Nursing Home Placement Decisions
by Dennis G. Mille

Most nursing home admissions happen under extremely difficult situations. It can be an overwhelming task of finding the best nursing home placement for a loved one. For example, where do you begin? Although this is a job that no one wants, it can be done with advance planning.

The Center for Medicare & Medicaid Services (CMS) (a federal government agency) has as a part of its Web site -- Nursing Home Compare (http://www.medicare.gov/NHCompare/Include/DataSection/Questions/SearchCriteriaNEW.asp?version=default&browser=IE%7C7%7CWinXP&language=English&defaultstatus=0&pagelist=Home&CookiesEnabledStatus=True)-- comparing nursing homes, which identifies facilities that have a history of poor performance. The Nursing Home Compare reports nursing homes that have repeatedly violated state and federal health and safety rules and that rank in the worst 5 to 10 percent of all inspected facilities in a given state. Using Nursing Home Compare, you can obtain detailed inspection information about each nursing facility that interests you, comparing various government-rated "quality measures" such as:

• Percent of Residents Who Have Moderate to Severe Pain;
• Percent of High-Risk Residents Who Have Pressure Sores;
• Percent of Residents Who Were Physically Restrained; and
• Percent of Residents Who Spend Most of Their Time in Bed or in a Chair.

The Nursing Home Compare Web site also rates the care and services that each facility provides to its residents, and allows you to view how each facility stacks up in staffing hours for each type of health care worker against the state and national averages.U.S. News and World Report also recently started providing rankings of America's nursing homes. The U.S. News rankings rely on Nursing Home Compare but provide some advanced search engine capability. According to U.S. News, their new feature --America's Best Nursing Homes (http://health.usnews.com/sections/health/best-nursing-homes/index.html)-- addresses these and other issues. Nursing homes are presented in tiers within each star category, based on their total stars in all three of the major areas. The topmost tier, for example, consists only of five-star homes that got 15 stars. The next tier down is five-star homes with 14 total stars, and so on. Within each tier, nursing homes are listed alphabetically. If you're looking for a nursing home by location, and turn up too many, search terms can be combined in order to narrow the results. For example, perhaps you want to search just for nursing homes that have a religious affiliation, or that accept Medicaid residents. Or you can launch a multipronged search, perhaps searching for non-profit four-star nursing homes that accept Medicaid and are located within 25 miles of a particular city.

Placing your loved one in a nursing home that accepts Medicaid is vitally important and you should plan to use the services of a Certified Elder Law Attorney. At Phillips, Mille and Costabile, Dennis Mille is a Certified Elder Law Attorney (by the National Elder Law Foundation (www.nelf.org) which is recognized by the Ohio Supreme Court) and can help navigate the family through the complicated Medicaid rules and regulations to help preserve family assets (even if the applicant is already in a nursing home)

Another free Web site that lets you compare nursing homes is MemberoftheFamily.net, (http://memberofthefamily.net/) which features easy-to-read, color-coded assessments of nursing homes nationwide.

Despite the ratings, in my experience nothing can substitute for visiting a nursing home in person. Virtually every nursing home will have some deficiencies. To find the best possible nursing home for your family's situation, the first step is to determine what is most important for your family in looking for a facility. The resident’s needs and desires must be included in this evaluation. Consider variables such as location of the facility, whether a special care unit (such as for dementia) is available, and what types of payment sources are accepted.

The second step is to identify the facilities in your area which meet the criteria you have established.

Step three is to tour those facilities you have identified in step two. You don’t need to schedule your visits in advance. If you show up during regular business hours, you should be able to meet with an administrative staff member, who should be able to answer all your questions. You will also want to tour a second time, in the evening or on the weekend, to see if there is a drastic difference in the atmosphere of the facility or the care being provided. It is important to tour at least two facilities so you can see the difference in the physical facility and the staff.

While you are touring the facility, pay attention to your gut feelings. Ask yourself:

• Do I feel welcome?
• How long did I have to wait to meet with someone?
• Did the admissions director ask about my family member’s wants and needs?
• Is the facility clean?
• Are there any strong odors?
• Is the staff friendly?
• Do they seem to genuinely care for the residents?
• Do the staff seem to get along with each other?

Listen and observe. You can learn a lot just by watching and paying attention. And ask questions. You want to be sure that the facility is giving proactive care, not just reacting to crisis. Here are a few examples of the types of questions the staff should be able to answer:

• How do you ensure that call lights are answered promptly, regardless of your staffing?
• If my father is not able to move or turn himself, how do you ensure that he is turned and does not develop bedsores?
• How do you make sure that someone is assisted with the activities of daily living like dressing, toileting and transferring?
• Can residents bring in their own supplies?
• Can residents use any pharmacy they wish?
• How many direct care staff members do you have on each shift? Does this number exceed the minimal number that state regulations require, or do you just meet the minimum standard?
• What sources of payment do you accept?• How long has the medical director been with your facility?
• What is your policy on family care planning conferences? Will you adjust your schedule to make sure that I can attend the meeting?