by Linda D. Pershall
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This is a list of guidelines and suggestions for selecting a quality nursing
home or other long-term care facility as compiled by medical professionals at
L D H P Medical Review Services Corp. This is not a federal or a specific state's
standard, but rather a composite of many standards and the experiences of our
medical professionals. These suggestions were designed for the public to use
in making their personal evaluations of a specific facility. This list was compiled
to assist individuals with the process of selecting a long-term care facility.
We believe these items should be met before considering any long-term care facility.
There are many excellent long-term care facilities, however there are a few
that need to be avoided. Please do not be intimidated about "looking"
carefully at a facility. Your loved one deserves the best of care. Use this
list to assist in the evaluation of a long-term care facility to your personal
standards and satisfaction.
The first step in the selection process of a facility is deciding the level
of care that is necessary for the personís needs. The individualís
personal physician would be an excellent resource to assist in making this decision.
Other resources that may be helpful are hospital discharge planners, hospital
social workers and visiting nurses.
Most facilities describe their care as skilled vs. non-skilled care. This is
not a reflection on the level of skill of the staff, but rather a classification
of licensed vs. non-licensed staff (licensed practical/vocational or registered
nurses vs. non-licensed certified nursing assistants). A non-skilled facility
may be supervised by a licensed nurse who is available for emergencies and the
care be provided by certified health care workers such as nursing assistants.
For someone needing moderate assistance with meals and dressing but not intensive
nursing care, this can be quite appropriate as well as cost effective. Before
selecting any facility, be sure the individualís physician agrees that
the facility will be able to meet their care needs.
Our suggestions are geared toward skilled facilities but many of these guidelines
will also apply and be very appropriate for facilities of a lesser level of
Our first suggestion is that the facility have valid and current licenses from
all state and local licensing agencies regardless of the level of skilled care.
Your state health care licensing agency will be able to advise you on this.
Secondarily, does the facility accept Medicare as a payer source? This is important
even if this is not your personal payer source as this creates a minimum standard
of care that must be met by the facility. This applies primarily to skilled
care facilities as non-skilled facilities are usually private pay.
Some basic standards for a facility to follow would be: Does the facility maintain
liability and malpractice insurance, regardless of the level of skilled care
being provided? Does the facility have a satisfactory referral from local hospitals?
Does the facility have a satisfactory referral from local physicians? Does the
facility have a satisfactory record with the local health inspectors and government
licensing agencies? Ask the facility you are considering if they have a copy
of their state inspection on file for you to read. Are there any lawsuits pending,
prior malpractice suits or suits for unpaid debts? Are there any mechanic liens
or any other types of liens or judgements against the owners of the facility
or the facility itself? Check with the local county clerkís office. Any
of these could indicate a management problem or financial problem. Management
and financial problems may make the incidence of negligence more likely due
to under-staffing and the inability to maintain the facility.
Emergency care provisions need to be addressed: Is there a physician on staff
or on call? Is there access to a physician 24 hours a day for emergencies? Is
there physician back-up coverage if the first physician is not available? Does
the physician maintain regularly scheduled visits at frequent intervals for
all residents? All residents should be seen by the physician at least twice
a year, even if they are medically stable. If the individual is not medically
stable, the frequency of physician visits would need to be increased. Physicians
visits may be within the institution or the person may be seen in the physician's
office. This would be appropriate for any level of care, skilled or non-skilled.
An equally important emergency question is, are all staff members trained in
basic first aid and C. P. R. (Cardiopulmonary Resuscitation) regardless of the
level of staffing or licensing? Also, is there an emergency equipment cart in
plain view and easily accessible if it is a skilled care facility?
Is there a licensed nurse on duty at all times (RN/LPN/LVN)? Ideally, one RN
per shift and one or more LPN/LVNs per shift depending upon the size of the
facility. Does the licensed nurse do direct patient care? A licensed nurse doing
some direct patient care makes for better supervision of all residents. This
applies only to skilled Nursing Home facilities. (see the above explanation).
Some basic questions/areas to investigate in general care would be: Is the
facility free of any strong or unpleasant odor? Please, give it the old "take
a deep breath and sniff test." You will know if it passes! If it does not
pass, suspect a lack of staff to keep the residents clean and/or a lack of appropriate
janitorial services. A strong odor is a strong clue to investigate further.
Are the residents clean and dressed in street attire when you tour the facility?
Residents need a home-like environment. This is "their home"
and not a hospital.
Also tour during a meal. Are the residents well nourished? Is there a staff
member present to assist the residents who need help cutting up food, opening
containers, etc.? Is the food appealing? Is the amount of food appropriate?
Is the meal served in a manner in which you would want your meal served? Are
residents who need to be fed receiving assistance in a relaxed and pleasant
manner? If the manner is rushed, the residents are at risk of choking or not
receiving adequate nutrition. Walk down the halls. Are the bed-bound residents
being assisted? Is there sufficient staff to assist all of the residents before
their meal is cold?
Other safety issues would include: Are all medications and emergency equipment
locked to prevent disoriented persons from gaining access to them? Are there
alarms on the exit doors to alert the staff if a disoriented resident wanders
off? Are fire and safety codes met? Is there easy emergency escape access and
plenty of fire extinguishers, smoke detectors, sprinkler systems, etc.? Also,
are the halls reasonably free of clutter in case of an emergency? If the building
is multi-level, are there fire escapes for the upper level? Check with the state
licensing boards and local fire Marshall to see if safety standards are met.
Another important question is family visitation. Are families permitted to
visit freely, including children? Are areas set aside for family visitations
in a private setting which would be safe for small children as well as not creating
a disturbance to other residents? Are small children welcome and able to visit
their elderly relatives (unless medically unwise in a particular situation)?
Are families encouraged to visit during and participate in activities such as
Bingo night? An excellent way to assess the quality of care is to visit at an
unexpected time to "catch" any irregularities. Visitations that need
prior arrangements are a "red flag" that the institutionís quality
is questionable. We stress that frequent, random family/friends visitations
are an important safeguard for quality care.
Does your loved one have a diagnosis of Alzheimer's disease? The facility under
consideration should be set up specifically for that disorder. The facility
should have staff members familiar with the unique needs of the Alzheimer's
patient. The setting should have specific physical safeguards in place, alarms
on exits, locked supply areas, locked medication cabinets, etc. The physical
environment needs to be more simplified for Alzheimer's patients as well. There
also needs to be an increased ratio of staff members to residents to allow for
more personalized supervision. Is the facility you are considering familiar
with recent Alzheimerís developments and treatments? There are unique therapies
geared specifically to the needs of the Alzheimerís patient and their family.
If this list is satisfactory, there is a supplementary list to utilize in your
selection process as well as a list of alternatives to nursing home placement
available on our Internet site at http://www.ldhpmed.com.