Don't choose a home for today's care needs. Too often people choose a facility for an elderly person based on their care needs today. Choose a care facility that is going to meet your needs tomorrow, six months, a year, two years down the line. If your relative or friend is going to need more help - not less - as time goes on make sure that the home you choose has the services they are going to need.
Make an appointment for your first visit.
If you think you might choose that facility, plan on dropping in unannounced at least twice thereafter. The best times are around mealtimes so that you can observe how meal service is provided.
Speak with some of the residents without staff present.
Ask them how they like being there. Try to get a feeling about whether your relative would fit in and be comfortable with the type of residents living in that facility . Are they experiencing similar problems and care needs?
Do NOT be Distracted by a Perfect Looking Home.
Although a residential care home or nursing home should be neat, clean, orderly and not have any offensive odors, ultimately you are looking for GOOD CARE, not perfect decor. At California Registry, we often visit homes that are exceedingly well decorated but have managers and owners that have little or no experience in caring for elderly people
Observe how residents and staff interact with each other.
Do the residents seem withdrawn and silent? Do they seem depressed and off in a world of their own? Do the staff treat residents as adults or more like children? If so, this may indicate that a facility is understaffed or that they don't understand the psycho-social needs of their residents. To a large extent the way the staff treat the residents will more than anything else determine the quality of life that a resident experiences in a facility. Competent, caring staff that respect the personal dignity of each resident is essential.
Read the rental contract or patient agreement carefully.
Take it home with you if necessary. What extra charges are there? What items are not covered in the care contract? If these are not listed ask the facility to list what is not covered and what it will cost for those extra services. Never choose a facility that will not specify basic rates and extras in writing for you. Another important thing to check is how much notice you contractually must give a facility if you must move your relative out of a facility either due to medical reasons or if you are not satisfied with the facility.
Observe and sample meals
Food is often one of the few pleasures that elderly people can enjoy on a daily basis. If the food is bland and tasteless or lacking in variety the quality of life of an elderly person is seriously impacted in our opinion. We think that food is very important in the choice of any facility, be it retirement community or nursing home.
Usually it is not possible to sample the food prepared in small homes, but in the larger facilities such as retirement residences, assisted living facilities and nursing homes you may be invited to eat with the residents. If you are not, ask if you may eat a meal with the residents. Observe how the meals are served to the residents. Are the servers courteous and friendly. Is the food served hot? Is the food easily managed by an elderly person (e.g. can they easily cut it up and chew it?) Is there a variety of drinks available? How many choices do the residents have at each meal? Are there adequate amounts of each item? Are there a variety of fruits and fresh vegetables available? Are their desserts tasty and attractive?
Ask to see the latest state licensing inspection survey
Every facility is visited at least annually whether it is a residential care home, assisted living facility or nursing home. In the case of nursing homes, the annual survey is supposed to be placed in a public area of the lobby or entrance to the nursing home. If you don't see it , merely ask someone at the front desk for a copy of it or where it is located. Every nursing home will have some violations - but what you don't want to see in the survey are documented observations of poor or negligent patient care. Many of the deficiencies can be for things that seem simple or even trivial, but the sheer number of deficiencies may indicate a facility with real problems. A nursing home survey that is ten pages or less and has no significant deficiencies in direct patient care may be a good facility. One that 20-40 pages of deficiencies and lots of patient care deficiencies is a facility that you may want to avoid.
Ask to speak to the Director of Nurses
Every nursing home will have a D.O.N. (Director of Nurses). In speaking to the D.O.N. try to ascertain his or her philosophy of care and how long that person has been in that position. The D.O.N. sets the standards for care in a facility. If that person is good at their job and is supported by management (i.e. the Administrator) then care generally is good. Where there is turnover you are likely to see a facility that has real problems in caring for its patients.
What happens if the money runs out?
Find out what the facility's policy is if the patient's money runs out and they can no longer pay for private care. Nursing homes generally have Medi-Cal contracts with the state which provides for the care of patients who have exhausted their funds for care. However, no such provision exists for licensed residential care homes or assisted living facilities. They can not bill Medi-Cal for the cost of care. Your only recourse in that situation is to transfer the person to a nursing home under the Medi-Cal program.
Is it better to place a person into a nursing home rather than a residential care setting because their money will run out? At California Registry we suggest that if a person's funds will run out in less than six months it usually is better to place that person in a nursing home rather than a residential care home. The reason's are practical. First, an elderly person finds it terribly upsetting to be moved and the fewer moves the better, both physically and mentally for them. Secondly, the care home will just be getting the person adjusted to the routine of the home and they will have to be moved. It is inconvenient for the home and the family to have to undergo two moves in a short time.
If there are funds, however, that allow the person to be housed for six months or longer in a residential care setting vs. a nursing home we usually advise the family to opt for the residential care setting or assisted living facility even though it may involve a move within a year. We believe that the quality of life is so much better in those settings over a nursing home that it should always be considered whenever possible.
In the final analysis there is no perfect solution, only some that seem better than others. But your knowledge of the system will help guide you to a decision that is best for your yourself or your relative.