“Man’s inner strength may raise him above his outward fate.”
– Victor Frankl
When I was ten I saw a small energy filled woman at her house every Tuesday afternoon. Her name was Mrs. Gordon. Mrs. Gordon was a beam of encouragement and love. For a little over a year we worked on my difficulties with reading.
With important people from your past you remember odd things. I remember Mrs. Gordon’s front hall carpet. It was red and I always felt like it was too thin, like I could almost feel the wooden boards beneath it. I also remember that she gave me Fig Newtons. I can still taste the small seeds in my mouth if I sit back and dream.
Years later I had graduated college and was giving my try at being an adult. One day I received this letter in the mail:
I smiled and like many people in their self-absorbed twenties put the note in a filing cabinet and went back to my life. A couple years went by and one day I was reminded again about how much Mrs. Gordon meant to me. I sat down and pulled out a pen and paper, eager to get back in touch.
A few weeks later a letter arrived in the mail. At first I didn’t recognize the writing nor the name but then I realized it was from Mrs. Gordon’s husband. She loved working with me he said. And sadly, after years of a battle, she passed from cancer.
It wasn’t until that moment that I realized what she meant by:
“I’m tapering off tutoring and indulging in family.”
The people who love us are so immensely powerful. Particularly those who love us when we don’t know exactly who we are or what we have to offer.
As we take this next step in finding the best nursing home I want you to remember the people who believed in you. I bet the person you’re trying to find a nursing home for is one of them. Let’s find them the absolute best. They deserve it.
In my last post I spoke about types of nursing home services and options for financing. In this post we’ll get into the gritty detail of exactly how to find the best nursing home. What steps to take, who to talk to, what to ask and what errors to avoid.
By the end of this post you will be an expert. You will have the tools you need to help your loved one in the next phase of his or her life.
Finding the best nursing home for a loved one takes eight steps:
- Step 1: Determine The Type Of Care Needed
- Step 2: Identify Research Method
- Step 3: Identify Candidates
- Step 4: Conduct Phone Interviews
- Step 5: Visit Facilities
- Step 6: Collect Documents
- Step 7: Visit Facility Again
- Step 8: Sign Up
60 percent of families begin this search process only after a loved one has been in the hospital. The advantage here is that they will likely have the assistance of a discharge nurse or social worker to find an appropriate nursing home. Multiple steps remain however. We’ll walk through each of them.
Step 1: Determine The Type Of Care Needed (1 – 2 weeks)
While a nursing home is a great path for many families, there are multiple types of care available to you. They fall into four buckets:
- At Home Care – Home health aide or a more experienced healthcare professional (e.g., a nurse) will visit your loved one in his or her home.
- Adult Day Care – Out of the home care for a period of time each day.
- Assisted Living – Residents live in their own room or apartment but get assistance with some activities of daily living. They are often part of a larger community.
- Nursing Homes – 24/7 care where your loved one receives assistance with activities of daily living as well as skilled nursing care.
Finding out exactly what type of care your loved one needs can be a challenge. Luckily there are experts that can help you this week.
They will come to your home and speak with your loved one and your family. They will walk through a series of medical questions and review your loved one’s physical and mental abilities.
The two primary experts are occupational therapist and geriatric care managers. The assessment will take a couple hours and cost around $500. I know it sounds like a good chunk of change (and it is). However it’s 100% worth it.
In the initial assessment they are trying to determine your loved one’s needs for assistance with:
- Activities of Daily Living (ADL’s) – Eating, clothing, bathing, etc.
- Medical Issues – Medications, cognitive support, etc.
They will return to your family with a specific care plan. It will have recommendations for where you can receive services, who will pay for those services, how the family can get support as well and what social services are available to you for free.
Do this as a family and think ahead. Consider what Mom or Dad will need in 2 years, 5 years and 10 years down the road.
Step 2: Identify Research Method (30 minutes)
“I think I’ve been in the top 5% of my age cohort all my life in understanding the power of incentives, and all my life I’ve underestimated it.”
– Charlie Munger, Warner Buffett’s business partner
You can search for a nursing home by using an agency or forging ahead on your own. I strongly recommended leveraging the online tools and this post (each step of which I will show you) to move forward without an agency.
There’s a secret most people don’t know. Agencies, or the groups that will help you for free to find a nursing home, are paid by nursing homes.
This means that agencies are incented to push you towards the nursing homes with the highest commission rates for them.
The New York Times ran a scathing report about some of these practices. The money at play is significant. For example, “A Place For Mom” is the largest player in the marketplace. The company can receive as much as $3,500 from a nursing home for placing a resident, including $600 in commission for the person talking to you on the phone.
If there is one nursing home that pays them $0 but is perfect for your mother and another that pays them $3,000 but is only a moderate fit which one do you think they’ll chose?
So let’s accelerate you into taking the right steps. I want to enable you with exactly the right tools. We’ll work through the search together.
Step 3: Identify Candidates (4 – 5 hours)
Start with your personal network. Call up friends and family who have gone through the process before. Ask them how they approached it. See what facilities they chose and why. Speak to three friends today. Take action.
Next search online. The best tool is the U.S. News & World Report’s nursing home search tool. Take action now and search for five nursing homes in your area. You will have results in less than 20 seconds.
The results are robust and trustworthy. The tool uses data from The U.S. Department of Health and Human Services. Their role is to evaluate every nursing home in America that accepts Medicare or Medicaid (most do) every 15 months.
Let’s laser in on the criteria that drives results for your loved one. By the end of this step you will know exactly what matters in evaluating the quality of a nursing home.
Criteria #1: Overall Rating – Each nursing home is given an overall rating based on health and quality standards. Focus on facilities with a rating of four or higher. Make a list of 10 in your target geographical area.
Criteria #2: Average Time Per Resident – Click on “full report” for the 10 candidates you have chosen. Under “nurse staffing” you’ll see information on the average time nurses and doctors spend with each resident. Look for ratio above the state benchmark. Whittle your list down to 7 based upon what you see.
Criteria #3: Health Inspection – Click on “health inspection” for a specific nursing home. This includes everything from food quality to resident’s quality of life to preventing bed sores. The inspection is conducted by an independent representative from the U.S. Department of Health and Human Services a minimum of every 15 months. Again refine your list to 4 to 5 candidates based on results (tip: if you’re not finding quality in your loved one’s area try cities near where you and family live so your loved one can be close by to someone they love).
Criteria #4: Quality – These are self-reported by the nursing home. Again look for ratings above the state average. Arrive at a list of 3 to 4 candidates.
Fantastic! You now have a list of potential facilities. Next we will look at exactly how to have a quality phone conversation with nursing homes. We will review what to ask, how to ask it and give you the tools to deal with unexpected turns in the road.
Step 4: Conduct Phone Interviews (5 – 6 hours)
Remember all of the difficult interviews you’ve had to sit through for jobs in your life? Well now the tables have turned. You hold the power now!
Call your 3 to 4 candidates and ask them the below questions. Now that we know they are quality facilities we need to know if they meet the specific needs of your loved one.
I know this may feel a bit intimidating and take already precious time from your day but you can do it! This step is a great accomplishment. You will be one step closer to finding the perfect facility for your loved one.
I want to enable you with all of the necessary information now in this post so you can quickly take action. You won’t need to search on line for the best information. Instead you’ll have the exact information at each step that will enable you to be successful.
Critical questions to ask:
- Do you have availability now? – How long is the waiting list? When can you expect to get into the facility?
- What is the cost? – Does the facility fall within your budget?
- What services are included in that cost? – What “hidden” costs are there (e.g., haircuts)?
- Accepts Medicare and Medicaid? – Will this facility accept government funds down the road if you need to use it?
- What services do you offer? – Will my loved one receive the appropriate care?
- Do you have specialized services? – Do you have wings for dementia, ventilator care, and rehabilitative care?
This is great! Well done. Many people forget to ask some of these questions up front and get far down into the process before they realize that the facility they love won’t take Medicaid down the road if that’s the only payment available. Or key medical services aren’t available.
Not you. You have taken these critical steps in advance.
At this point you may have eliminated a few more facilities than you would have liked. That’s just fine, it’s an evolving process and this is expected. Go back to the tool and search for a few more candidates. Come back to this step and make a few more calls. You’re doing great.
Step 5: Visit Facilities (1- 2 weeks)
Fantastic! Now we are at the stage where you will need to physically visit facilities. At this point you may want to speak with a trusted family member about partnering up for these visitations. You also may need to schedule a trip to the town where your loved one lives. Take action now and get started.
First, call your nursing home candidates and schedule a time to visit. These visits often last between one and two hours. Ask to have schedule time with the director of the facility and the primary doctor during your visit.
Do not forget. This is your loved one and your family’s finances. While it can be intimidating to ask to meet with the senior people at the facility, you deserve it. Be an advocate for your family’s needs.
Secret Tip #1: Immediately Watch What Is Around You.
You are going to have the key tools in advance of arriving at a nursing home for a review. This will put you far ahead of the pack. Before you even walk in the door you will know what to do and where to look.
Immediately upon entering the facility look to see a few very specific items:
- Staff – Do they know residents’ names? Are they having fun with each other? Is their relationship with residents fun and respectful?
- Residents – Are they out of their beds and moving around? Do they function on a level that’s similar to your loved one? Are they engaged and enjoying the activities?
- Rooms – Are they personalized? Is there room for storage? Is there a personal phone and television? Are there lockable closets?
Great. If the facility doesn’t feel right make a mental note of it. If the energy and flow is attractive that’s a win.
Now when you enter the office of the director of the facility here are the key questions to ask. Before you even step into the room you’ll know exactly where you want to take the conversation.
- What is your vision for the facility?
- What are you doing to improve care here?
- How do you incorporate feedback from family members and loved ones?
- What are some of the facility’s strengths and weakness? How are you maximizing the strengths and minimizing the weaknesses?
- What is your staff turnover? How are you increasing retention at your facility?
- What recent trends in caregiving do you find important?
- How often are you able to spend one-on-one time with residents?
As with all conversations body language and tone is critical. You want to feel comfortable and engaged with the director. In addition they must know the latest developments in the field and show a genuine passion for the residents and families they serve.
The director should clearly feel like an advocate for you and your family.
One last thing. Take notes! This will keep a record of where you went and what you thought.
Great stuff! Let’s keep the momentum going.
Step 6: Collect Documents (1 day)
“We are what we repeatedly do. Excellence, then, is not an act, but a habit.”
At the end of your first visit, make sure you leave the facility with:
- Sample admission contract
- Statement of residents’ rights and responsibilities
- Recent list of weekly activities
- Recent list of week’s meals and snacks
- Recent report or agenda from a resident or family council meeting
- Most recent inspection reports by state and federal authorities
- Records showing the facility’s financial stability
Before you feel too overwhelmed by collecting even more information, be assured that these documents are standard at nursing homes. You need to them to form an objective and fact based view of how different facilities meet your needs.
Notice there are no marketing documents or brochures in the above list.
Step 7: Visit Facilities Again
Now you have narrowed your list to a few target nursing homes. Well done! You should take the time to review the top candidates with your family. While your loved one has likely been involved to varying degrees so far they must be involved at this step.
Review Medicare’s checklist of key questions to ask when visiting a nursing home. See if there is anything you missed or would like to follow up on.
At this stage you want to ask questions that reflect how up to speed the nursing home is on trends in the industry. One example is do they have a Resident’s Council? What are they doing to actively seek out the opinions of their residents?
You can also speak to them about “person-centered care” and “consistent assignment”.
- Person-centered care means residents keep more independent hours. They eat and get up when they feel most comfortable, as opposed to living by a strict schedule.
- Consistent assignments means having the same assistants, nurses and doctors addressing the same residents each shift. Continuity of care decreases error rates, increases emotional wellbeing and decreases staff turnover.
Use this time to speak with the nursing home’s leadership about any final questions you have. Great work! Now you have your final list of the candidates. You have come a long way.
Step 8: Sign Up
At this point, you and your loved one should be comfortable choosing a nursing home. Share this with your family and make sure everyone is on board. Inform the nursing home of your choice.
Nursing homes will ask you to complete a brief application once you have informed them that your loved one would like to become a resident. The application is divided into two parts: medical and financial.
- Confirmation that your loved one needs 24-hour care. The nursing home will contact your loved one’s primary care physician and/or physician from a recent stay in a hospital.
- Guidance on what to do during a medical emergency. They often collect key documentation: do not resuscitate orders, advanced directives and durable power of attorney for healthcare.
- Confirmation that your loved one and family can cover the cost of care. The nursing home often asks for a profile of assets for all involved in paying.
Submit the application. Don’t worry. You haven’t signed on the dotted line yet and you still have the option to choose another facility.
At this final stage of the process, ask more detailed questions before signing on the dotted line. Below are good ones to start with:
- How do my loved one’s records remain confidential?
- Are pharmacy services made available? Who prescribes? Who pays?
- What are the facility and state rules for transferring my parent from the nursing home to the hospital or another medical facility in an emergency?
- If my loved one is in the hospital, how long do you hold the bed at the nursing home, and how does my loved one’s per diem rate change?
- What are your billing practices? Are there late charges? If my loved one should go on Medicaid, will anything change regarding his or her care or residency at the facility?
- What are your rules and policies regarding personal fund accounts (small amounts of money residents have access to for incidental spending)?
- How will decisions be made about moving my loved one to another room?
Once you feel comfortable and your application is accepted, you’ll be asked to sign a contract. Don’t sign it yourself unless you plan to pay for the care. Your loved one should be the one signing the contract, unless they’re mentally unable to do so. In that case, their guardian should sign.
Upon admission, your loved one will be given a resident’s bill of rights, description of legal rights, information on how to file a complaint and instructions for contacting the physician providing care. File these important documents in your records.
Fantastic. You did it! You took the best steps to enable your loved one to live a fulfilling and enriching life in the next stage of their journey. Well done!
January 15, 2015
By: JP Adams