Choosing a Care Facility? Listen To Your Gut

Carol Bradley Bursack, Minding Our Elders 

People often ask what to look for when choosing an assisted living facility or a nursing home for a loved one. There are grading sites such as the Medicare Nursing Home Guide, found on Medicare.gov, and I suggest you use them. However, there are many things that go into good care that can’t be measured on a chart. In order to see the heart of a facility, you need to spend some time there. Observe routines and pay attention to the atmosphere. What is your gut feeling about the place?

Do you feel that the staff members respect one another? If you notice that the people who give your loved ones the most hands-on care – the Certified Nursing Assistants (CNAs) – are treated with respect by the nurses and other professionals in the facility, you are likely visiting a good home. If the hands-on caregivers, who aren’t often well-paid, at least receive respect for their work and are treated as professionals in their own right, there is more chance of job satisfaction. Job satisfaction can translate into better care for your loved one.

People smiling at one another, sharing a laugh or helping out even if something isn’t “their job” can be a tip off as to the way the staff works together. This is not to say everyone will always be jolly. Nursing home staff work very hard and must cope with frustrating and heartbreaking situations on a daily basis. Still, you’ll get a general feel if there is some sort of fellowship among those hard at work.

Consistent assignment is something else to consider. As you question staff members about services, ask if the CNAs are consistently assigned to the same group of residents so that the staff and the residents get to really know each other. If so, you are likely looking at a quality facility.

Consider how the staff interacts with the residents. Do you get a feeling that they genuinely care about their residents or does it seem like they are just doing a pretty basic job? Do they get down to eye level with the residents in wheelchairs when they communicate? Do they look residents in the eyes when they smile at them or address them? Do they smile often? Give a tender pat on the arm or a hug?

How do they handle difficult resident behavior? Do they have the patience and training to correctly distract and redirect people who are agitated? Have they been trained in the validation method? Validation of the individual, no matter how outrageous a comment or action may be, can be vital to the self-esteem of an elder, so that is an important element, particularly in good dementia care.

You may not be able to witness enough life at a facility to answer all of these questions to your satisfaction, but keep them in mind as you observe. You’ll get a better feel for the care home.

Location has much to do with our choices in our review of care facilities and often we have to choose among less than perfect options. It may help ease your mind if you check with the long-term care ombudsman for the location you are considering. Go online to www.ltcombudsman.org. Then, type in the Zip code of the assisted living or nursing home. Here you’ll find contact information for the ombudsman. Contact this person and ask whether or not there have been a significant number of complaints about the facility you are considering.

If the general atmosphere of the care home seems depressing or fearful, you might consider looking elsewhere even if official ratings are good and there have been no major complaints. Conversely, if you get a good feeling when you are around the staff, question the administrator if the Medicare Nursing Home Guide or another resource shows less than desirable ratings for the home. There may be a good explanation for a slip in numbers at a particular time.

In the end, it’s about balance. You want a facility that is clean, safe, serves good food and is medically sound. However, you also want one where the caregivers enjoy the care receivers and each other. That is the intangible factor. That’s where you need to trust your instinct and listen to your gut.