How To Choose A Nursing Home. Part 2

This week, we continue our suggestions about how to choose a long-term care facility. After checking out the facility on paper and talking to people who have had experiences there, visit the facility and have the administrator or a staff member give you a tour. As suggested last week, we think it is a good idea to hire a geriatric care manager to help you in this phase of your investigation.

While appointments may be preferable to the facility, dropping by unannounced may be more enlightening to you as you will be able to see the day-to-day operation without giving the facility the opportunity to put on it’s “best face” for the family of a potential new resident. Once there, here are some of the things you should look for and do:

(1) Pay attention to the general appearance and atmosphere of the facility. It is pleasant and comfortable? (2) While most nursing facilities have some odors, if you smell what you consider to be unreasonably unpleasant odors, watch out. (3) Look into the rooms of several residents on each wing to see if these areas are clean and comfortable and if the residents have their personal belongings in their rooms (4) Ask what administrative procedures are used to try to insure the compatibility of residents who share a room. (5) If there are a large number of vacancies and the facility is not fairly new, take heed because the better facilities almost always operate at near capacity. (6) Since your family member will need medical care, it’s a good idea to check out about the facility’s doctor. Make it a point to meet with him or her, make sure you find out how frequently residents are seen by the doctor, how often their records are reviewed, and what arrangements for emergencies are in place. (7) Go to each nurses' station and find out the procedures used by residents who need to signal the nurses for help. (8) Ask about staff turnover, whether the facility uses temporary help on the weekends or in the evenings, and how staff are interviewed. While there is always turnover, staff longevity is a good indication of a stable facility. (9) Make sure your learn about resident activities, therapy sessions, and weekly schedules. (10) Go into the dining areas and inspect the kitchen. Try to get to the facility while meals are being prepared and eaten so you can see the kitchen and dining room staff in action. Look at the week’s menue and ask about special diets. (11) Take notice of the residents. Are they active and involved or are they immobilized in chairs? How many are in their rooms as compared to being within the community.

While you are there, make sure you check into cost and financial arrangements, especially if long-term care insurance, Medicare (for a limited period of time in limited circumstances), and Medicaid will not cover your family member’s entire bill. Find out whether the basic monthly fee covers the major expenses such as room and meals, housekeeping, linen, general nursing care, medical records services, recreation, personal care, and similar services and materials that are provided for all residents. If not, get a list of the extra’s.

In most long-term care facilities, extra charges include such items as (1) the services of doctors, dentists, ophthalmologists, podiatrists, and the like; (2) drugs and various medications; (3) physical therapy and such diagnostic services as lab work, x-rays, and other procedures; (4) personal services such as telephone calls, personal laundry, beauticians and barbers. In some instances, Medicare and Medicaid may cover some extra charges; however, private residents are generally charged either a flat fee each month or a fee each time an extra service or material is provided.

Since most facilities bill a month in advance, find out whether refunds are made for unused days that are paid in advance. Ask how the facility deals with a resident's cash and other assets. Proper procedure requires that the resident be given a signed receipt for each deposit and withdrawal and that there be a quarterly statement of funds which is signed by the administrator.

Lastly, review the admission contract which should include all of the costs, the services which are included in the fee, and all legal responsibilities. Other information given at the time of admission should include explanations of residents' rights, grievance procedures, minimum nursing care requirements, emergency procedures, and standards of food service.

While contract clauses that seek to make another individual responsible for payment are illegal, some people are led to believe that either they are not signing as a responsible party or that they must sign as a responsible party for the prospective resident to be admitted.

Choosing a nursing facility is a difficult, time-consuming task; however, the effort is worth it if you make the right choice for your family member.

Jan Collins is an award-winning writer and editor. Jan Warner is a matrimonial, elder law, and tax attorney. Both are based in Columbia, South Carolina.

Please send your questions to P.O.Box 11704, Columbia, S.C. 29211 or send your questions by email to janwarner@nextsteps.net.