Let's Get Serious About the Nursing Home Tour
Before you tour your facility choices be sure you have done your
homework. Go online and visit Medicare.gov. They have wonderful
resources available to you for free. They are user friendly.
Please see the end of this article for details.
To narrow down your choice between two or three nursing homes or
just considering the only available nursing home to place your
family member or friend, it takes two visits. Take someone with
you and if at all possible take the person who will be moving
into the nursing home.
Your first visit to the nursing home is what I call "THEIR
PITCH". Set it up for the morning anytime before 11:00 AM on a
Saturday and plan to be there at least an hour. Get there 15 to
20 minutes early with a magazine or a newspaper and let the
receptionist know you are there. Take a seat in the lobby and
wait. This is not waisted time. Open up your newspaper or
magazine and eaves drop without calling attention to yourself.
Let your senses lead the way. Have you been offered
refreshments? Does the facility smell? Does the interaction of
others sound pleasant?
When you opened the front door into the nursing home did you
smell urine, bowel movement, vomit or body odor? Did it to smell
like flowers or antiseptic? Or like bad odors are being covered
up by good odors. Broccoli, cabbage and brussels sprouts are the
only offensive smells that come from the kitchen when they are
being prepared.
After a short while close up your magazine or paper and
reseptive to your visual surroundings. If there is someone else
sitting there try to start a conversation about the nursing home
and find out what they think. Listen to the tone of their voice,
watch facial expression and body language. By now the admissions
coordinator or someone is going to invite you into their office
or take you for a tour and give you "THEIR PITCH".
When they take you into the office they are going to ask you
questions. Names, name of potential resident, age, diagnosis,
who their doctor is, where are they now, do they have Medicare,
insurance, are you the health care power of attorney, do they
have a living will, have you applied for assistance, how soon do
you plan to place them here, etc. They are going to try to
emotional connect with you as well. They are looking for
potential problems too. Pleasantly answer their questions. If
you have a few questions ask and be sure to ask if you can have
a copy of an information packet or pre-admission packet.
So on to the tour. The tour is about showing you the best of
what they have to offer. They will introduce you to everyone and
show you the facility. Let "THEIR PITCH" happen and go along
with it. Don't ask too many questions now because you will
distract yourself from observations that you need in order to
make a sound choice.
During the tour you will be introduced to the different
department managers and shown their offices. You won't be
expected to remember names and it is more important how they
respond and take an interest in you. Also, during this tour pay
attention to the interaction between staff and residents in
every area you are toured through. This is important.
Observe the residents. Are their clothes clean and in good
repair? Are they wearing footwear? Do the men look clean and
shaved? Does their hair look cared for or is it a mess? Do the
women have appropriate hairstyles (I have seen them put pigtails
on top of balding 90 year olds)? Do they still have bibs on from
their last meal? Does any one look cold and not have a sweater?
Do you see a number of residents that are wet or smell of urine
or BM? Do the hands look clean especially under the nails? Do
the wheel chairs look clean and cared for with no sharp edges or
tatters? Do the residents in wheel chairs look comfortable? Are
residents in wheel chairs being pushed too fast or backwards?
Are residents that are being walked rushed or are they allowed
to walk at their own pace? Is a resident yelling out the whole
time you are there?
The flooring should be clean and free from any debris. The walls
should be clean. The lighting should be good. Carpets free from
spots. Decorative items should look well kept. Drapery should be
open to allow the natural sunlight in.
You will be taken to the nurse's station. The nurses should be
pleasant and responsive to the residents and family members.
Listen to their tone and responsiveness in their voice. Watch
their body language as they acknowledge you or others at the
nursing station. Is this representative of how you would like
your loved one to be responded to?
One area you will be taken to, will be the Rehabilitation area
where physical, occupational and speech therapies are provided.
How are the therapists interacting with the residents? Are there
residents in the area alone? Is privacy being respected? Is it
busy with activity or is no one there? Listen to find out if
they have at least a full-time physical therapist and
occupational therapist, it is important to know, as your loved
one may require these services from time to time. Do they
mention at least a part time speech-language pathologist? It is
always good to have one available to screen your loved one if
they ever begin to have speech problems or eating problems like
swallowing.
Once at the Activities Department, observe what is going on each
time you pass by. Make it a point to stop for a few minutes and
observe residents and don't be surprised if not every resident
in the activities room, is not doing something. Are at least 25%
of the residents doing something like reading, watching TV, or
doing the activity that is going on at the time? Ask to see or
have a copy of the activities calendar. Observe interactions.
The dining areas are a very important area to make observations.
Check to see if they have more that one dining room or area? If
the nursing home that you are at has 120 beds and is not
specific to only Alzheimer's/dementia residents, then there is a
mix of residents functioning at different levels. There are
usually three functional levels of dining: residents that can
dine independently, residents that require cueing, and residents
that need to be fed. Observe for the different types of dinning
rooms or areas. If residents are dining observe for a few
moments. Are they socializing, smiling, having a difficult time
with the food? This is important because as your loved one's
functional ability may decline and they may need cueing or to be
fed from time to time. What is the facilities policy about
reidents dining in their room?
The tour guide (admissions coordinator) will show you a few
resident rooms. Most of the time they will show you the rooms of
clean, fairly independent, and continent residents with good
family support, a well decorated room, not the room they would
be admitting your loved one into. Facilities are limited to the
number of private rooms they have. Most of the rooms are semi
private with a private bathroom for the two sharing the room or
a bathroom that is shared with the adjoining room. Look in the
bathroom if you can. There is much to consider.
During the tour they will hopefully show you outdoor areas for
the residents. Is it shaded from the sun? Is it partially
protected from the weather like rain, snow, and wind? Do they
have an area outdoors for residents who smoke? Are there seating
areas? Is it visually appealing?
This is usually what happens during"THEIR.PITCH". They ask you
for information and you ask questions and make observations.
Just like when you are with a salesman they want you to get
emotionally connected with their facility.
At the closing be sure to thank them for their time and let them
know that you will be in touch with them soon.
Before your second visit, try and read the information related
specifically to the nursing home and what their expectations are
of you and the resident from the information packet or a
pre-admission packet you recieved. Then make a list of questions
for the next visit. If you can't think of any questions,
Medicare's publication Guide to Choosing a Nursing Home has
questions on several pages that you can tear out and take along
with you to what I call the "YOUR Q&A VISIT".
Try to make "YOUR Q&A VISIT" unexpected on a weekday. Ask to
speak to the admissions coordinator or some one who can answer
some questions that came up. I will just tell you now, that if
they respond timely to you at this visit that's how you will be
responded to if your family member was in the nursing home. This
is your opportunity to get your questions answered and to get
any additional information that will help you make the best
choice.
If you live in a small town this nursing home may be your only
choice and you will learn to be a good advocate. However, if you
live in a large town or metropolitan area you will have a choice
of several nursing homes, pick the one that suits your loved
ones needs and not your convenience. I wish you the best of luck
on your search. Thank you.
Here are the valuable Resource Links that I promised. Just click
on the title.
Nursing Home Compare - Will provide you data about a nursing
homes most recent survey and compare it with other nursing homes
you select for free.
http://www.medicare.gov/NHCompare/Include/DataSection/Questions/S
earchCriteria.asp
Home Health Compare - Will provide you data about home health
agencies most recent survey and compare it to others you select
for free. http://www.medicare.gov/HHCompare/Home.asp
Long-Term Care Counselor - Will help you make a determination of
the type care and where the care can best be provided for you or
for some that needs help or supervision.
http://www.medicare.gov/LongTermCare/Static/LTCCounselor.asp
Publications - Guide to Choosing a Nursing Home, Medicare and
You 2004, and Medicare Coverage & Skilled Nursing Facility Care
http://www.medicare.gov/Publications/Search/SearchCriteria.asp