Nursing Facility / Nursing Home

Choosing a Nursing Facility / Nursing Home
Each day we at the Department of Aging get many questions about nursing homes from how to get into what to look for. The links and articles below will hopefully answer some of those questions.
Make an Appointment for Your 1st Visit
If you think you might choose that facility, plan on dropping in unannounced at least twice thereafter. The best times are around mealtimes so that you can observe how meal service is provided.

Speak with some of the Residents Without Staff Present
Ask them how they like being there. Try to get a feeling about whether your relative would fit in and be comfortable with the type of residents living in that facility. Are they experiencing similar problems and care needs?

Do not be Distracted by a Perfect Looking Home

Although a residential care home or nursing home should be neat, clean, orderly, and not have any offensive odors. Ultimately you are looking for good care, not perfect decor. At California Registry, we often visit homes that are exceedingly well decorated but have managers and owners that have little or no experience in caring for elderly people.

Read the Rental Contract or Patient Agreement Carefully

Take it home with you if necessary. What extra charges are there? What items are not covered in the care contract? If these are not listed ask the facility to list what is not covered and what it will cost for those extra services. Never choose a facility that will not specify basic rates and extras in writing for you. Another important thing to check is how much notice you contractually must give a facility if you must move your relative out of a facility either due to medical reasons or if you are not satisfied with the facility.

Observe & Sample Meals
Food is often one of the few pleasures that elderly people can enjoy on a daily basis. If the food is bland and tasteless or lacking in variety the quality of life of an elderly person is seriously impacted in our opinion. We think that food is very important in the choice of any facility, be it retirement community or nursing home.

Usually it is not possible to sample the food prepared in small homes, but in the larger facilities such as retirement residences, assisted living facilities, and nursing homes you may be invited to eat with the residents. If you are not, ask if you may eat a meal with the residents.

Observe how the meals are served to the residents. Are the servers courteous and friendly? Is the food served hot? Is the food easily managed by an elderly person (e.g. can they easily cut it up and chew it)? Is there a variety of drinks available? How many choices do the residents have at each meal? Are there adequate amounts of each item? Are there a variety of fruits and fresh vegetables available? Are their desserts tasty and attractive?

Ask to see the Latest State Licensing Inspection Survey

Every facility is visited at least annually whether it is a residential care home, assisted living facility, or nursing home. In the case of nursing homes, the annual survey is supposed to be placed in a public area of the lobby or entrance to the nursing home. If you don't see it, ask someone at the front desk for a copy of it or where it is located.

Every nursing home will have some violations - but what you don't want to see in the survey are documented observations of poor or negligent patient care. Many of the deficiencies can be for things that seem simple or even trivial, but the sheer number of deficiencies may indicate a facility with real problems. A nursing home survey that is 10 pages or less and has no significant deficiencies in direct patient care may be a good facility. One with 20 to 40 pages of deficiencies and lots of patient care deficiencies is a facility that you may want to avoid.

Ask to Speak to the Director of Nurses
Every nursing home will have a D.O.N. (Director of Nurses). In speaking to the D.O.N. try to ascertain his or her philosophy of care and how long that person has been in that position. The D.O.N. sets the standards for care in a facility. If that person is good at their job and is supported by management (i.e. the Administrator) then care generally is good.

Where there is turnover you are likely to see a facility that has real problems in caring for its patients.

Ask What Happens if the Money Runs Out

Find out what the facility's policy is if the patient's money runs out and they can no longer pay for private care. Nursing homes generally have medical assistance grant contracts with the state which provides for the care of patients who have exhausted their funds for care. In order to apply for this money the facility will usually fill out the medical paperwork and ask the family to fill out any other financial paperwork.

This paperwork is sent to the Department of Aging and the County Assistance Office for an assessment and review to received funding. This process can be explained further for anyone who has questions.