Health beat: Lots of resources available when choosing elder care
Choosing a nursing home can be a difficult, time-consuming and emotional task. But there are many useful resources to help with choosing a new home.
Quality of life and care, and knowing your rights, is essential in choosing an appropriate nursing home. Here are some resources to start.
NURSING HOME COMPARE
The Centers for Medicare and Medicaid (CMS) rates more than 15,000 nursing homes in the country on a site called Nursing Home Compare.
It’s important to note, the site only rates the facilities it certifies, so nursing homes that only accept private pay or are licensed by the state won’t be listed in the database.
The site only requires a zip code, a state name, or a city name to conduct a search. It can be used not only to research a facility before or after your loved one is admitted, but also to track a facility’s progress following violations.
It will compare the nursing homes within 100 miles of a geographic area, and ranks nursing homes by star; the more the better.
CMS rates nursing homes by category, which will include: overall health, quality measures, health inspections, and staffing.
Information on how to file a complaint, a list of resident’s rights, alternatives to nursing homes, and more resources are also available on the site.
CALL THE FACILITY OMBUDSMAN
An ombudsman is an appointed individual who investigates complaints against a facility and its administration.
The ombudsman will know if a facility is under investigation, if it has pending complaints, and can disclose the kinds of infractions a facility has endured in the past.
A state ombudsman can instruct on what to look for when visiting a nursing home and will sometimes share information on the types of complaints a particular facility has, though they often won’t go into detail.
They can be consulted before and during care, about resident’s rights, preventing abuse, and quality care issues, said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, an organization that formed in 1975 because of public concern about substandard care in nursing homes.
“The ombudsman is a wealth of knowledge,” she added.
If after visiting a list of nursing homes you decide it isn’t the best option, an ombudsman can lead you toward other health care options.
USE OF PSYCHOTROPIC DRUGS
There’s much debate over the use of psychotropic drugs, which are typically used to treat mood disorders like schizophrenia, bipolar disorder, depression, and anxiety.
The Food and Drug Administration has mandated black box warnings on psychotropic drugs and the American Geriatric Association lists guidelines on when to use them, as they’re often used to sedate residents in long-term care facilities.
They are especially dangerous for residents with Dementia, Smetanka said, and are widely used off label.
Dr. Sheri Gibson, chair of the steering committee for Colorado Coalition for Elder Rights and Abuse Prevention, said such drugs can increase mortality and also lead to cardiovascular problems in elderly populations. However, she maintained they can’t be eliminated completely.
Smetanka said these drugs are often used by nursing homes to combat “challenging behaviors exhibited by residents,” for convenience of staff, who are overworked or understaffed and who may need them to manage their patients.
The Long Term Care Community Coalition tracks the use of psychotropic drugs at facilities across the United States. It recommends avoiding nursing homes that use higher percentages of psychotropic drugs.
Awareness around the use of these kinds of drugs gives individuals the option to inquire about higher percentages of usage at certain facilities. It allows individuals the opportunity to monitor their loved one’s condition while they are at a facility that uses such drugs, and most do.
“If you have a choice between facilities that are using higher levels of psychotropic drugs versus low levels, that is something you can ask questions about or that should inform your decision,” Smetanka said.
HEALTH INSPECTION REPORTS
Every state is required to conduct unscheduled inspection reports at nursing homes.
The information is public and can generally be found at each state’s department of public health and environment.
Colorado’s Department of Public Health and Environment keeps inspection reports and complaints on their site.
ProPublica, a well-known news organization, also began compiling its own list of inspection reports, after one if it’s reporters wrote an expose on a nursing home facing many severe allegations of abuse.
It is important to note, one database may not have an inspection report that the other does. These two links can be used to cross check a specific nursing home.
Understaffing is one of the main contributors to poor and inadequate care, Smetanka said.
During a facility tour, ask how many nurses are assigned to a specific wing, she said.
It could be useful to ask staff how much overtime they work, and if they work double shifts. If staff is overworked, patient care can be affected, Smetanka notes.
Question a nursing home’s staffing ratio, specifically the number of nurses to residents.
Are residents generally seen by the same staff member?
Dr. Gibson, of Colorado’s Elder Right Coalition, says that, if so, it generally helps develop relationships, and greater knowledge about a specific resident’s needs. Since staff can pick up on nuances and changes in a patient, this can better meet the resident’s needs, she said. That can also prevent high turnover, as well.
Dr. Gibson trains nursing homes on identifying “staff burn out.”
When staff is overworked, she said there’s a high frequency of absenteeism and avoidance of different tasks. She encourages administrators to monitor such symptoms, while offering training on self-awareness regarding these issues.
She says there’s no federal standard identifying a nurses to resident ratio but each state is required to come up with such a number. The ratio, she said, should be posted in each facility. That’s also an important question to ask.
IS TURNOVER HIGH?
The ombudsman should be able to answer this question, and so should staff. Like understaffing, turnover is also generally high in this profession.
The ombudsman and other staff should be able to put that information in perspective, though, comparing it to other similar facilities.
Dr. Gibson says losing a certified nurses assistant is astronomically expensive, and it could cost a facility more than $10,000 to replace that individual.
She attributes it to the time and money spent in replacing the person, as well as costs associated training the individual, and compensating others to cover that position once they leave.
“If you have four or five people quit, that’s a huge loss to the organization,” she said.
When considering a facility, sign up for multiple tours, as different groups may ask different questions.
• Visit during mealtime and question residents on what it’s like to live there.
• Show up unannounced during off-hours.
• Find people who have previously lived at the facility, as well as their family members. If you can’t find them on your own, ask the ombudsman to give them your contact information.
• When administrators or others aren’t around, ask staff of their honest opinions.
Other important questions could include inquiries about food and activities offered. And, keep an eye on hygiene and safety concerns, asking yourself if you’d want to live there.
There are certainly more suggestions beyond this list, but it’s an important lifestyle change so it’s worth the effort.