Choosing a Safe Nursing Home: A Comprehensive Guide

Understanding the Importance of Safety in Nursing Homes

Choosing a nursing home is one of the most critical decisions you can make for your loved one’s health and well-being. Safety in nursing homes directly impacts the quality of life for many residents, providing them with a secure, nurturing environment where they can thrive. Unsafe conditions, on the other hand, can lead to serious harm, from neglect and abuse to medication errors and poor hygiene.

For families, ensuring the safety of residents means peace of mind, knowing their loved ones are in capable and caring hands. However, it can be difficult to determine the true safety levels of a particular nursing home for an older person, from an outside perspective, so it’s essential to know what things to look out for when choosing a residence for your loved one.

Common Safety Issues for Nursing Home Residents

Nursing homes can face several safety challenges. Each type of safety challenge comes with its own risks and potential for harm that it’s vital to understand as you are choosing a nursing home.

Understanding these issues is crucial when evaluating potential nursing home care facilities:

Neglect and abuse: Unfortunately, some nursing homes have a history of resident neglect or abuse. While it’s impossible to always predict when abuse may happen, as abuse can happen on an individual or systemic level, there are steps you can take to ensure that the nursing home itself has high standards of care. It’s essential to research and ensure that the nursing home prioritizes the safety and dignity of its residents.
Medication errors: Mistakes in administering medications can have serious, sometimes fatal, consequences. Check the nursing home facility’s medication management protocols and staff training.
Poor hygiene and sanitation: Cleanliness is a fundamental aspect of a safe nursing home as poor hygiene can lead to serious complications such as infections and illness. Inspect the nursing home facility’s hygiene standards and housekeeping practices.
Inadequate staff training and supervision: The quality of care heavily relies on the staff of the nursing home. Ensure that the nursing home employs qualified and trained staff members and registered nurses who are regularly supervised. Additionally, ensure there is adequate staffing as even well-trained staff can make mistakes when overworked.

Initial Research and Planning

Identifying Your Needs and Priorities

Before diving into the search for a nursing home or skilled nursing facility, it’s important to clearly identify the specific needs and priorities of your family member.

Consider the following:

Medical and personal care needs: Assess the level of medical care your loved one requires. This includes chronic conditions, medication management by a qualified pharmacist, physical therapy, and other public health services. Remember that if your loved one requires more round-the-clock medical care, then they may need a skilled nursing facility rather than a nursing home.
Location and accessibility: Choose a location that is convenient for family members to visit regularly. Visits can boost your loved one’s emotional health, and also allow family to keep an eye on any concerns at the nursing home. Proximity to care facilities is also a key consideration.

Researching Nursing Homes

Researching nursing homes for your family members can seem intimidating, at first, as the internet is filled with potentially useful reviews and data.

Before you start, take a deep breath, and jot down some notes on aspects you are looking for, as well as aspects that are absolute no’s. The American Health Care Association is focused on creating the best nursing homes for our loved ones, so you can research their facilities as well.

Start your research by gathering as much information as possible about potential nursing homes:

Online resources and databases: Medicare covers resources like Medicare.gov to find nursing homes in your area. These sites often provide ratings for medicare and medicaid, an inspection report, and other valuable data. Please note, though, that Medicare’s ratings should only be one piece of data that you use as the nursing home rating system they use does have some noticeable gaps and issues with how ratings are calculated. For example, the health inspection report follows state-by-state guidelines rather than a set federal level. This means that the rating is through comparison of other nursing homes in that state, rather than on a wider scale. This can mean those in states with poorer overall ratings may score high even if they have some health inspection issues.
Additionally, some data is also self-reported to a local area agency by the nursing homes.
Reading reviews and ratings: Look for reviews from other families. Websites such as Yelp, Google Reviews, and specialized senior care sites can provide insight into the experiences of other residents and their families. Additionally, ask your own circle of friends and colleagues whether they have recommendations for nursing homes used by their loved ones. First-person experience can often offer the most comprehensive insights into how a nursing home is run.
Checking for state inspections and violations: Ensure the nursing home has a clean record with state regulatory bodies. Look for any violations or issues in their inspection reports. If they have any violations within the last few years, ask them to explain what corrective actions they have taken.

Making a Nursing Home Checklist

Once you have completed your first round of research, you can move on to a more direct form of research. Narrow down your options by creating a shortlist of potential nursing homes.

In some cases, it may be helpful to rank them as an initial step as well. Prepare specific questions and a nursing home checklist to evaluate each facility during your visits.

Key factors to consider include:

Reputation and history of the facility
Services provided (e.g., skilled nursing care, physical therapy, speech therapy, social services)
Staff-to-resident ratio
Cleanliness and hygiene standards
Resident activities and engagement opportunities

Conducting Visits and Assessments

Scheduling and Preparing for Visits

Visiting the nursing homes on your shortlist is a crucial step in the decision-making process. While many nursing homes may “look good on paper,” it’s essential that you see their day-to-day operation.

Schedule visits in advance and come prepared:

How to schedule visits: Contact the nursing homes to arrange a tour. Try to visit during different times of the day to get a comprehensive view of the facility’s operations. Multiple visits will also allow you the opportunity to see other members of staff at work and get a better sense of what your loved one’s daily routine would look like.
What to bring: Bring a checklist of key questions and a notebook to jot down observations. It’s also helpful to have a camera or smartphone to take photos for later reference.

Key Areas to Observe During Visits

While it is important to get a sense of the entire nursing home facility and grounds, there are a few areas that can give some extra helpful insight into the overall quality.

During your visit, pay close attention to several critical areas to gauge the overall environment and care quality:

Cleanliness and maintenance: Inspect common areas, dining rooms, residents’ rooms, and bathrooms for cleanliness. Pay attention to not only high-traffic spots in a room, such as around the bed or the sink but also to more hidden areas. These might include places such as under the bed, behind the toilet area, or in the corners of rooms. Well-maintained care facilities are a good indicator of high standards.
Staff-resident interactions: Observe how staff members treat residents. Compassionate, respectful, and professional interactions are essential. Something as small as a registered nurse always using a patient’s name when addressing them, or the social worker making small talk with patients rather than strictly “business/care” talk can make a world of difference to the comfort of your loved one. Try to talk to a few staff members if possible, such as staff in the dining room as well as those who provide medical services to residents. Your loved one will likely interact with many different types of home-certified staff during the day and should be comfortable with all of them.
Resident activities and engagement: Check the schedule of activities and observe a few if possible. Try to assess if there is a broad range of activities offered. Engaged and active residents often enjoy a higher quality of life.
Meal services and dietary options: Visit the dining room and, if possible, sample a meal. Verify that the nursing home offers nutritious and appealing food options that meet residents’ dietary needs. If your loved one has any special dietary restrictions, such as being a vegetarian or following religious restrictions, make sure to discuss with staff whether that can be accommodated and how it will be. For example, a vegetarian does not eat meat but still needs adequate amounts of protein during the day.
Living arrangements: Make sure to look at the specific type of room that your loved one would live in. Resident rooms are the space where your loved one may spend the majority of their day, so you should check for aspects that you know are important to them such as windows. Also check that there are safety protocols in place around the room, including grab bars on walls and in bathrooms.

Questions to Ask Staff and Management

Prepare a list of questions to ask during your visit. In addition to the following important topics, also consider ones that are specific to your loved one, such as if they have a particular phobia that should be addressed, preferences if there is a necessary hospital stay, or a hobby that they enjoy and will want to continue doing such as reading.

Important topics to cover include:

Staff qualifications and training: Inquire about the qualifications of the nursing staff and any ongoing training programs. If medical services, Medicaid services, or skilled nursing will be provided to your loved one on-site, discuss the qualifications of anyone who will be providing those services. Additionally, if your loved one has any specific medical conditions that require more specialized care through the Medicaid program, ask if this is available and how it will be provided by Medicare and Medicaid.
Staff-to-resident ratio: Ask about the ratio of staff to residents, especially during different shifts. Adequate staffing is crucial for quality care. Adequate nursing home staffing is often cited as one of the most important factors when it comes to resident safety.
Emergency protocols and medical care: Learn about the facility’s emergency procedures and the availability of care, including access to a medical director, social worker, or other health care professionals. You should also inquire about how pharmaceutical services are handled by the medical director.
Policies on family visits and communication: Understand the policies of the nursing home on visiting hours and how they keep family members informed about their loved one’s health and well-being. A personal visit is often one of the most cherished parts of your loved one’s routine, so it’s vital to understand visiting hours and when and how you can visit the older person and offer them some fresh air.
Ask about other residents: Depending on the abilities and health of your loved one, they may wish to start up friendships or have conversations with other residents. Ask about how most residents interact with one another or his or her family, and if there are adequate opportunities for socializing.

Evaluating Safety Measures

Accidents and emergencies can happen anywhere, no matter how safe a nursing home care facility may be, so it’s crucial to know how these issues are handled.

When choosing a nursing home, it’s essential to evaluate the facility’s safety and security measures:

Secure entrances and exits: Ensure that the nursing home has controlled access points to prevent unauthorized entry and exit, enhancing the security of residents. If your loved one wanders, you may also ask about whether staff can respond quickly to a resident who has wandered off the property. Such as installed security cameras, or devices that can assist residents with safety and security and help monitor a resident’s whereabouts.
Fire safety measures: Check for smoke detectors, fire extinguishers, and well-marked emergency exits. Inquire about the facility’s fire drills and evacuation plans.
Availability of emergency call systems: Confirm that residents have access to emergency call buttons in their rooms and common areas, allowing them to quickly request assistance if needed.

Health and Hygiene Standards

High standards of health and hygiene are non-negotiable in a nursing home. Infections and the spread of illnesses are some of the biggest concerns when it comes to the safety of your loved one, and health and hygiene practices are one way to ensure those never become issues.

Evaluate the facility’s practices:

Infection and illness control procedures: Ask about the protocols in place to prevent and control infections. This includes regular cleaning schedules, hand hygiene practices, and vaccination policies for staff and residents. Inquiring about their practices for COVID-19 or other illness breakouts can also help educate you on the safety of a facility.
Cleanliness of facilities: When evaluating several facilities, inspect the overall cleanliness of the nursing home, from resident rooms to common areas and bathrooms. Consistently clean environments are a sign of a well-run facility.
Availability of personal hygiene supplies: Ensure that residents have access to necessary personal hygiene supplies, such as soap, sanitizers, and incontinence products. Many nursing home residents need help with their personal hygiene.

Staff Training and Background Checks

The quality and reliability of the staff are paramount to resident safety and care:

Ongoing staff education: Verify that the nursing home provides continuous education and training for its staff and social workers, ensuring they are up-to-date with best practices in elderly care.
Background check procedures: Ask about the nursing homes’ background check policies for new hires. Ensuring that all staff members and nursing staff have undergone thorough screening can help prevent potential safety issues.
Supervision and support for staff: Adequate supervision and support for staff in nursing homes, including Certified Nursing Assistants, are essential for maintaining high standards of care. Inquire about the supervision protocols and availability of senior staff for support and guidance.

Understanding Legal and Regulatory Compliance

Nursing homes, skilled nursing facilities, and assisted living facilities all should hold some sort of licensing and accreditation. Additionally, there are regulatory compliances at both the state and federal government levels that they should be following. Assessing these is important.

Licensing and Accreditation

Ensuring that a nursing home is properly licensed and accredited is crucial for resident safety and care quality:

Importance of licensing and accreditation: Licensed and accredited facilities meet specific standards set by regulatory bodies, ensuring a baseline level of quality and safety.
How to verify credentials: You can verify a nursing home’s licensing and accreditation through state health departments or other regulatory agencies. A nursing home certified properly will have proof of their credentials to see.

Understanding Residents’ Rights

Knowing the legal rights of residents helps ensure they receive proper care and respect:

Legal rights of nursing home residents: Residents have rights protected by law, including the right to be treated with dignity, the right to privacy, and the right to participate in their own care decisions.
How to report violations: Learn the process for reporting any violations of residents’ rights. This may involve contacting state regulatory bodies or seeking assistance with legal and financial matters.

Reviewing Contracts and Agreements

Before making a final decision, carefully review all contracts and agreements:

Key clauses to look for: Pay attention to clauses regarding services provided, fees, and the rights and responsibilities of residents and their families.
Understanding fees and charges: Ensure you have a clear understanding of all costs involved, including any additional fees for special services or care, and whether or not you can pay privately.

Making the Final Decision

Choosing the right nursing home for your loved one can be a daunting process, but with the right amount of research, you can feel much more confident in your decision.

Comparing Your Options

After conducting thorough research and visits, it’s time to compare nursing homes:

Pros and cons list: Create a list of pros and cons for each nursing home. Consider factors such as location, cost, human services, and overall impressions from your visits.
Family discussions and consensus: Discuss your findings with other family members and reach a consensus. Involving multiple perspectives can help make a more informed decision regarding details and financial matters.

Trusting Your Instincts

Your instincts and personal feelings about how to choose a nursing home are important:

Importance of feeling comfortable and confident: Trust your gut feelings. If something doesn’t feel right, it’s worth considering other options.
Listening to feedback from residents and families: Take into account feedback from current residents and their families. Their firsthand experiences can provide valuable insights.

Choosing a nursing home involves careful research, thorough evaluations, and thoughtful decision-making. Key steps include understanding safety issues, conducting visits, asking the right questions, and reviewing legal and financial aspects of nursing home costs.

Encouragement and Support

Making this decision can be challenging, but it’s important to take your time and ensure the best possible care for your loved one. Remember, support and resources are available to help you through this process.

Frequently Asked Questions

Here are answers to some common questions about selecting a safe nursing home:

What is the difference between a skilled nursing facility and an assisted living facility?

Skilled nursing facilities provide medical care, health care, and assistance with daily activities, including medical appointments with a primary care provider, while assisted living facilities offer a more independent living environment with some support services.

How can I ensure my loved one receives quality care?

Regular visits, open communication with staff, and staying informed about the facility’s policies and procedures can help ensure quality care. Check in with your loved one as well, if they are exhibiting symptoms of being stressed or scared, always have them thoroughly assessed by care providers who are not connected with the nursing home.

What should I do if I suspect neglect or abuse?

Report your concerns to the facility administration and, if necessary, contact state regulatory bodies or seek legal assistance. Nursing home care should always mean that your loved one is treated with care and respect.

Contact Crossen Law Firm to Find Skilled Nursing Care

Crossen Law Firm is here to help you choose a nursing home for your loved one. We know the best living facilities in Indiana for an older person and can help you determine where you’ll get the best nursing care and health care for your loved one.

If you or a loved one has been neglected by a nursing home care facility or nursing staff, reach out to our lawyers at 317-401-8626 so we can set up a free consultation.