warning. There are so many things to consider; it can be overwhelming.

1. How do I know which homes will accept my relative? Do they and can they refuse an admission?
2. How do I research a facility's reputation? (on-line and in person)
3. Should location be a factor? Is closer always better?
4. Does somebody need to accept financial responsibility if my loved one has Alzheimer's or some other form of Dementia?
5. How do I know they will receive quality care?
6. Should I prepare advanced directives like a Living Will prior to admission?
7. How do I know if something else might be more appropriate, like an Assisted Living Facility, Home Care, Senior Apartments
or Adult Foster Care?

3. Should location be a factor? Is closer always better?

This is a matter of personal choice. If the location is too far away, it can present some problems. If you like a nursing home but it
is located 30+ miles away from friends and family, it can be inconvenient to visit or stop in unannounced to inspect the home.
You should also ask how close the nursing home is to the nearest hospital. Is your loved one's hospital of choice nearby?
Choosing a home that is nearest to you is tempting but ask yourself, does it pass my personal inspection? If not, you are wise to
choose a quality home that may be further away.

4. Does somebody need to accept financial responsibility if my loved one has Alzheimer's or some other form of Dementia?

Yes. Prior to admitting your loved one, determine if they are mentally competent to make their own financial decisions. Are they
able to read and understand a contract? Are they able to sign their name? Are they aware of their assets? If you are unsure
about any of these questions, you may want to consult a family attorney prior to admission. Someone will need to accept
financial responsibility upon admission. You will also want to consider having someone appointed as DPOAF (durable power of
attorney for finances). Even if they haven't been diagnosed with a disease that impairs their cognition, you may want to evaluate
their ability to understand the financial implications. Another important note to remember, this advice also applies when they are
being covered under Medicare or private insurance. Under traditional Medicare part A, if they are receiving skilled care, they
will have a 20% co-pay starting on day 21 which on average can be around $130/day. This adds up quick if they stay beyond
20 days which happens a lot. Private insurance can be even weirder. Find out prior to admission (if able) what the co-pay is and
when it starts. Also determine if your loved one has Medi-gap insurance or Medicaid, both of which may pay some or all of the
co-pay.

5. How do I know they will receive quality care?

I could write a book on this topic alone. There are some basic indicators on whether or not your loved one can expect to
receive quality care.
- Staffing - The sad truth is that many nursing homes are poorly staffed, both in quantity and quality. If you were to ask any
director of nursing or nursing home administrator from any nursing home across the country what is their number one issue
managing their home they would probably all say staffing. Nursing homes in general have a very high staff turn over ratio. This is
the number of new staff hired in a given time period. High staff turn over is bad for several reasons. It is costly to train a new staff
member. The more new hires a facility has in a year, the higher the cost. New employees do not perform as well as experienced
ones. Continuity of care is diminished when a resident is cared for by many different people instead of the same ones who know
their needs the best. The lower the staff turn over ratio, the better care you can expect for your loved one. Whether or not a
facility uses temporary staff (also known as "agency staff") vs. permanent staff. Temp staff usually work in multiple facilities at the
same time. They do not know from one day to the next where their next assignment will be. They also do not know the resident
and their needs as well as permanent staff do. They often just "wing it" and provide care as best as possible. How well the facility
is staffed (the amount) will greatly affect the quality of care. If the facility is frequently short staffed, the quality of care will
decline.

- Past performance - How a facility performs in the past usually dictates how well they will perform in the future. One tool to
help you is the nursing home compare website provided by the federal government. I recommend you read my page here before
proceeding to the site.

- For profit vs. non-profit- Nursing homes that are classified as non-profit have an operating budget that determines how they
spend their money. To put it simply, the home uses the money it receives to meet their financial obligations and any money that
remains is reinvested into the home to hopefully improve the quality of life for the residents. They are typically affiliated with a
church or religious denomination. For -profit nursing homes are a business. They have owners or a board of directors and
investors. Very few anymore are family owned and operated as they have been purchased by the larger nursing home chains.
They also have an operating budget and must meet their financial obligations. Any money left over however goes to the owners
and shareholders as profit. The biggest chains make 100's of millions of dollars a year. They have a "profit motive" to reduce
cost, avoid fines and function appropriately. The cheaper that they can operate, the more money that they can make. I have
personally worked for both. If I ever had to make the decision to place my family member into a home, I would only place them
into a non-profit facility. The quality of care is superior, in my opinion, at non-profit Christian based homes.

- Medical director - The last consideration is the Medical Director or house Physician. How often is the doctor available in
person? Do they work alone or with partners? Do they specialize in Geriatrics? The majority of Physicians that I have worked
with were excellent and experts in their field. I have never witnessed poor care or incompetence. Ask how many times a month
the medical director visits the home. Some do weekly, some less. Ask if they are available for emergencies or do they send
residents to the hospital instead?

6. Should I prepare advanced directives like a Living Will prior to admission?

Basically everyone, whether entering a long term care facility or not, should prepare advance directives. Young or old, rich or
poor, everyone should be prepared at a minimum with a living will. If you are anticipating admission into a nursing home it is
imperative that you prepare advance directives prior to admission or as soon as possible after entering a nursing home. Click this
link to read "Advance Directives FAQ".

7. How do I know if something else might be more appropriate, like an Assisted Living Facility, Home Care, Senior Apartments
or Adult Foster Care?
This is pretty straight forward and is based on different criteria.
- Appropriateness - Either the discharge planners at the hospital or the potential resident and their family will contact a facility or
provider. The provide will then determine if you are appropriate for admission. See my page " How do I know which homes will
accept my relative?"
- Cost - A potential resident may qualify for one level of care, for example assisted living but prefer to pay the extra cost of
skilled nursing (nursing home) or they may qualify for a senior apartment but choose to pay for assisted living instead.