CANHR
Fact Sheets:
How to Choose a Nursing Home
Updated 4/14/2008
What to Look for...How to Choose a Facility
Choosing a nursing home for a family member is one of the most difficult
decisions in life. While every potential resident’s situation is
unique, there are some common criteria that can be used as a guide to
selecting a nursing home that best suits their needs. In addition,
adequate knowledge of local resources, residents’ rights and the
potential problems that can occur in nursing homes can ease the process
of pre-placement. The following information highlights some of the primary
pre-placement issues to consider when seeking a nursing home.
Method Of Payment
Unless a resident can pay privately for an indefinite period of time,
even if the initial stay is covered by Medicare, choose a Medi-Cal
(Medicaid) certified facility. While the majority of nursing homes
are certified for Medi-Cal, such certification is not mandatory and some
facilities are private-pay only. Even someone with $100,000 in liquid
assets can spend that down in two years in a nursing home, and private-pay
only facilities can and will evict someone who converts to Medi-Cal.
Given the average rate of private pay (APPR) in a California nursing
home ($5,496/month in 2008), few people can afford private pay
on an indefinite basis. Once a resident is admitted to a Medi-Cal
certified nursing home, however, he/she cannot be evicted simply
because of a change from private pay to Medi-Cal.
Although “duration of stay” requirements, i.e., making a resident
pay privately for a set period of time, are illegal, California nursing
homes have the right to review potential residents’ finances prior
to admission. Since the Medi-Cal program pays less per day than the private
pay rate, the longer you can pay the private rate, the more options you
will have when looking for a nursing home.
Location
It is important to choose a facility that is close and convenient to
the person(s) who will be visiting the resident most often. Most studies
of nursing home residents have shown that residents who are visited often
may recover more quickly, may be happier and healthier for the love and
attention received and may receive a higher quality of care if staff knows
that visitors come often and unannounced. In addition, when family members
and friends are close enough to visit frequently, they can monitor the
resident’s condition, participate in care planning and respond quickly
to emergencies.
Special Needs
Special care needs of the resident should always be considered: whether
the resident will require a ventilator, psychiatric care or extra supervision
due to wandering or combative behavior. Although the majority of nursing
homes are licensed as “skilled nursing facilities” (SNFs), they
are licensed to provide both skilled and “custodial “care.
There are a number of different types of nursing homes, and levels of
care, costs and admitting requirements will vary. California also has
very stringent regulations governing nursing home admission agreements.
Questions about such admission agreements should be directed to the long
term care ombudsman program in your county.
Quality
While quality of care should always be a primary consideration, it doesn’t
do the potential resident any good to choose a “fancy” nursing
home if the resident can’t afford it, if it can’t meet the needs
of the resident or if it is too far away for family and friends to visit.
Do comparative shopping. When evaluating a facility, take into account
the following factors:
Objective considerations: Nothing substitutes for a personal
visit to the facility. Once you have identified a nursing home
that seems (on paper, at least) to be affordable, to have the services
necessary and to have a vacancy, visit the facility. Ask to see the entire
facility, not just the nicely decorated lobby and one wing or floor.
Try to get a feel for the quality of care provided and how the residents
are treated by staff. Resident appearance, use of restraints, residents’
rooms, quality of food and activities are all important factors in evaluating
a nursing home. However, nothing is more important than the quality and
quantity of nursing home staff.
Word of Mouth: If possible, talk to friends, other residents’
family members, ombudsmen, physicians’ or others familiar with the
facility.
Record of Care: Information on nursing homes’ compliance
records, including penalties assessed for violations, deficiencies and
consumer complaints are available from the local long term care ombudsman
programs, the District Office of Licensing and Certification and from
California Advocates for Nursing Home Reform (CANHR). CANHR maintains
up-to-date profiles on every nursing home in California. You can also
review facilities by county here.
Subjective Feelings: How do you feel when you visit the facility?
How does it compare to others? How did the administrator and staff treat
you? Remember that you’ll be depending on these people to take care
of your family member. If you don’t like visiting there, imagine
what it would be like living there.
Choosing a nursing home is an emotionally wrenching experience. However,
criteria listed above can give you the guidance needed to make the best
possible placement and can alleviate many future problems.
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