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 "Picking a Nursing Home" (NYT 3/18/10) 
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Post "Picking a Nursing Home" (NYT 3/18/10)
This article on selecting a nursing home is in the "Patient Money" series in the New York Times. Two useful resources mentioned in the article are:

* a list of the ombudsman contacts by state.
http://www.ltcombudsman.org/ombudsman

* Medicare's Nursing Home Checklist
http://www.medicare.gov/nursing/checklist.pdf

Here's the full article:


http://www.nytimes.com/2010/03/20/health/20patient.html

March 18, 2010
Stressful but Vital: Picking a Nursing Home
By Walecia Konrad
New York Times

The decision is one of the hardest you will ever make. Your spouse, parent or another loved one needs care that assisted living or home health care simply cannot provide. You need to choose a nursing home.

It’s a difficult and emotional task. The horror stories are well documented, and even in the best nursing homes the transition can be wrenching for the entire family.

Finding a good nursing home takes research and perseverance. You want a safe, engaging and pleasant environment with caring staff and solid medical practices.

“You can actually get all of that in a nursing home — if you know what to look for and how to search,” said Larry Minnix, chief executive of the American Association of Homes and Services for the Aging, a trade group for nonprofit nursing homes and other organizations for the elderly.

Unfortunately, the typical search for a nursing home is made under duress. More than 60 percent of admissions come from hospitals. The patient may have broken a hip or had a stroke and now needs rehabilitative care. The hospital is in a hurry to discharge and may move quickly to get the patient moved to an available nursing home bed, regardless of the operator’s quality or reputation.

“Hospitals ought to be more aware, but it often is just not on their radar screen whether they are sending a patient to a good nursing home or a bad one,” said Janet Wells, director of public policy at the National Consumer Voice for Quality Long-Term Care, an advocacy group.

In such situations, you have precious little time to do your research. What is more, these temporary stays often become permanent, depending on the individual case and sometimes on the quality of the temporary care received.

Paying for a nursing home is another huge source of stress. Medicare pays only for medically necessary care in a skilled nursing home, like physical therapy or intravenous medicine. It does not pay for what is called custodial care — help with walking, eating, bathing and other daily tasks. Instead, the majority of nursing home residents pay from personal money, long-term care insurance policies or, if they qualify, through Medicaid.

The average cost of nursing home care is $200 a day, and that does not include additional fees for specialized services like care for patients with Alzheimer’s or dementia.

To find a nursing home you can really feel good about, consider these important steps.

START WITH THE DATA Every year the Centers for Medicare and Medicaid Services collect data on more than 15,000 nursing homes throughout the country. Health inspection data, staffing and quality measures are combined to come up with an overall ranking of one to five stars. To look up nursing homes in your area, go to medicare.gov and click on the “nursing home compare” tool.

In addition to the rankings, the site offers a useful brochure entitled Medicare’s Guide to Choosing a Nursing Home, as well as other resources.

Keep in mind that government rankings have their limits, and they reflect the nursing home’s performance during only a short period.

“Health inspection data is only as good as the data itself,” Ms. Wells said. She points out that many studies show that state inspections tend to underreport nursing home deficiencies and the seriousness of those deficiencies. “The home could be even worse than it appears in the rankings,” she said. “Of course, it could also be better.”

There are other shortcomings. For example, under the grading curve Medicare uses, precisely 10 percent of nursing homes in any one state are permitted to get five stars.

That could mean a four-star-rated facility may be just as good as a top-rated home down the street but simply falls below the percentage cutoff, said David LaLumia, president of the Health Care Association of Michigan, which represents nursing homes and rehabilitation centers in the state. On the other hand, it could also mean that more homes would fall into lower rankings if the curve did not exist.

VISIT, THEN VISIT AGAIN Nothing substitutes for what you see, hear and smell when you visit a nursing home, Mr. Minnix said. Be sure to visit more than once and at different times of the day and different days of the week. Take the checklist from the Nursing Home Compare Web site with you.

“Trust your five senses,” advised Mr. Minnix. “Does it smell like cleaning fluid and urine when you walk in or fried chicken and apple pie? You also want to see an ant farm of activity. Are the staff friendly and interacting with the residents?”

Be sure to ask to speak with crucial leaders, including the executive director, lead physician and head nurse. If those people are not available, ask when you can meet with them. If you get the runaround, Mr. Minnix said, that could be a red flag.

When you do meet with the staff, ask them if you may attend a resident council or family council meeting. These groups are usually run by family members to address concerns and improve the quality of care. You will get a good inside view of what is really going on at the nursing home from these meetings.

After your visits, always ask your loved one’s doctor, clergy, friends and family what they know about the homes on your short list.

WHAT TO ASK There are two big buzzword trends in nursing home management that can significantly increase the quality of care.

Ask the nursing homes you visit if they engage in “person-centered care,” as well as “consistent assignment,” suggests Carol Benner. She is the National Director of the Advancing Excellence Campaign, a coalition of industry, government and consumer groups working to improve nursing home quality.

Nursing homes that provide person-centered care allow residents to wake up when they want to, eat when they want to and generally set their own schedules. Traditionally, many nursing homes have had residents wake, eat, bathe and go to bed at the same times.

Consistent assignment, meanwhile, simply means that the same staff members — doctors, nurses, aides — treat the same patients each shift. The continuity of care reduces errors or problems and helps residents and staff members to develop a lasting relationship that can significantly improve a resident’s emotional well-being.

“Imagine how much nicer it would be to know the same person will bring your tea each evening and already knows you like sugar in it,” Ms. Benner said. “We know from the evidence out there that a strong relationship between residents and staff consistently leads to better care.”

It can also lead to lower staff turnover, because employees are naturally more engaged in their jobs and less willing to leave if they have developed relationships with their patients.

Be sure to ask each nursing home you visit what percentage of their staff leaves each year. Less than 30 percent annually is considered good. More than 50 percent is a sign to look elsewhere.

A nursing home is not obliged to disclose this information to you, but if it does not, “that tells you something, too,” Mr. Minnix said.

CALL YOUR OMBUDSMAN Each state has a federally funded long-term care ombudsman who is an advocate for nursing home patients.

This person can tell you if there are state rankings or surveys available in addition to the Medicare ratings. The ombudsman can also help you find the latest health inspection reports, which are public information, on specific nursing homes. Ombudsmen can also tell you how many complaints the office has collected about a specific nursing home and the nature of those complaints.

You can find the ombudsman in your state online at the National Long-Term Care Ombudsman Resource Center.

Maybe most important, a good ombudsman will know about recent significant changes at various nursing homes.

When Ms. Wells recently helped a family member find a nursing home, for example, she was considering a three-star center close to home. But when she called the ombudsman’s office she discovered that the well-regarded director of that center had moved to a nearby one-star home. Ultimately, Ms. Wells decided to go with the lower-ranked facility because of the change in management.


Mon Mar 22, 2010 1:04 am
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post Re: "Picking a Nursing Home" (NYT 3/18/10)
These tips on choosing a nursing facility were published in April 2010 by the American Geriatrics Society (AGS). The tip sheet also recommends these resources:

* "Nursing Home Care"
This is a terrific overview of nursing homes, published in 2005, that is a chapter in a larger AGS online publication called "Aging in the Know." For the chapter on nursing home care, see:
http://www.healthinaging.org/aginginthe ... .asp?ch=15

* "Choosing a Nursing Home"
This is another helpful set of suggestions on how to choose a nursing home and how to monitor the one you've chosen. It's also a chapter in a larger AGS publication called "Eldercare at Home -- A Comprehensive Online Guide for Family Caregivers." For the chapter on nursing homes, see:
http://www.healthinaging.org/public_edu ... are/26.xml

* Medicare's "Nursing Home Compare" website at www.medicare.gov/NHCompare/Include/Data ... riaNEW.asp

Here's the recently-published tip sheet:


http://www.healthinaging.org/public_edu ... e_tips.php

Finding Quality Nursing Home Care:
Advice from The American Geriatrics Society's Foundation for Health in Aging

Nearly 1.6 million older Americans live in nursing homes in the United States. While many are receiving quality care, the move to a nursing home can still be difficult for older adults and their family members alike.

Among other things, family caregivers may feel guilty because they're unable to personally meet their older loved one's complex care needs. Caregivers may also worry that their older loved one may not receive quality care at a nursing facility.

If you're considering moving a loved one to a nursing home, experts with the American Geriatrics Society Foundation for Health in Aging (FHA) offer the following advice for ensuring the best possible care:

Before you choose a nursing facility

Check licensure, certifications, qualifications and care. When touring a prospective nursing home, ask to see the nursing home's license if it's not displayed in a public area. Is the nursing home Medicare and/or Medicaid certified? Inquire about the services the nursing home offers. Does it provide services your loved one needs or might need, such as wound management for seniors who develop bedsores, physical rehabilitation services, or a specialized unit for those suffering from Alzheimer's disease or other forms of dementia?

Get to know the staff. When visiting a nursing home, evaluate your comfort with staffers. Are they approachable? Do they answer questions from both residents and family members? What policies are relatives supposed to follow if they have concerns about their loved one's care? Are routine care planning meetings held at convenient times for family? It's important to get to know the staff and create a "partnership relationship" with those who will be caring for your loved one. The better the communication and interaction between staff and relatives, the better residents will fare. If possible meet with and assess the personal qualities of the nursing home administrator and nursing director. These two leadership positions are central to maintaining quality care in the nursing home.

Scrutinize facility cleanliness and safety:

* Are there handrails in the bathing areas and hallways?
* Are there sprinkler systems and are fire extinguishers easily accessible?
* Are there plenty of secured walking areas inside and out?
* Are the floors difficult to walk on (are they slippery, for example, or covered with too-thick carpeting?)
* Are the doors operated by electronically equipped devices to reduce wandering?
* How many staffers are working at a given time during different shifts? And are there policies stipulating minimum staffing levels for specified numbers of residents?
* Are there emergency preparedness and evacuation plans in place in case of fires, floods and other hazards? Are staff trained to evacuate residents if necessary?
* Are the bed rails or guard rails on nursing home beds raised up? Raised guard rails on beds pose a serious injury risk for older adults, and should rarely be used to restrain patients. Likewise, residents sitting in chairs should not be restrained with seat belts or trays.

Make sure residents with special nutritional needs are well nourished. Find out how staff accommodate residents who have dietary restrictions, or are unable to feed themselves. Ask such questions as:

* Does the staff make every effort to feed seniors out of bed? What strategies do they use to do so?
* Does the nursing home accommodate special dietary needs by, for example, preparing pureed foods, and carefully monitoring meals for residents with diabetes and food allergies?
* Does the nursing home provide supplemental vitamins and minerals in residents' diets when necessary?

Evaluate routines and activities. Residents who don't have dementia or other cognitive problems should be able to make choices about their daily routines, such as when to go to bed, and when to bathe. In special care units for residents with dementia, however, it should be apparent that the nursing home follows a consistent routine. This is especially important for residents with dementia. Consider the range of activities offered. These may include arts and craft classes, chair exercise programs, religious services, discussion groups, entertainment such as musical and dance performances or "movie nights." If your loved one has difficulty participating in the activities the nursing home offers ask what other activities it can provide to help him or her become engaged and stimulated.

After you've placed your loved one in a facility

Keep visiting! Family interaction is crucial for your loved one's well-being. So make frequent social visits. Not only will your loved one feel happier and comforted by your presence, he or she will also feel more settled in his or her new home. If you make regular visits you're also more likely to notice signs of new health problems or injuries or other changes in your loved one that may be overlooked by staff. Additionally, you're more likely to notice changes in the nursing home staff - changes in staff and administration that could affect quality of care.

Be on the lookout for signs of neglect or abuse. If you see an older adult - your loved one or any other resident - who is wearing soiled clothing, is dirty, looks malnourished, or appears to have untreated health problems, investigate immediately. Pressure or "bed" sores - a painful breakdown of the skin that results in mild redness and swelling or, in extreme cases, in deep wounds and infection - can be evidence of serious neglect. Bruises may be signs of abuse.

Visit the nursing station often. You should stop at the nursing station each time you visit, not only to monitor your loved one's daily activities - which staff should record in his or her medical chart - but also to review the services provided by the staff and inquire about any changes in medications, diet, behavior, sleep or exercise. Ask about your loved one's mood, his or her interest in food, participation in activities, and his or her health. You or another family member should be contacted immediately if a problem occurs -- if your loved one falls, for example, or begins wandering. As a caregiver, you have the right to be informed.

This tip sheet was created on April 22, 2010


Tue Nov 02, 2010 8:17 pm
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Joined: Fri Aug 11, 2006 1:46 pm
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Location: SF Bay Area (Northern CA)
Post Re: "Picking a Nursing Home" (NYT 3/18/10)
Previously I may have mentioned Claire Berman and her excellent book "Caring For Yourself While Caring For Your Aging Parents." On a California caregivers' email list in September 2010,
someone posted this March 2002 interview by the CBS Saturday Early Show with author Claire Berman. The answers three questions -- at what point is a nursing home needed, what if the person says "no," and what if you think a nursing home is the right option but a sibling says "no" -- and gives tips on choosing a nursing home.

Here's a link to the interview and the full text.


http://www.cbsnews.com/stories/2002/03/ ... 4334.shtml

New York, March 23, 2002

When It's Time For A Nursing Home
Author Offers Practical Advice For A Difficult Time
By Ellen Crean

(CBS) According to the National Center for Health Statistics, more than 1.6 million Americans live in nursing homes. Admission to these facilities can be traumatic for everyone involved. On The Saturday Early Show, tips on how to choose a nursing home are offered by Claire Berman, author of "Caring For Yourself While Caring For Your Aging Parents."

The book is designed to be a guide for people who are involved in caring for aging parents (and for those who see care-taking in their future). It centers on the emotional stresses and needs of caregivers, while addressing practical issues they are likely to confront.

Berman, drawing on her own experiences, the experiences of many other adult children, and interviews with specialists in geriatrics, discusses the wide range of emotions that can accompany care-giving. She discusses the practical tools necessary to balance the needs of the parent and the caregiver. Her book is completely revised with new information on nursing homes, as well as updated statistics and resources.

Here is part of Berman's pre-interview with The Saturday Early Show:

At what point is someone ready for a nursing home?
It is not when the patient is ready to be placed in a home but when the caregiver decides it is the right option. The three biggest reasons a person is placed in a home is if they are incontinent, are constantly sleepless or when they have dementia and don't really know who is caring for them.

Some children will place a parent in a home the first time an adult diaper needs changing. Other people can handle changing diapers and will keep their parents with them as long as possible. For children who are close to their parents, this is an opportunity to give back.

What do you do when that person says no?
Many people who are still of sound mind dread the thought of being placed in a home. But sometimes this is the only option and they need to be told that every other option such as home care has been exhausted. If the problem is money, let the parent know that home care won't work because it costs too much.

Suppose you feel a nursing home is the right option, and your brother or sister says no.
Siblings often don't agree on when a parent should be placed in a home, and this can cause a great deal of tension in the family. Old emotions are often dredged up such as one sibling feeling that the parent likes the other better. At the first sign of any dissent, bring in a third party, such as a social worker, who will look at the situation with no prejudices.

Some of Berman's tips on choosing a nursing home:

* DO YOUR HOMEWORK. It's best to plan ahead. You may even want to look into nursing homes before your parent is in need of one. The last thing you want is to be forced into a situation that isn't right. A person can fall ill and require round-the-clock care very quickly. A spur-of-the-moment decision is a bad


Tue Nov 02, 2010 8:21 pm
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