FINDING A HOME
The following information should serve as a starting point. Remember: Making several visits to the facilities you are considering will give you a true feeling for the quality of care provided. If you forget to ask a question, call back and ask it. Making the decision to seek long-term care is difficult enough. Using the suggestions above will help you make informed decisions based on sound research.
What if My First Choice is Unavailable?
Michigan nursing facilities run at an occupancy rate of about 87 percent. It is not uncommon to discover there are waiting lists.
It is still worthwhile to go through the process of visiting and assessing facilities. If there is no space in the facility at the top of your list, make sure your loved one is put on the waiting list. Check with the admissions department weekly to let them know you are still interested in the first available bed.
In the meantime, use the checklist to choose the best possible facility for your needs or those of your loved one.
Most residents come to nursing facilities from hospitals after an injury or an accident or a health event makes it clear that returning home directly from the hospital is simply not a realistic option.
Ideally, hospital discharge planners would start working with the families of such residents immediately. All too often, however, families are presented with one or few options just a day or two before their loved one is to be discharged. When this happens, families often feel they have no alternative but to accept whatever facility the hospital discharge planner has identified.
Some actions you can take that may help include:
• Contact your hospital’s discharge planning unit as early as possible in your loved one’s hospital stay if you believe there is any chance he or she may require nursing facility placement.
• Begin your own search as early as possible in the hospital stay and present the discharge planner with your top three choices. Ask the discharge planner to focus on securing a placement in one of the facilities you prefer. You may also contact them directly.
• Check out area nursing facilities before you need one! It is not necessary to wait until a hospital stay to do some research on long-term care options in your area. If you have a loved one you think might need nursing care in the near future, why not start researching the options now, while your loved one is in good enough health to participate in the research?
• Know and stand up for your rights. The hospital does have a right to discharge your loved one when it is medically appropriate to do so. But if you believe your loved one is being discharged before he or she is medically ready, ask if the hospital has an appeal process. If your loved one is a Medicare patient, there is a formal appeal process that the hospital is required by law to respect. This appeal process may give you a few extra days to find care with which you are comfortable.
• Don’t give up on finding a bed in your chosen facility. It is always possible to transfer a resident when a bed opens up. However, many people find that by the time a transfer is possible, the resident will have settled in and may prefer to stay where he or she has made friends and has become familiar with staff. That is why it is important to do everything possible to make sure your loved one’s first placement is positive.
Visiting the Facilities and Narrowing the List
Visit each of the facilities. Visit two or three times, during the day and night. Try to visit on a weekend, as well as during the week, if time permits. There are many things you must carefully consider when choosing a nursing facility. Review all Michigan Department of Community Health inspection and regulation records. The law requires the following documents to be available at the facility for public review.
A. A complete copy of each inspection report during the past five years.
B. A copy of each notice of a hearing or order pertaining to the nursing facility issued by the Department of Community Health for the last three years.
C. A description of the services provided and the rates charged.
D. A list of each individual who has a proprietary interest in the nursing facility, each officer and director of any nursing facility that is a corporation and of each trustee or beneficiary of a nursing facility that is in a trust.
E. A list of the licensed personnel employed or retained.
State inspection reports, word-of-mouth recommendations and promotional literature can all be helpful. But nothing is more valuable than the insight you gain from making personal visits to the facility(s) you are considering.
Following is a checklist you may want to take on your visits. The checklist suggests things to observe about the facility, the staff and the residents, as well as questions to ask while you are there.
Things to Observe About the Facility:
______ Is the facility free of overwhelming unpleasant odors?
______ Is the facility well-lit?
______ Is the facility clean and well maintained?
______ Do chairs and other furniture seem sturdy and difficult to tip? Attractive and comfortable?
______ Does each resident bed have a privacy curtain?
______ Are activity schedules and menus for the week posted?
______ Are there hand rails in hallways and grab bars in bathrooms?
______ Are toilets convenient to bedrooms and easy for wheelchair-bound residents to use?
______ Are call bells near each toilet?
______ Are the hallways wide enough to accommodate passing wheelchairs?
______ Are the rooms large enough to allow a wheelchair to maneuver easily?
______ Is the temperature comfortable? (Remember: Many seniors prefer warmer environments.)
______ Do all residents have closets or separate drawers for clothing?
______ Has the facility owner filed for bankruptcy?
______ Is the atmosphere generally friendly and welcoming?
______ Do the state inspection/regulatory records reveal problems?
______ Is the facility under a remedial or monitoring program for deficiencies by the regulatory agency or other entity?
Things to Observe About Staff:
______ Is staff actively using the privacy curtains to protect the dignity of residents receiving treatments?
______ Is staff answering call lights promptly?
______ Do staff members appear happy and content in their jobs?
______ How do staff members interact with residents? Are they courteous and friendly? Do they smile and address residents by their names?
______ How do staff members interact with you? Are they friendly to family members and willing to interact and answer questions?
Things to Observe About the Residents:
______ Do residents appear well groomed?
______ Are residents engaged in activities?
______ Do most residents appear content? Happy? (Remember that some residents have conditions that can make them appear unhappy or confused.)
Questions to Ask About Medical Care Services:
______ Does the facility have a current license from the state? Does the administrator have a current license from the state? If not, do not use the facility.
______ If Medicare and/or Medicaid coverage is needed, is the facility certified to provide such care?
______ Is there an operating agreement with a nearby hospital for emergency services?
______ Is a physician available in an emergency?
______ Are personal physicians allowed?
______ How often are residents seen by a physician?
______ How are residents and families involved in treatment planning?
______ Are other medical services available (i.e. dentists, podiatrists, optometrists)?
______ Does the facility report periodically to the resident’s personal physician on resident progress? To families?
______ What services are provided for terminally ill residents and their families?
______ Is there an Alzheimer’s disease or memory care program?
______ A separate unit?
______ Is a licensed nurse always available?
______ Does a pharmacist review resident drug regimens?
______ Is there a physical therapy program available under the direction of a qualified physical therapist?
______ Are rehabilitative services available?
______ Is a social worker available to assist residents and families?
Questions to Consider About Food:
______ Do meals appear tasty and attractive? Ask to sample a meal. Does it taste good to you?
______ Do posted menus feature a variety of foods throughout the week?
______ Do foods being served match the description on the posted menu?
_____ Are residents who need help eating being given that assistance?
______ Are snacks available?
______ How are resident food preferences handled? Are substitutions available for foods residents don’t like?
______ Does a dietitian plan menus for residents on special diets?
Questions to Consider About Activities:
______ Are arrangements made for residents to worship or attend religious services as they please?
______ How are residents encouraged to participate in activities?
______ How are resident activity preferences respected?
______ Are group and individual activities available?
Questions to Ask About Admission and Financial Issues:
______ Are beds currently available? If not, is there a waiting list?
______ Are all services covered in the basic daily charge?
______ If not, is a list of specific services not covered in the basic rate available? (For example linen, personal laundry, haircuts, shampoos, pedicures, incontinence briefs, dental care, etc.)
______ Will they help you handle third-party (insurance) billing?
______ Are advance payments returned if the resident leaves the facility?
______ If my loved one is a private-paying resident in the beginning and he or she becomes dependent on Medicaid later, will he or she be able to stay in the same bed and receive the same level of care? Is this in the admission contract?
Questions to Ask About Facility Policy/Procedures:
______ Do they perform pre-employment and/or periodic employee drug screening?
______ What are their policies on the use of physical and chemical (drug) restraints?
______ Are residents or family members regularly surveyed to find out how satisfied they are with the quality of services the home provides? If so, are they willing to share the results? (Please see the Family Satisfaction and willingness to recommend boxes for those facilities that participated in the study.)
______ How does the facility match roommates?
______ Is there a “visiting hours” policy? Are family members welcome to visit at any time?
______ How are disputes, problems or complaints with the quality of care settled?
______ Is there a Resident Council? A Family Council?
Questions to Ask Yourself:
______ Do I feel comfortable coming here or leaving my loved one here?
______ Is the location of the facility convenient for frequent visits of family and friends?
______ Am I committed to continuing involvement in my loved one’s life and care (i.e. personal visits, serving on family council, etc.)?