Written by:
2/8/2010 2:00 PM 

In my previous blog I discussed the difficulty of assessing a nursing home’s quality based on government survey reports, media stories or web searches. While all of these are useful, and my host SNAPforSeniors.com has been a search game-changer (See the SNAPforSeniors Assisted Living and Skilled Nursing Checklists, Worksheets and Documents), the inescapable fact is that you absolutely must visit the nursing homes in your area that interest you before making any decisions.

So let’s assume you’ve made a visit appointment with a facility’s marketing person, administrator or nurse manager. What should you look for when you walk through the door? Remember, you can’t fully understand any facility on one or even two visits. But here’s what I would suggest to sharpen your search:

Relax and accept your first impression. Keeping eyes and ears open as you walk about, notice: What is your impression of the people who work there? Do they seem friendly, open to questions, supportive and warm with the residents? Or do they seem standoffish, indifferent, even dour? Years of experience visiting nursing homes and hospitals have taught me that the overall feeling staff projects on your first impression is a good indicator of upper management quality.

Take the famous (or infamous) smell test. No need to belabor the point that nursing facilities are occupied with people who, in large measure, have serious bladder and bowel control problems. The question is, can you tell? Or, conversely, does the facility smell like a northern Vermont pine forest? That indicates to me an effort to cover up. A facility, not only in patient rooms but all over, should smell like a clean house.

Do the residents seem interested in life? It is unlikely you will see residents hobnobbing about, strolling arm-in-arm through the corridors or chatting over coffee. These days, especially, residents tend to be seriously ill or disabled; the less frail are occupying “nursing home alternatives,” like assisted living. But do you see the residents of the facility sitting in their wheel chairs observing the passing scene, interacting with staff as they sit in corridors or wait in the dining room line, exchanging friendly hellos with your visit host? Or are they staring into space or apparently sleeping through the day? Are they restrained to their wheelchairs or gerichairs (something you shouldn’t be seeing much of at all these days, but it still happens)?

Is attention being paid — i.e., when residents are in apparent discomfort or feeling stress, are they being attended to? It’s not uncommon to hear residents call out for various reasons, sometimes very oddly, but two real ravages they’re subject to are chronic pain and pressure sores from long periods of sitting or lying in bed. Ask about the facility’s pain control philosophy. Regarding skin condition, learn what you can about the facility’s approach to pressure ulcer prevention and detection. When my mom was admitted to a skilled facility after a surgical procedure several years ago, a nurse was at her bedside examining her skin for incipient pressure sores within 10 minutes! Needless to say, I was impressed.

Is the place really noisy? Speaking of (occasionally) noisy residents, what really contributes to din in the nursing home are the overhead pagers - you know, when the peace of a corridor or resident room is suddenly shattered by a loud broadcast for someone’s attention. Enlightened facilities these days have taken advantage of new wireless technologies that have emerged over the past 10 years, so that people can be paged silently on small portable devices. For this reason alone, wireless has truly has transformed the nursing home (and hospital) environment. (Side note on noise: What does one do about blaring TV sets? I have no idea. This seems to be a built-in feature of double rooms, with dueling volume controls - yet another argument for the “all private room” movement taking hold in facilities.)

The final “tell”: How do you feel once you’ve left the facility - do you feel encouraged and satisfied that you’ve found an appropriate place for your loved one? Or are you depressed, suspecting you’re right that facility life isn’t for you or yours? Don’t second-guess your instincts - trust them, they’re probably right on the money.

Trackback Print

Tags:

Categories:

Location: Blogs Caregiving by Richard Peck

Your name:
Your email:
	(Optional) Email used only to show Gravatar.
Comment:
Security Code Enter the code shown above in the box below
Add Comment   Cancel