Choosing a nursing home> ranks among the most painful and emotionally fraught decisions you or I will ever make, even if we are ultimately able to find satisfying environments for our loved ones. As a result, too many of us wait to talk with our parents about nursing homes until it s already clear they can no longer safely live alone when our elders are already falling repeatedly or chronically forgetting to take medication or leaving the stove burner on. Even worse, approximately one-half of all nursing home admissions come directly after hospital stays, according to AARP and once a hospital decides to discharge a senior, the patient can have as little as one day to name a nursing home. These kinds of massively stressful emergency situations do not make for good decisionmaking.
So instead of choosing in crisis, treat nursing home selection like estate planning or the completion of end-of-life legal documents a chance to have conversations now that may initially be unpleasant but will ultimately be empowering, because your parents can better align their future with their wishes. Then your entire family will be ready to follow the three key steps for finding the right nursing home for the day when your elders need around-the-clock care.
First, create a list of potential facilities. With more than 16,000 nursing homes operating nationwide, chances are that you know of a few, but not all, local facilities. Two kinds of government organizations can help you locate opportunities for quality care. Every state has a long-term-care ombudsman who advocates for nursing home residents and, generally, oversees paid staff as well as volunteers certified to handle complaints. Your state ombudsman will help you find facilities in your area and can investigate any future problems you have. To find yours, go to www.ltcombudsman.org/ombudsman. Further, many counties and municipal governments have an Agency on Aging, which can also provide the names of, and sometimes information about, nursing homes in an area. You can find yours at www.eldercare.gov.
Step 2: Mine the data available on local homes to narrow your list. The critical tool here is an amazing Web page called Nursing Home Compare, at www.medicare.gov/NHCompare. The Centers for Medicare and Medicaid Services regularly collect information on health inspections, staffing, fire safety and 19 quality measures at nursing homes in the U.S., and summarize the results in ratings of one to five stars at the Nursing Home Compare site. You can quickly find ratings for all nursing homes near your city or town, then look at more detailed information for up to three nursing homes at a time.
For example, I was surprised to learn that there are 41 facilities within 10 miles of my home zip code. I was even more surprised to see how widely, and just why, they diverged in the federal ratings. Park Manor Nursing Home in Bloomfield, N.J., got five stars overall (meaning it ranks in the top 10 percent of nursing homes in the state), in large part because of a favorable staff-to-patient ratio. Just a few miles away, Cedar Hill in Cedar Grove, N.J., rated two stars, partly because it had nine health-inspection deficiencies in May 2009. (Cedar Hill notes, and data confirms, that these problems were relatively minor and quickly corrected.)
Some federal officials have claimed that by spurring competition, Nursing Home Compare is improving nursing home quality. And the latest research agrees with them to a point. A 2009 study by the University of Pennsylvania found that in the three years after Nursing Home Compare launched in 2002, there was no change in the rate at which patients were hospitalized for preventable reasons, but the number of nursing home residents who improved their walking skills increased 0.7 percent, and the number living without pain rose 0.6 percent. These seem like fairly marginal gains that won t really take off until the federal government starts basing its payments to nursing homes much more strongly on these kinds of results.
The main value of the nursing home ratings to your personal search is that by showing you which local facilities are performing well, they can help you winnow your list to three to six contenders. Then you ll be ready for the third step: Visit, visit, and then visit some more. The great advantage to advance planning is that over several unhurried trips, you and your parents can get a feel for every part of a nursing home s typical day. You can see where residents spend their time whether they congregate in groups, participate in activities and go outdoors, or are alone in their rooms. You can tour the kitchen, try the food and make sure residents have menu choices. You can check bathrooms for cleanliness and hot water.
Veterans of this process offer a few tips. Among them: Don t announce your visit, since you want to see how things operate on a daily basis. And don t judge a place by your first impression, says Dorothy Sheridan, 63, of Miller Place, N.Y., who has researched nursing homes on Long Island for her mother-in-law and her father. You may walk in and see someone who looks half-dead, but that s just going to happen in a nursing home. Much more important, experts say, is to observe how the staff interacts with patients.
Finally, make sure administrators at any home you visit take seriously the concept of resident-centered care. Led by reform initiatives such as the Eden Alternative (www.edenalt.org) and prodded by boomer customers, many American nursing homes are undergoing profound cultural changes, providing patients more individualized care and giving them more control over their daily activities. To make your cut, a nursing home should explicitly allow residents to set their own schedules and create their own living spaces. And it should have a policy of assigning a consistent team of doctors and nurses to each resident, which increases staff familiarity with individual cases and reduces medical errors.
There s a huge amount of homework involved, so the sooner you get cracking, the better. Do your research and eventually, you ll find a nursing home that meets your criteria and clicks with your family. And then one of the hardest decisions in your life will become one of the best investments you ll ever make.