How to Choose a Nursing Home - Charleston, South Carolina

Although there is not a fool-proof way to choose a nursing home, there are steps you can take to better ensure the safety of your family members. By asking questions and looking for signs at the facility you can better prevent unnecessary instances of nursing home neglect and abuse from occurring.

Be careful not to focus on properties relating to physical appearance when evaluating a potential nursing home. An attractive tour that showcases expensive furniture and a pleasant staff does not necessarily reflect the reality of the environment in which your loved one will be spending their days.

1. Check out the nursing home reports available to the public

Fortunately, there is information available on all facilities that receive Medicare funding that will enable you to see the nursing home’s recent Quality Care Deficiencies, Fire Safety Inspections, and Health Inspections. The Medicare site will rank each nursing home against the state and national average so you can see whether you are getting quality care. The Medicare database is searchable by name or by location. Go to http://www.medicare.gov/NHCompare/Include/DataSection/Questions/ProximitySearch.asp.

2. Ask basic questions about the facility’s licensing and structure

During your initial phone call or meeting, find out as many facts as you can, such as the following:

• Is the nursing home and its administrator licensed by the State of South Carolina to operate?
• Do the nursing home’s procedures to screen potential employees for a history of abuse meet your State’s requirements? Your State’s Ombudsman program might be able to help you with this information.
• Some nursing homes have special service units like rehabilitation, Alzheimer's, and hospice. Learn if there are separate waiting periods or facility guidelines for when residents would be moved on or off the special unit.
• Do the nursing home’s training programs educate employees about how to recognize resident abuse and neglect, how to deal with aggressive or difficult residents, and how to deal with the stress of caring for so many needs? Are there clear procedures to identify events or trends that might lead to abuse and neglect, and on how to investigate, report, and resolve your complaints?
• Are there policies or procedures to safeguard resident possessions?
• Find out how often patients are seen by a medical director or doctor.

3. Take Time to observe the nursing home on your own

Visit with Residents

Establishing a relationship with at least one existing resident in a prospective nursing home will help you to evaluate a facility from the inside. Whereas a guided tour may be misleading, visitations with pre-existing nursing home residents will provide accurate information regarding the conditions of a given care facility.

Use visitation time to explore the physical surroundings of the facility. Making conversation with bedridden and wheelchair-bound residents will allow you to investigate the cleanliness of the facility as well as the hygiene of the residents. Take time to notice the physical appearance of residents, including hair, nails, and teeth. Evaluate the emotional and mental disposition of the residents, taking time to notice any visible signs of depression or unhappiness. If the majority of the residents you come in contact with appear out of touch or unable to maintain a regular conversation, be cautious about the nursing home in question.

Avoid Restricted Access Facilities

Avoid nursing homes where visitor access is restricted. If a facility only allows visitation with specific clients who are willing to socialize, this should be seen as cause for concern. Although every care facility will have certain areas that are inaccessible to visitors and the general public, be cautious of nursing homes that only allow selective access to common areas or those that impose restrictions regarding visitation, or only allow visitation with a select group of willing residents

Notice Odors

Take notice of any odors surrounding the physical elements of a facility as well as the residents themselves. Noticeable odors of urine or feces surrounding the common areas, rooms, or residents of a facility could be an indication of improper treatment. Health hazards related to lack of proper care (changing of clothing) can include such potentially life-threatening illnesses as urinary tract infections and decubitus or pressure ulcers (bedsores).

Time Your Visits

Plan your visits so that they occur at various times throughout the day. Visiting a facility during the day may provide a much different picture than what is seen at night. Often, a nursing home may appear to be more adequately staffed during daytime than during the evening or on weekends. Be sure to evaluate the conditions of a prospective care facility at various times and on different days.

Visit During Meal Times

Visiting during meal times allows you to observe how the residents are being fed, and if they are being fed properly. Take notice of the amount of time each staff member spends with each resident, how much food is being eaten by the residents, and the visible physical health of the residents that are eating. Compare the general physical stature and size of the residents in the dining room to that of those senior citizens you see outside of nursing homes. If residents appear to be too thin, this should be cause for concern.

Take time to notice the eating habits and conditions of those residents who are fed in their beds. If the residents are unable to properly access their food, if the food appears cold, or if required aide assistance appears to be unavailable or scattered, be reluctant of the nursing home in question. If it is possible to eat a meal yourself, take advantage of the opportunity to judge the quality of the food based on taste, freshness, and temperature.

Check for Water

Every room should include a pitcher of fresh ice water, easily accessible to the resident. Staff should be providing water to those residents unable to obtain it themselves, and clean cups should be available in each room.

Evaluate the Staff

Inquire about the amount of available staff working at a care facility during various shifts, morning, afternoon, and evening. Request information regarding the number of available nurses and aides on duty, as well as the amount of certified nursing assistants (CNAs) present at any given time.

Compare the ratio of staff to residents. Take note of the number of wheelchair-bound or bedridden residents, as these clients require additional care related to daily activities, such as showering, drinking, eating, toileting, and grooming. If there is a large population of those residents in need of additional attention or special care, there should be an adequate number of CNAs on staff. With a greater population of bedridden or wheelchair-bound clients, the ratio of CNAs to residents should be smaller. Specific South Carolina licensure rules and regulations are available at http://www.scdhec.gov/administration/regs/docs/61-17.pdf and should be double-checked when evaluating the staff-to-resident ratio of a care facility.

Talk with Family Members

Introduce yourself to the relatives of existing clients in prospective nursing homes. Take the time to discuss the nursing home in which their loved one resides, and make note of any potential concerns or issues that you may have. If friends and family members of an existing client in a prospective nursing home have experienced difficulties with the care facility, it is likely that your loved one will experience similar problems.

4. Stay in Close Contact

The best way to keep your loved one happy and healthy in to stay in close contact. Visit as often as possible, talk with them, and give them plenty of opportunity to talk with you if they are able. Ask them questions about what is going on at the facility, what they like and dislike, and whether they are comfortable. While they many not be perfectly happy all of the time, your care and concern may go a long way toward showing both them and the nursing home staff that your loved one is still an important person in your life and that you care about their well being.

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