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Choosing a Nursing Home

In a perfect world, your parent would never have to go to a nursing home. In a near-perfect world, both of you would have already explored nursing-home options and made decisions before the need arises. In the real world, you may be doing the investigating and choosing alone as Mom or Dad is about to be discharged from the hospital.

Here are some suggestions for making that choice less difficult when visiting nursing homes:

--Do your research first. Viewing on-line is not as good as in person. Don't rely on that information only. Find a few facilities to visit.

--Take a sibling or friend along to help more clearly evaluate the home. The more eyes the better.

--Don't be shy when asking about costs. A nursing home admissions director may quote a figure, but you need to find out what is included, what costs extra, and what that additional cost will be.

Ask what's covered by Medicare, Medicaid, insurance and private pay. Ask if your parent's bed will be held if he or she has to be temporarily hospitalized.

--Find out how a patient's care plan is written. Is it personalized or does a general plan apply to almost everyone? Find out who monitors the care plan. Ask what happens to that plan if your parent's health improves or gets worse. Can you be involved in the planning? How often is it reviewed and evaluated?

--Ask if one doctor is assigned to the nursing home, if there are several doctors, or if a patient continues to use his or her own physician.

--Verify the certification and licenses for the facility. Request a copy of the most recent audits by your state Department of Health. Be sure any "deficiencies" have been corrected.

--Walk through the facility. Look around inside and out. Is it clean and well maintained? Are the halls stacked with various kinds of equipment because there isn't enough storage space? Are there any unpleasant smells?

Look at the patients. Do they appear well taken care of? Are they clean, appropriately dressed and groomed?

Look at the rehabilitation unit. Most nursing homes have a room for physical and occupational therapy. Is the equipment falling apart? Is it being used at all?

A good plan is to walk through, talk to the admissions director and then walk through again, about an hour later. You should be able to tell if there has been some activity. Does it seem all the patients are in the same spot they were in sixty minutes ago? No patient should be in a hallway "waiting for lunch" for an hour.

Many places will be happy to let you have a meal at the home. Ask to be served whatever the residents are being served. Is it nutritious? Does it look and taste appetizing?

--Ask about security. Not just protecting the patients from someone wandering in from the outside, but also problems of theft by fellow patients and staff. Find out who is responsible for monitoring this, to whom one reports a problem and what the procedure is when something is missing.

--Ask how room assignments are made. Obviously rooms will be all-male or all-female, but are matches done according to compatibility or is it just the next person through the door gets the next vacant bed? What's the procedure if problems arise between roommates?

--Find out if there's a continuum of service. If your parent's health gets better or worse, will he or she need to move?

--Ask who helps with the transition when Mom or Dad first moves in. Depression is typical and certainly understandable. Is there a social worker available to help?

--Get a copy of the nursing home's "bill of rights" for its clients.

--Don't sign a contract during that first visit. Go home and think about it. Take notes during your visits to several homes so you can remember what you saw and where you saw it.

--If your parent is in a nursing home, get to know the staff and make sure they know you. The more contact you have with them, the better care your parent will receive.