Looking to put grandma in LTC...what to be on look out for?

Specialties Geriatric

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Hi! As the title suggests, my family has recently come to the acceptance that it is time to put my grandmother in a skilled nursing facility. She has been living in a senior independently living facility and up until a few months ago was functioning decently with family checking on her every few days. Well her memory has now detoristed to the point where she forgets to eat, take her meds, and even clean herself after going to the restroom. She's become incontinent and needs pt a few times a week as well. She has Medicare andwe are trying to find the best care for her without going into debt ourselves.

When we begin meeting with diffent facilities, what are things we should be looking for as a sign its a loving place vs. a place to run for the hills. What are any buzz words we should pick up on? Or what do you wish you could tell your resident's family to be weary of when choosing a home?

She is the first one in our family to go through so many issues and need extra care that we are not able to provide with her moving in with us, so I thank you in advance for your advice and help during this difficult time!! And thank you for compassionately caring for people like my grandma :)

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One of my first things I would check into is the staff to patient ratio. This in my opinion should be any family's first question and you can also find out by scanning reviews online. A long term care facility can look like a 5 star hotel but if they staff with a skeleton crew it's really just a motel 6 with a nice paint job, know what I mean?

The best facilities I have seen are the ones that maybe don't look so fancy but spend money on staffing instead of flat screens in every room. Good staffing ratios make all the difference because it means less falls, less bed sores, less things that go unnoticed. It's hard to find a properly staffed long term care, but they are out there, you just gotta do your research. Good luck, I hope you find a wonderful place for her.

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Ask for tours of the places you are looking into When you visit, really look around and take note of what you see. Are the Elders clean, shaved, without odor, and are staff interacting with them; or are they walking right by and talking about their plans for the weekend? Are people engaged in the environment, or sitting around waiting for something to happen? Look at fingernails on people. Dirty nails means attention to details isn't given. I've worked at beautiful state of the art facilities that take "ok" care of people, and I've worked at smaller, older buildings that lack fancy things, but have the right people doing the right jobs. You can tell fairly quickly. Don't get distracted by rhetoric. Use you own observations.

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Specializes in Complex pedi to LTC/SA & now a manager.

Some information from medicare.gov

Medicare Nursing Home Finder

Guide to Choosing a Nursing Home: Medicare.gov - PDF Interim Page

Nursing Home Checklist:

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Specializes in retired LTC.

On line, you can check State survey results and see if there are any complaints investigations also. In NJ, all LTC facilities had tohave a copy of State surveys avail for public review. It's usually found lying around the front sign-in desk somewhere. When I go for interviews, I try to QUIETLY review it to see if something jumps out at me. The report describes what was wrong and how the facilty planned to correct the deficiency. (Just be careful when reading a survey and don't get alarmed - sometimes it sounds worse than it really is.)

Your State DOH, State Dept Senior Services, etc sometimes publish or e-line information on how to select NHs.

When you go for a tour, pay attn to the call-bell response. PLEASE, in all fairness, there will be some delay; but there's a difference between a LITTLE OK delay, and an outright prolonged delay. Note that sometimes it sounds like the bells NEVER stop - but just as fast as staff answer 1 bell, the next one is ringing! Pay attn if the bells are ringing & ringing & ringing and there's staff just sitting around.

Try to go for an initial tour on the weekend. On weekdays, you'll probably meet the Admissions Director whose job it is to sell the place to you (she keeps the census up and she'll make her bonus). On weekends, the nsg supervisor or Administrator-on-Duty (AOD) conduct tours; just call ahead so they can be ready for you. (The nsg supervisor might be involved on a unit with an emergency.) After you visit on a weekend, the Adm Dir will most likely give you a follow-up call.

Whenever you go, ask to see any Recreation/Activities Dept programs going on. Are pts involved in the prescheduled activity, or is there just a Lawrence Welk tape on the VCR?

Other posters mentioned to take a good look at the personal care details of the pts - ABSOLUTELY. Excellent info (my personal thing is men needing shaves!). Look to see if their wheelchairs seem relatively clean and in good repair, like 2 footrests and large enough for the chubby pts.

Are there nice bedspreads or home-like décor items/details seen (family pictures, stuffed animals, flowers, decent TVs)?

Some sources say to visit at mealtime, but that's a super busy time for even the nsg supervisor to get out of dining room duty. But if you are there, do meals look appetizing and are staff helping to assist pts?

Outside, has the lawn been mowed? Any flowers? You know, curb appeal!!!

And lastly, does the staff look decently dressed and no potty-mouth language or yelling?

I could go on & on. A lot to take in and think about. But bottom line is - will this be a good place for your family? It'll NEVER be like the old homestead, but it can be as good as poss with some research and checking-out.

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Specializes in LTC, assisted living, med-surg, psych.

This sounds all New Age-y, but pay attention to the feel of the place when you walk in. You can often get a sense of how a facility treats residents and families the instant you step into the foyer. Does it feel homelike, or is it sterile and cold? Can you smell urine/feces, or is there a pleasant, fresh scent around that's not merely masking these odors? Are the entrances welcoming? Do the staff members smile genuinely and ask you if you've been helped?

Look at the residents. Are they clean and dressed appropriately for the season? Are both men's and women's faces free of chin whiskers? Do they seem alert and engaged, or are most of them sitting around in their wheelchairs asleep?

Look at the surroundings. Are there plants, interesting artwork, maybe even pets for the residents to interact with? Are the hall carpets clean? Do resident rooms look attractive, and is there enough space for them to keep personal items and memorabilia? How many residents have to share a bathroom?

Try to observe a meal. Is the food attractive, or does it all look like it came out of a can or a box? Are all meals served on trays, or may residents eat from dishes placed directly on the table? Are they allowed to choose whether or not to use a clothing protector, or does the staff just put them on everyone automatically? Do the staff wear clean aprons to serve out meals and remove them afterwards? Keep their hair up and out of the food? Assist residents who need it and avoid rushing those who require more time to finish?

Ask how residents' toileting needs are met. (A word to the wise: if you EVER overhear an aide telling a resident to "go ahead and pee/poop in your diaper", report it to management. This is a huge dignity issue and is never okay.) Is there a schedule for toileting, and who follows up to make sure it's being done according to the care plan? There is perhaps nothing more distressing to me as a former LTC nurse, and relative of someone who's currently in a nursing home, than the sight (and smell) of an incontinence pad or drawsheet that has several dark rings around the yellow stains, indicating that a resident has voided multiple times without being changed.

There are many other aspects to choosing a good nursing facility, as previous posts have advised. Good luck to you in finding that special place for your grandma.

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Specializes in Gerontology, Med surg, Home Health.

Walk in the front door and ask for a tour. Take a deep breath. Does it smell like urine? If it does, get out!

Observe the staff's interaction with the residents. Even if they are busy, do they engage the residents in conversation? The websites can only tell so much of the story. You will get a sense of the place if you walk around. I've worked in old old buildings with 4 beds in a room that gave wonderful care and worked in beautiful new places where the staff wasn't so great.

Don't make a quick decision. If your grandmother has dementia, look for a place with a dedicated dementia unit.

Good luck. It's not an easy decision.

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Pretty isn't always better. My company closed down after over 50 years. It was a old building. Most of the employees had worked there for over 20 years. However yes it was a nursing home that had problems at times. My new job was a brand new nursing home. It was beautiful. I stayed 4 months to give it my best shot. The only good about the place was it was pretty, short drive to work and of course the residents. It made me physically sick to get up and go there every day. I got out quick. I worked to hard to get my license. So pretty isn't always better. Wish that I was at my old job. Right now I am enjoying the couch while I look for another job. Good luck. P. S. Make sure when you find a place for your loved one that family shows up to check on them frequently.

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Specializes in LTC,Hospice/palliative care,acute care.

After you have toured a few facilities and narrowed down your choices make sure you go back un-announced, preferably during the early evening or on a weekend and walk around.Things can look very different after the administration leaves and staffing is generally more sporifice on the evenings and night shifts.Also-look at security.You want her in a safe and secure environment.I would want my loved one protected from outside invaders and also from wandering herself (a simple UTI can make an oriented elderly woman extremely confused)

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Specializes in LTC.

Just a word of caution with Medicare: Medicare will only kick in if she has had a "qualifying stay" in a hospital within the last 30 days. Meaning, she would have to have been in the hospital for at least 3 nights in a row with an approved diagnosis for Medicare to pay. She could then come in on Medicare for rehab. Also, Medicare will only pay 100% of the first 20 days of a SNF stay, then only 80% of the remaining 80 days for a total of 100 Medicare days. She/family/another income source would be responsible for the remaining 20%. Medicare is rather fickle, and most facilities will not bill Medicare for the whole 100 days because most residents of SNF's do not have an illness that qualifies them for the whole 100 days. If she doesn't meet the criteria, then another source of pay would be expected, whether it be private insurance, self-pay or Medicaid.

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Most things have been covered so my advice would be to show up without an appointment for a tour. This happens fairly frequently at my facility and we welcome it, if its the weekend I might give the tour (I'm charge nurse), during the week administration will do it. You get a better feel for a place if no one knows you are coming (think about it, do you clean your house before a planned visit from your parents)? You want a real feel for the place, and I've worked in a 109 bed facility and a 61 bed facility, the smaller facility gives much better pt care, though I'm sure all facilities are different.

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Whenever you go, ask to see any Recreation/Activities Dept programs going on. Are pts involved in the prescheduled activity, or is there just a Lawrence Welk tape on the VCR?

Make sure you check at different times. My facility has a movie every few days, but the rest of the time is scheduled activities.

Look at the printed schedule of activities (assuming they have one). Are they actually doing what is on the schedule for right now? Are there things grandma would find interesting? Check out those activities and see if they're actually at an appropriate level for her (ideally, they should be adaptable to any level of functioning.). If she's not really the social type, what independent activities do they have? How often do activities that involve leaving the facility occur?

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