Finding Quality Nursing Home Care

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

Among other things, family caregivers may feel guilt-ridden because they're unable to personally fulfill their elderly loved one's complex care needs. Caregivers may likewise worry that their older loved one may not get quality care at a nursing facility.

If you're weighing 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 practicable care:

Before you select a nursing facility

Ascertain licensure, credentials, qualifications and care When touring a prospective nursing home, ask to see the nursing home's permit if it's not exhibited in a public area. Is the nursing home Medicare and/or Medicaid licensed? Ask 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 particularized unit for those suffering from Alzheimer's disease or other forms of dementedness?

Get to know the faculty When inspecting a nursing home, appraise your comfort with staffers. Are they accessible? Do they answer questions from both residents and family members? What policies are relatives supposed to adopt if they have concerns about their loved one's care? Are commonplace care planning meetings held at favorable 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 get along. If feasible meet with and appraise the personal qualities of the nursing home executive and nursing director. These two leadership spots are central to sustaining quality care in the nursing home.

Inspect 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 indoors and out?
Are the floors difficult to walk on (are they slippery, for example, or covered with too-thick carpeting?)
Are the doorways operated by electronically outfitted devices to reduce wandering?
How many staff members are engaged at a given time during various shifts?
And are there policies specifying minimum staffing levels for delineated amounts of residents?
Are there emergency preparedness and evacuation plans in order in event of fires, floods and other hazards?
Are staff prepared to evacuate residents if necessary?
Are the bed rails or guard rails on nursing home beds raised up? Heightened guard rails on beds present a serious injury risk for older adults, and should rarely be employed to restrict patients. Similarly, residents seated in chairs should not be restrained with seat belts or trays.

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

Does the staff make every effort to feed seniors out of bed? What schemes do they use to do so?
Does the nursing home accommodate special dietary demands by, for instance, preparing pureed foods, and carefully monitoring meals for residents with diabetes and food allergies?
Does the nursing home supply 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 day-to-day routines, such as when to go to bed, and when to bathe. In special care units for residents with dementia, however, it should be obvious that the nursing home adopts a coherent routine. This is particularly important for residents with dementia. Consider the range of activities offered. These may include arts and craft classes, chair exercise programs, spiritual services, discussion groups, amusement 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 furnish to help him or her become involved and stimulated.

After you've placed your loved one in a facility

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

Be on the lookout for signals of neglect or abuse If you see an older adult - your loved one or any other resident - who is wearing unwashed clothing, is dirty, seems undernourished, or appears to have untreated health problems, investigate right away. Pressure or "bed" sores - a painful breakdown of the skin that results in mild inflammation and swelling or, in extreme instances, in intense wounds and infection - can be evidence of severe negligence. Bruises may be signs of abuse.

Visit the nursing post often You should stop at the nursing station each time you visit, not just to supervise your loved one's daily activities - which staff should enter in his or her medical chart - but also to review the services provided by the staff and inquire about any modifications in medicines, diet, demeanor, sleep or exercise. Ask about your loved one's temper, his or her interest in food, engagement in activities, and his or her health. You or another family member should be contacted right away if a problem comes about -- if your loved one falls, for instance, or starts wandering. As a caregiver, you have the right to be advised.




“Under the care of Leo J. Borrell, M.D. since December 2001, I have seen a remarkable improvement in my mother’s condition. She is responding dramatically to the new regiment Dr. Borrell has prescribed”

- Beth Rose


Feb 3, 2008

The Interdisciplinary Team; The Role of the Psychiatrist

by Dr. Leo J. Borrell, featured in Assisted Living Consult for November/December 2006. A HealthCom Media Publication