Finding a nursing home for your loved one can be an emotional and difficult process. Just in the past month, my grandma who has lived at home with our family for decades, fell and due to this fall needed more care than we could handle. The process of finding a new “home” for Mama was heart wrenching (it still makes my heart sink thinking back). We all knew that the move meant she was one step further in her decline. From the youngest littles in our family to the oldest, our family wanted so badly to keep her at home.
Through work experience, I have am pretty familiar with senior living options in my area. 5 years ago I wrote a post on exactly this same topic. Yet as I initiated the search this time around for Mama, there was an added amount of hesitation, anxiety and a great deal more caution. My grandma is by far one of the most lovable people I know. And because she is that precious to us, it was all the more important that we made the best decision we could. I even considered moving her into my home (for real). And as I sought out advice from colleagues and pretty much anyone who could offer good insight, I learned so much along the way.
If you are in a similar pickle, my heart goes out to you. Moving your own to a nursing home can be a make-your-heart drop, cry-your-eyes out type of experience. In case you need some guidance or don’t even know where to start, here are some questions to ask and things to consider to give you more peace of mind when you make that difficult decision.
- Ratings – When you go out to eat, you Yelp to find a good restaurant. So when you’re looking for a home or a temporary home (short term rehab) for your loved one, you should also look at the ratings. Consider this a starting point. The two places I would suggest looking are Medicare.gov and Google. Medicare.gov has a page called NursingHomeCompare where you can look at ratings (based on a 5 star scale) that includes health inspections, staffing, and quality measures for every nursing home in the country. If at all possible, avoid any nursing homes with 3 stars or lower! Along with looking at Medicare.gov, I would also suggest googling nursing homes by name to see if you can get anymore insight from the ratings of families/caregivers. Don’t stop there.
- Location – Our elderly relatives and friends need us more than ever when transitioning into a new residence. A common misconception that people often have of nursing homes and assisted living facilities is that they handle everything for your loved one. Drop them off and you can get on with life. Not so. Nursing homes are there to help specifically with the physical needs of residents, but having frequent visits from family and friends can be a huge blessing for the wellbeing of your loved one. Being able to find a nursing home that is easy for you or other family/friends to visit is something I highly encourage. By visiting frequently, you can help smooth the transition for your loved one – you are the ones who know his/her preferences and tendencies. Even if you have found a wonderful nursing home, it takes time for even the most attentive staff to get to know someone. In my grandma’s case, we found a nursing home that was down the street from my house. Telling her that we would be moving her down the street gave her (and us) peace of mind.
- Staff to resident ratio – The reality is that nursing homes have limited staffing. When you call or visit a nursing home, be sure to ask them the ratio of staff to residents. How many aides do you have per resident? How many nurses do you have per resident? From what I know, an average ratio is 1 nursing aide: 10 residents. The lower the number, the better and the more attention your loved one will likely get. I had my heart set on another nursing home close to my home that had a better staff to resident ratio but in the end, due to time and location and cost, we chose another facility.
- Bed availability – Let’s just stop here. Determine how soon you need to move your loved one and then ask the facilities you are considering whether they have bed availability. If you are planning to pay privately, then you likely have more options. Medicare, from what I know, does not provide room and board for nursing or assisted living. If your loved one is on Medicaid, be sure to check that the facility will accept Medicaid residents. Not all do. In terms of time, there is often a longer wait for long term care. Long term care at a nursing home could have a waiting list for 1 year while there is often more availability for short term rehab stays. Identifying the urgency of how soon you need to move your loved one is important.
- Staff turnover/longevity – Whenever you have the chance, ask any staff you meet how long they have worked there. A nursing home with high staff turnover is bad news! It means management is not good. At one nursing home I went to, the dining manager had been there for 32 years and she was able to give me very thorough information about the place. Impressive! At the nursing home we chose to move my grandma into, the medication aide had been there for 30 years! When I heard that, my heart smiled.
- Visiting hours – When are you allowed to visit your loved one? What are visiting hours at this facility? A seasoned social worker and friend shared with me that the more you visit your loved one, often the better care they will get as staff tend to perform best when they know they are being watched. Make sure visitors are very welcome.
- Falls – A common problem in nursing homes are falls. For my grandma, she had just experienced a fall so she is now weaker and more susceptible to falling. Ask a facility what they do to prevent falls. Some facilities have bed alarms to alert them when a resident is trying to get out of bed (though I believe this is now frowned upon by CMS). One facility said their staff sits in chairs in the hallway at night to make sure they can be more accessible to residents.
- Did you visit? – You don’t book a daycare or buy a home without visiting so don’t depend on the internet to make this decision. Though it is more time consuming, I cannot overemphasize the importance of visiting (assisted living or nursing home). See how long it took you to get there, how it feels, smells when you walk in, how the staff interact with you and with each other.
And though there is still no place like home, if you consider these factors, I think you can have comfort knowing that you did your homework in looking for the best place possible. And even after all the research and visiting, I feel the decision and act of moving someone you love dearly is still emotionally difficult. If I missed something else, please feel free to comment.