Finding a Quality Nursing Home

There are many choices available when your loved one needs long-term health care services.

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Finding a Quality Nursing Home
11 Min Read
Guide Updated:
October 31st, 2021

There are many choices available when your loved one needs long-term health care services. There is no question that most people would prefer to be in their home or assisted living which is much less institutional than a traditional nursing home. Unfortunately, there are times when being at home or in assisted living is not appropriate, and the best care setting will be provided in a nursing home.

What Exactly is a Nursing Home?

A nursing home, otherwise known as a skilled nursing facility, renders a comprehensive range of health and personal care services, including skilled, semi-skilled, and custodial care services. 

There are legal definitions of what makes a facility a nursing home. Generally, the facility will provide care under the immediate supervision of a registered nurse (RN) or a licensed practical nurse (LPN) who is on duty and physically present in the facility 24 hours a day.

Nursing homes have access to medical doctors on call when necessary. Nursing homes offer all levels of care (skilled, intermediate, and custodial). Nursing homes will have medical charts on each resident that is kept updated.

Nursing home residents often require much more attention and care and can handle residents that an assisted living facility cannot. Sometimes, a nursing home resident may only need care for a short period of time before returning to an assisted living or memory care facility or home independently or to in-home care.

Those who need only short-term services typically receive rehabilitation services, such as physical, occupational, and speech therapy. Although, permanent residents may also require these types of services. 

Cost of Nursing Homes

Most short-term rehabilitation services are covered by health insurance or Medicare as they are skilled services. However, there is generally a maximum of 100 days of care that are covered per diagnosis. 

Nevertheless, most nursing home residents live there permanently since they have ongoing long-term physical or cognitive conditions that require continuous care and supervision. This means the responsibility of paying for nursing home care is placed on the resident.

Nursing homes are the costliest of available long-term health care services. Not to say other types of long-term care are inexpensive; however, nursing homes are expensive. 

Find Cost of Nursing Homes Where You Live

You can find the average cost of nursing homes and other long-term health care costs in your area by using the LTC NEWS Cost of Care Calculator. 

Medicaid, the medical welfare program, pays for six out of ten nursing home residents. However, Medicaid reimbursements only cover 70 to 80 percent of the actual cost of nursing home care. Many Medicaid primary facilities have ongoing operating losses, which often affect the quality of care provided in those facilities. 

Long-Term Care Insurance

People who own Long-Term Care Insurance, or have enough income and assets to foot the bill, will find private pay facilities with better quality care. Keep in mind; you cannot purchase Long-Term Care Insurance when you need care; this is a product that is usually purchased before retirement, usually in your 40s or 50s when a person still has reasonably good health. 

LTC Insurance Claims

If you are making a claim on a Long-Term Care Insurance policy for the first time, LTC NEWS can help you in the claims process - just click here for free no-obligation assistance. Policies pay a daily or monthly benefit toward the cost of the facility. The trigger for benefits is usually when a person needs help with at least two of the six primary activities of daily living OR they need to be supervised due to cognitive impairment.

Most Long-Term Care Insurance policies will have an elimination period which is deductible based on days, not dollars. This elimination period is the number of days after a person qualifies for benefits before the policy starts paying benefits. Any days that health insurance and Medicare pay for will go against this elimination period. 

Learn more about the claim's process by clicking here

Finding the Best Nursing Home

The first thing to consider is whether a nursing home is the most appropriate option for your parent or loved one. If their needs are beyond the ability of assisted living facilities and in-home care is not practical or safe, then start the search.

There are several things to consider when choosing the appropriate nursing home. 

EXPERT TIP: Many experts suggest looking at how current residents are groomed. Grooming, or lack of it, is a crucial indicator of the overall quality of care and the attention the facility offers residents. 

  • Does the individual need many skilled medical or other skilled services? Examples of this type of care services include catheter care, intravenous (IV) therapy, injections, monitoring vital signs and other medical equipment, physical therapy, and wound care. Nursing homes are generally the only type of long-term care facility that is able to provide this level of care. Ask about their staffing, their credentials, and how many staffers are onsite at any time.
  • Does the individual have substantial cognitive decline? If so, is the facility equipped to provide this type of care? Toward the end stages of dementia and Alzheimer's disease, they have many more problems that must be addressed. Some have minimal mobility, and others are hard to control and wander. A nursing home is better equipped to handle advanced cognitive issues, which include:
    • Communication problems
    • Incontinence
    • Loud groaning, moaning, and grunting
    • Seizures
    • Violent or puzzling behavior, including aggressive reactions, rocking back and forth, and hallucinations.
    • Weight loss and refusal or inability to eat (inability to swallow)
  • What daily activities does the person need help with (bathing, eating, dressing, toileting & continence, eating, and transferring)? How often do they need help? Do they require the hands-on assistance of another person or just stand-by help? How does the staff at the facility address these needs? For example, if a resident needs to go to the bathroom, how long does it take for staff to come and help? How long does it take for bathing or showering? Are meals delivered on a timely basis? If a person needs help eating, how much longer do they need to wait after a mean is delivered?
  • What social and recreational activities does the facility offer? Do the available resources at the facility fit with the person's interests and abilities?
  • Where is the facility located? Location is important. Is the facility close to family and friends? How about doctors and hospitals? Is the facility in a safe area? Is there a nice view from the rooms, or is the facility located in a city or industrial park area?
  • Is there a religious or cultural affiliation? Some nursing homes have religious or cultural affiliations. If that is important to the individual and the family, seek a facility that means those spiritual or cultural needs. 
  • Can staff communicate with the individual's native language? Language barriers can be a serious threat to the health and safety of residents in a nursing home. Communicating with a resident in their native language can be very important depending on their fluency in English. You will find facilities that speak many languages, in addition to English and Spanish. If the potential resident is suffering from cognitive decline, their fluency in English, if that is their second language, can be affected. Common languages that are spoken in some facilities (in addition to English and Spanish) include Chinese (including Cantonese, Mandarin, and other varieties), Tagalog (Filipino), Vietnamese, and French (including Creole French), 
  •  Fancy décor does not necessarily mean quality care. — Avoid what is called the "chandelier effect" — meaning if the facility looks very bice or the price is higher than other facilities nearby, it must mean it provides quality care with attentive staff. Concentrate first on the quality of the care and the attentiveness of the staff. Looks and price don't always mean quality.
  • Does the nursing home have an arrangement with a nearby hospital? Most do, but better be sure. Does the family have a preferred hospital, and will they transport to that hospital if they need hospitalization in an emergency?
  • Does the facility have care meetings with the care recipient and their family? If they conduct meetings, are they held with residents and family members at times that are convenient and flexible whenever possible? 
  •  Review the relationship between staff and residents.  Look to see if it appears that the staff and resident interactions are warm, polite, and respectful. However, keep in mind some residents, because of their conditions, may be abusive themselves, and this doesn't necessarily reflect on the facility or the staff.
  • Ask about how the facility addresses safety and abuse. Safety is essential. How does the nursing home keep its residents safe from abuse, neglect, mistreatment, or exploitation? Have they had issues in the past? How long ago? How did they address the problem?

Seek Help

There are several ways to get input on finding an appropriate nursing home. If the person owns Long-Term Care Insurance, many policies include case management and advisory services. Use that help; it is typically advisory in nature and not managed care where you must use their recommendations. 

If you are making a claim on a Long-Term Care Insurance policy for the first time, LTC NEWS can help you in the claims process - just click here for free no-obligation assistance. 

If the individual is currently receiving in-home care or assisted living, ask the providers their opinion. Case managers from hospitals can offer views in addition to your doctor, friends, and neighbors.

Be sure to visit facilities in person. COVID-19 concerns have limited this to some extent. However, with better protocols and more people being vaccinated for the virus, this is getting closer to normal. 

Medicare Nursing Home Ratings

Medicare's Nursing Home Compare website has strengths and weaknesses but is an excellent site to compare available nursing homes. Only choose a nursing home with the highest rankings, which is four or five stars. 

There is a rating for each nursing home. They include separate ratings for each of the following areas:

  • Health Inspections – The health inspection rating contains the three most recent health inspections and investigations due to complaints. The most recent survey findings are weighted more than the prior year.
  • Staffing – The staffing rating has information about the number of hours of care provided on average to each resident each day by nursing staff. This rating considers differences in the levels of residents' care needs in each nursing home. For example, a nursing home with residents who had more severe needs is expected to have more nursing staff than a nursing home where the resident needs were not as high.
  • Quality Measures (QMs) – This rating reviews 15 different physical and clinical measures for nursing home residents. The QMs offer information about how well nursing homes are caring for their resident's physical and clinical needs.

Keep in mind the numbers can be faulty or misleading. Use this as a guide. 

Visiting After Admittance

Once your loved one is in a nursing home, be sure to visit them. When visiting, be sure you look around. Staff can change. Managers can change. Ownership can change. The changes in these areas can change the quality of care.

EXPERT HINT: Be sure to visit at all hours, including evenings and weekends. No matter the quality of the facility, if the staff knows the family is paying attention, your loved one will get more attention and better care.

Talk to the staff and be friendly. People respond better to nicer people. If you start barking orders, they could begin to resent your involvement. 

Don't be afraid to call the duty nurse from time to time to see how your loved one is doing. Communication is good.

Nursing Home Don't Have to Be Warehouses - Planning Helps

Nursing homes don't have to be a warehouse for older people. The right nursing home can mean a better quality of life physically and emotionally. Even in cash-pressed Medicaid facilities, the staff tries their best, and your involvement will go a long way for better quality care.

The experience of a parent or loved one in a nursing home reminds all of us of the need to plan for future changes in our health, bodies, and mind. Planning for the costs and burdens of aging should be an essential part of your retirement planning. 

Use the resources available on LTC NEWS to start your research. The best time to obtain coverage is before you retire, ideally in your 40s or 50s. Click here for the resources. 

If you are seeking a specialist in Long-Term Care Insurance, click here.

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