What to look for in a new facility

[LaterAlligator]

Hey Everyone, turns out I was wrong about L&I insisting my current facility pay for the trainng they promised me in orientation, so I've had to give my notice there. My last day is at the end of this month, which has me thinking:

How do you evaluate a new facility before you apply/accept a job there?

I know everyone has different priorities, so of course not everyone has the same answers, but I'd love to hear what you look for and why.

I know I'm hoping to find somewhere where the staff tends not to turn over all the time, because for me that's a clue that management is making them feel valued and not firing them over petty things. I don't need the place to look fancy or high-tech (LTC) but I want it to be reasonably well-maintained/have supplies avaliable.

How about everyone else?

[yousoldtheworld]

Yes, like you said, I ask about turnover rates.

I also ask about: pay, benefits available, and most important to me - STAFFING LEVELS. I ask how many residents each aide normally has per shift. Understaffing is one of the biggest problems in LTC.

[CoffeemateCNA]

When you ask questions, especially about staffing levels, be sure to listen very carefully.

During an interview I asked the DON what the facility's staffing ratios were. She said 6-7 residents per staff member. All I heard was "6-7." It sounded too good to be true, and it was. When I started, I realized that there were indeed 6-7 residents per staff member -- this number included nurses, nurse managers, secretaries, clinical educators, and a whole lot of other people that do little-to-no direct patient care. The resident to CNA ratio was more like 15-20. You live and learn, I guess.

[Cinquefoil]

If there's any way to hang out and chat with residents, especially the more "with it" residents, they will give you the dirt. They discuss this almost all day with each other anyhow - which aides are responsive and kind, which ones left them for one hour on the toilet, which ones were late with what.

Ask for a tour of the facility. Does it pass the smell test? Do the aides already working there smile at you? At residents? Do they look intimidated when the manager walks up with you or do they tease the manager and say hi in a friendly way? When you hear an aide talking to a resident, does it sound like a good conversation, or is it the aide telling the resident how they should feel about something, or talking down to them, or telling them what to do?

Is there fresh art on the walls, or does the place look like a terrible motel? How many activities are scheduled and how many people tend to go on them?

How many call lights are going off at once?

[KimberlyRN89, BSN, RN]

Everyone has given great advice! I wish I had done this before I accepted "the job from hell". But you live & learn! I think you should ask if there is a hoyer lift in the building & what the resident:cna ratio is for the shift you're interested in. And www.medicare.gov does a great job of ranking facilites too. Stay away from ones that are 1 or 2 stars! That's pretty telling of the conditions of the facility.

[Poi Dog]

Everyone has given great advice! I wish I had done this before I accepted "the job from hell". But you live & learn! I think you should ask if there is a hoyer lift in the building & what the resident:cna ratio is for the shift you're interested in. And www.medicare.gov does a great job of ranking facilites too. Stay away from ones that are 1 or 2 stars! That's pretty telling of the conditions of the facility.

What about facilities with 3 stars? Should they be avoided also?

Thanks, I am curious.

[LaterAlligator]

Oh man. I've been looking on the medicare.gov reports for a while now, and honestly, the highest rated nursing home in my county is only 3 stars . But the one I'm wanting to apply to, that I am in 3x/week for my other job and that I always hear great things about is only 2 stars. This makes me doubt the star ratings. Either that or I've just never been in a decent nursing home because of where I live!

The other thing I did was to search by the county health dept. to see what specific citations/enforcement letters different facilities had. That turned out to be more useful for me, because I want to know if somewhere was cited because the residents were sneaking cigarettes into their rooms, or because staff failed to prevent residents from abusing one another.

I love the idea of asking the "with-it" residents about their care; I always have to take what staff says with a grain of salt because there's a good chance they're putting on their "game face" for an outsider (I know the pressure to do so is huge at my current job).

[CoffeemateCNA]

What about facilities with 3 stars? Should they be avoided also?

Thanks, I am curious.

That tool is useful, but only to a certain extent. A previous facility of mine was rated 4 stars (SOMEHOW) when in reality it should have been 1 or 2.

[yousoldtheworld]

The thing about the medicare.gov stats are that they are based on what is observed during state surveys, not everyday care. A person could make one mistake in front of state and have it counted against the facility.

Similarly, a facility might drastically improve its staffing and care while state is there, but be absolutely dreadful the rest of the time. It’s just not necessarily a great indicator.

Not to mention that some of the things counted against is SILLY.

An example: Our facility had a count of abuse against it, in the "dignity" category. Do you know why? Because one of the aides said "Hey Sammy!" to a girl named Samantha. Since it was not in her chart that she was to be called "Sammy", it was counted as abuse, as you are to call them by their given names only.

These are MRDD kids/adults, who enjoy nicknames and "informal" closeness with the staff, but according to state, calling them a nickname is abuse.

Other things that can count against facilities can be as simple as forgetting to cover a catheter bag, not completely covering a resident during a bath, etc. While these things aren't ideal, it's also simple human error and not malicious intent.

I'm not saying that you shouldn't look at the medicare.gov scores, especially to take note of things rated 4 (immediate jeopardy or harm), but just remember to kind of take it with a grain of salt, too. :)

[CoffeemateCNA]

Just to clarify for everyone reading this thread:

When you are searching for nursing homes through Medicare's site, you want the overall rating to be a HIGH number (the more stars, the "better" the facility -- just like it is with hotels). You want the seriousness level of each deficiency to be LOW (the higher the number, the more life-threatening it is).