Here at 2Sisters, we have been helping families find suitable nursing home care for their loved ones for a long time. We do this kind of thing every day, so we know what to look for and what matters most.
For most families, though, evaluating the options and making an informed choice is difficult.
First, because there is so much to consider and most people lack the experience to evaluate everything. This can be a big stumbling block.
Second, because it’s a difficult topic to address; nobody looks forward to the day when they will move into a nursing home. As a result, many families wait until a moment of urgency forces action, whether that’s a hospital discharge of a loved one following an unforeseen medical event, financial circumstances that require an older adult to come under the state’s care, or something else entirely.
That’s why our message to clients is always the same: Don’t wait! Do your preliminary research now – before a crisis occurs. This doesn’t mean you have to move forward, today or ever. It’s just a way to narrow the possibilities calmly and carefully, so that in the event of a change in circumstance, you are not scrambling at the last minute.
When you begin your research, here are four things to keep in mind that you may not have considered…
What are the staffing ratios?
Among the nursing home staff, the people who have the most interaction with residents are the Certified Nursing Assistants (CNAs). These are the folks who answer the call buttons, get residents dressed, help them to the bathroom, assist with eating, and so much more.
That’s why it’s important to ask about “CNA hours per resident per day.” This statistic will give you a good sense of overall care, including things such as whether a loved one will wait 5 minutes or 45 minutes for someone to respond when they have a need.
For this, and other performance data, you can visit the nursing home compare website (https://www.medicare.gov/care-compare/?providerType=NursingHome) or call us to walk you through the most important statistics based on your needs and concerns.
Who is in charge?
Are there going to be some hiccups in the care of your loved one? Absolutely. What matters is not if mistakes are made, it’s how the mistakes are handled. That’s why it’s important to meet with the nursing home Administrator and the Director of Nurses, two people who set the tone for the entire facility.
To get to the heart of this, we rely on a technique known as “behavioral interviewing.” In short, it means asking questions based on actual situations to see how the other person responds.
For example, we had a client whose dad was afflicted with aphasia – an inability to communicate using language. Just by looking at her dad’s eyes, our client could tell what he needed, whether that was a glass of water or to use the bathroom. So, she asked the Executive Director, “Have you had other residents living here recently who also had aphasia? How did you manage communicate with them? How are you going to determine what my dad needs, and when?” To her credit, the Director brought in a care nurse who demonstrated the use of a picture board for communicating the essential day-to-day stuff.
The point is, having facility leaders who are nice or friendly isn’t enough. You want to get a sense for how problems are solved. Behavioral interviewing helps to uncover that.
Is there an Alzheimer’s Specialty Unit?
All nursing homes are secure, so if somebody has Dementia, any nursing home can accommodate them. But if they are actively “exit seeking” – not just wandering, but trying to “go to the store,” “find my husband,” etc. – you’ll want a facility with an Alzheimer’s Specialty Unit (ASU).
All staff in an ASU have specialized training, including a dedicated activities person, so there are more things going on. ASUs are also required to have a secure, outdoor courtyard, which is a nice feature.
ASUs can be hard to find, though; fewer than 10% of nursing homes have them. Another good reason to do your research early if your loved one has memory impairment.
Where is it located?
Nearly everyone considers location when evaluating a possible nursing home. Just make sure you are narrowing your focus based on what will matter most to you and your family.
If the person is very tied to their community, don’t discount that in your decision. If they have been going to the same church for 50 years, for example, uprooting them from that can be difficult.
On the other hand, if you don’t live near your loved one now, but intend to visit frequently, it may require prioritizing based on your location rather than theirs.
None of us can stop the aging process. For many people, that will mean entering a nursing home at some point. What we can do, however, is ensure that our loved ones are as comfortable and well cared for as possible when the day comes. By doing some preliminary research now, you’ll be well-positioned to make sure that happens.