Choosing the Right Nursing Home

The first time I stepped into the nursing home that I would spend the next three years working as a certified nursing assistant, I was a bit overwhelmed. I recall looking at all the faces of my would be residents and knowing that for my entire shift I would be the only one they could depend on to change their soiled clothing or supply them with that much needed sip of water when they were unable to ask for it. This was a job where mistakes were unacceptable and could cost someone their well being or possibly their very life. I was able to accept this responsibility and develop close relationships with my residents. Unfortunately, some of my co-workers did not. It has been widely exposed in media outlets what happens when the workers of long term health facilities are over worked and/ or unfit for the job. However, there are things to look out for to ensure that you choose the correct facility, where the already difficult transition can be made as pleasant as possible.

MAKE A IN HOUSE VISIT
By far, the most important tip available. Never choose a facility without first personally visiting the facility. Do not schedule the visit prior to arriving, announcing your arrival gives a bad facility time to "prepare" and clean up loose ends before your arrival. While visiting, do not be afraid to ask too many questions, this is where you/ or a loved one could possibly spend the rest of their lives, you have the right to ask any question you see fit. No question is inappropriate when it deals with the overall condition of the facility.

Some important questions to inquire about includes the facilities employee database. Ask the administrator their policy on nursing aide certification,"What are non-certified aides allowed to do while working on their certification?" "How long does it take non-certified aides to get certified?", etc. When a facility allows non-certified aides full range as the certified, this can be dangerous. Usually this allowance occurs when the facility has a shortage of aides or the facility tries to save money. A certified aide automatically gets a increase in pay when they become certified, therefore it has been known for facilities to delay the certification process solely to avoid the pay increase. Any facility that practices this tradition should be avoided, if they skip costs in this manner, they are surely to skip costs in the overall care of their residents. Inquire about the certified/ non certified ratio, and make judgement by these figures.

While visiting there will be some areas restricted such as offices with personal files to protect privacy issues and entering a residents personal room, do not be discouraged by this. In fact, this should be encouraging to know that the facility cares enough about their residents to not allow strangers to enter their rooms and interview residents to make a profit. Any facility that allows you or takes you into a residents personal room should be looked down upon for this practice. After all, it could be your loved one one day that is nominated for this intrusion.

While some areas should be restricted, there are others that should not be, and if they are this should raise a red flag. Any areas that are used by residents/ and employees for leisure should not be restricted. Two of the most important areas to demand a visit is the cafeteria/ eating area to check for cleanliness and the most neglected area requested to visit: the employee break room. Many times, when touring the employees rest area will be pointed out but passed up quickly. Many tourist allow this, believing this area has nothing to do with them when it has everything to do with them. Any important memos or notices documenting problems with the facility will be placed here. If the facility has a problem with aides neglecting to change soiled linens, a memo will be on the wall addressing the problem. If the facility has a problem with employees attendance, it will be here. If a facility has a problem with attendance, it is a problem to be taken seriously and one that should be questioned, "Do you have PRN employees (that is part time employees who get called in when a regular aide misses their shift)?" If not, who covers the shift? If the answer is the prior shift aide pulling a double rethink this facility. While it is acceptable for double shifts on occasion, in fact it can't be avoided in some cases, if this practice is one occurring often you will have burnt out employees in charge of caring for your loved one. If the employees work schedules is posted, examine in with a fine eye, and if not hanging in view, request to see one. How many are first shift aides, second shift and third? If the third shift only has 3 aides scheduled in a 65 resident facility, this means your loved one will probably be neglected during the 3rd shift hours due to the fact that not enough aides are on staff to properly assist all residents.

There are other simple things to notice during your visit that should affect your decision.

* The temperature of the facility during your visit. Too cold/ or too hot can lead to potential health issues in the future. If the temperature is not comfortable, require as to why. The air/ heating unit is broken? How long has it been broken, does the facility have a maintenance crew to address these issues or do they hire outside help. In other words, "If my loved ones heating goes out in the middle of the winter, will there be someone to fix it instantly or will they be expected to sleep in a cold room until a outside agency can be reached?"

* Is the building filled with overwhelming odors? Accidents will happen, and when passing a residents room, if you detect the odor of human waste, do not jump to harsh judgement, the aide may be in the process of correcting the issue. However, do make an effort to walk past the door again after a certain period of time has passed to insure the correction has been made. If touring a facility, you notice the odor hangs in the hallway constantly omit the facility as your loved ones future home, this is proof that the staff does not give the proper measures of care.

* What is the quality of lightening in the facility? Is the hallways bright enough for your loved one too see clearly.

* Is walking areas free of derbies? Is wheelchairs left open in the hallways? Is bed side commodes sitting outside doors? These type of articles can create hazards to elderly persons trying to get around the facility.

* Discreetly examine the aides on shift without their knowledge. Does the aide knock on a resident's door before entering or do they just barge in? If they did knock, did they announce who they were before entering the room? Every aide is trained to do these two things before entering a residents room, if you notice that the aides on duty is not doing one and/ or both of these things, it shows that they do not respect the resident's privacy or their training.

* Notice the residents interactions with the staff, are they happy to see them or do they try to avoid them?

* Are the staff neat in appearance? If their own appearance is unkempt, it is probable that your loved ones appearance will be the same.

* While watching staff members, notice whether or not they follow infection preventive measures. Do they wash their hands often? Is the facility well stocked in gloves? My experience has taught me that one of the tell tell signs that prospective residents and their families overlook during this process is the absence of gloves. A fresh pair of gloves is required for every action when interacting with a resident. Therefore, if you visit a facility that only has a small amount of gloves, chances are your loved one will not be safe from cross contamination.

INTERVIEWING THE FACILITY ADMINISTRATOR

When visiting the facility, you should always request a meeting with the facility administrator. If the administrator is unavailable at the time of your visit, tour the facility then make an appointment for the interview. Make it clear that unless you get a meeting, the facility will no longer be considered. During the interview, keep in mind that it is the administrators job to win your loved ones placement. If flaws of the facility are exposed during the interview and the administrator makes excuses for the flaws instead of providing steps being taken to correct them, this may not be the right facility. Your loved one should not suffer for the facilities problems. Important questions to ask the administrator regarding the facility includes:

* Are all staff subject to background checks/ drug testing before employment?

* Does the facility maintain all the proper credentials state and federal government requires?

* What is the facility procedures for handling complaints? Is the Ombudsman complaint number in full visible access for everyone in the facility to see?

* Does the facility have a high turn out rate for employees? If the facility can't keep employees, that should be a sign that the facility requires too much responsibility on their employees and this raises staff stress levels. Elevated stress levels is one of the causes of the many cases of elderly abuse reported nation wide. A facilities employees happiness should be important in your decision, if the employees are unhappy chances are your loved will be unhappy too.

* Does the facility offer continuing education programs for it's staff? If the answer is no, inquire as to where the staff gets it continued education since that is a requirement for staff to maintain their certifications/ licenses through continued education.

THINK YOU FOUND THE PERFECT FACILITY?
So, you have visited a facility and it passed the test. Everything looked clean and the residents looked well cared for. The staff seemed friendly and helpful in answering your questions. It would be an injustice to your loved one to choose the facility based only on your personal approval. The facility passed your test, but did it pass the State's test? Now your ready to research the facility outside of the facility. Now is the time to make sure other agencies agree with your opinion.

Nursing homes are regulated by all states and several agencies exist to insure that a nursing home is caring properly for their residents. One of the most powerful and feared in the world of long term health facilities is
Ombudsman. Ombudsman makes their presence known in facilities by placing notices with a number for complaints. Contacting this organization before sealing the deal would be a very wise decision. The organization genuinely cares about its cause for senior citizens and their adequate care in long term health care facilities. Ombudsman also makes it easy to contact them by various methods. Since it is federal law that every state have a Ombudsman for long term health care facilities, you can contact your state's Ombudsman by finding them on the Ombudsman website.

There are many wonderful long term health care facilities that take their responsibilities to the elderly in their care seriously. They consider their residents as family and put forth their effort to make a comfortable home. Finding these facilities can be possible with a little research.