When a Loved One Needs a Nursing Facility – part 1

June 21, 2010
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If at all possible, plan ahead for any future long-term care needs. By doing so you will maintain greater control of your care or be better able to honor the preferences your loved one may have.

Before you look for a nursing facility, have your loved one’s condition evaluated by a specialist. Some medical conditions, when accurately diagnosed and treated, can improve significantly if the right treatment is undertaken.

Since most people prefer to stay at home, it is important to investigate alternatives to nursing home care such as home care, assisted living facilities, hospice and medical or social day programs. Providing good quality care that ensures your loved one’s safety and comfort should always be the guiding principal.

If a nursing home is required, determine whether short-term rehabilitation is needed or whether a long-term care stay is indicated.

Statistics have shown that a person is kept at home at least 6 months longer than is healthy for them or for their caregiver. The following indicators inform the caregiver when a decision for alternative care must be made:

  • The care requires physical abilities that the caregiver does not have.
  • The care requires around the clock care that the caregiver cannot maintain over a period of time. For example, loved ones may have care needs (such as being turned every two hours, suctioning, or constant supervision) which will prevent the Caregiver from obtaining a healthy amount of sleep.
  • The caregiver’s health is being affected adversely.
  • The family is endangered. Families are at risk when a patient becomes violent or non- compliant with the medical provider’s directions.
  • The caregiver cannot financially afford to care for a patient at home.
  • The caregiver is unable to insure a safe environment. The caregiver is unable to guarantee that their loved one will not accidentally walk outside where they could get lost or hit by a car, fall down stairs or find access to dangerous materials.

Steps to Take Prior to Entering a Nursing Facility

Family members dealing with an elderly and infirm relative cannot simply “check” their loved one into a skilled nursing facility. Skilled nursing care requires an assessment to determine whether a person is appropriate for that level of care. The Patient Review Instrument, or PRI, is an assessment tool used by hospitals and nursing homes to determine the cognitive and physical skill levels of a person.

The PRI screening is typically good for 30 days and is performed by a nurse and is performed in one of two possible environments. The majority of PRIs are completed at a hospital as the result of an emergency room visit as people with dementia or an advanced chronic illness are assessed before discharge in order to determine their cognitive and physical impairment. At this point, the hospital’s discharge nurse uses the tool to determine whether the person should be released to return home or whether skilled nursing care is appropriate. The second way is through an assessment at home by a private nurse. A family can either privately hire a nurse or they can call the nursing facility of their choice and obtain a home visit from one of their nurses. This nurse performs the PRI to determine whether skilled nursing is the next step. The PRI can either be paid privately or, if qualified, through Medicaid.

Prior to visiting any nursing facilities, it may be a good idea to do some preliminary research. Some important issues to consider when evaluating facilities include quality of care and life, bed availability, types of services available to meet your loved one’s needs, cost of care, and location in an area where friends and family of the resident can readily visit.

Try to get word of mouth opinions on different nursing facilities. Good sources of information can include current nursing home residents and their family members, hospital discharge planners, your physician, clergy and friends or family that have already gone through the process.

Nursing home data is also provided by the federal government through “Nursing Home Compare” http://www.medicare.gov/NHCompare/home.asp. This site will provide you with the opportunity to search for nursing homes by state, county, city, or zip code. To help make the task of comparing facilities easier, a Five-Star Quality Rating System was created. A five star rating means much above average and a one star rating means much below average.

Nursing home ratings are taken from the following three sources of data:

  • Health Inspections
  • Staffing
  • Quality Measures

To look at a summary of the state inspection information on “Nursing Home Compare” click on the tab labeled “Inspections”.

Important things to consider when viewing the inspection reports:

  • Each facility is required by law to make the latest state inspection report available in a place readily accessible to residents.
  • Inspections take place every 9-15 months.
  • View previous inspection results to see what the pattern of quality has been over a three year period.
  • Be aware of choosing a facility with a very high number of deficiencies compared to other facilities in the area or the state average.
  • Don’t assume that a ‘deficiency free” rating necessarily means that there are no problems with care at a particular facility.
  • If a facility has received a deficiency citation in a particular area, be sure to ask questions about this when you visit the facility.

Staffing levels are critically important to consider in evaluating the quality of care given at a facility. The “Nursing Home Compare” website provides information about the hours of nursing care provided at a facility, as well as the nurse staffing levels on a state and national average.

Important things to consider when viewing the Staff Levels are:

  • Pay attention to the number of Certified Nursing Assistant (CNA) staffing hours. CAN’s provide 90% of the hands-on resident care.
  • Look for facilities with high levels of RN staffing. Studies show that RN involvement in care is important for quality.
  • Visit the facility and ask staff and families about the actual number of staff available to directly care for residents of each shift.
  • The staff hour data used for “Nursing Home Compare” is self-reported by the facility and is not audited for accuracy.

The “Nursing Home Compare” website will also allow you to view Quality Measures. The quality measures provide an important in-depth look at how well each nursing home performs on important aspects of care. For example, these measures show how well the nursing home helps people keep their ability to dress and eat, or how well the nursing home prevents and treats skin ulcers or bed sores.

Quality Measures include 14 indicators for chronic (long term care) and 5 indicators for acute (short-term) care. Quality Measures are designed to provide comparison information among facilities and are not intended to be a nursing home rating system. You should use quality measure information as one indicator of care, however, the importance of actually visiting facilities and talking with residents, family members and staff can not be overemphasized.

Important things to consider when comparing Quality Measures:

  • Most of the Quality Measures are negative measures. Consumers should look for facilities that score below the state average and the lower the score the better.
  • A high percentage score on some Quality Measures may indicate that there is not enough staff available to attend to residents.

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