Choosing a nursing home can be an emotionally challenging
time in an individual's or family member's life. For most of us, as we grow
older, we recognize the need to plan for the future. The Department of Health encourages
you to spend a little time thinking about your wishes and preferences. Even if
you were not ready to choose a nursing home right now, we would like to provide
you with some resources and tips you can consider in the future.
Do I need a nursing home? Are there other options?
Nursing homes provide both short and long term nursing and
rehabilitative care. Individuals who require nursing home care usually have
great difficulty completing many daily activities independently. These
individuals require supervision or assistance to complete activities such as
taking medications, walking, completing grooming tasks like brushing their hair
and teeth, taking a bath or shower, and using the toilet.
Nursing homes can be a place for someone who needs brief
rehabilitation; it is no longer true that a nursing home placement is “forever.”
Hospitals tend to discharge people sooner than they have in the past. Often a
brief nursing home stay allows an individual to recuperate prior to returning
to her/his previous lifestyle. Whether choosing a nursing home for a short-term
or long-term stay, the first step is to have a physician evaluate your needs.
The physician will determine the services you will need and make a
recommendation for the length of your stay. Your physician may provide you with
opinions as to the appropriate nursing homes to meet your needs. If you are in
a hospital, the hospital social worker can also help you choose a nursing home
and plan your discharge.
The Area Agency on Aging will also complete a need
assessment to determine the level of care and length of stay appropriate to
your situation, called an options determination. To learn more about this
program go to the Department of Aging website.
Under certain circumstance you may even be able to
rehabilitate at home with assistance from home health services. This option is
considered when there is adequate support available from family, professional
caregivers, and the communities in which you reside.
It is important to remember that nursing homes provide a
high level of supervision and resident interaction. Some medical conditions
require this intense type of monitoring, however, not all medical conditions
require this skilled level of care. Some individuals can benefit from less
stringent monitoring and assistance. Options for this type of care can vary
widely including personal care homes, assisted living, boarding homes, and
continuous care retirement communities (commonly referred to as CCRC’s). There
is a wealth of information on these placement options available on the
Internet. Simply enter key words and complete a search. The Pennsylvania
Department of Human Services monitors many of these types of facilities.
Selecting a Nursing Home
It is often best to research as many nursing homes as
possible prior to making your selection. By going to our web site you can print
an alphabetical list of all nursing homes in the county that you select. Once
you have the list, cross off those nursing homes that are outside of the area
you feel comfortable traveling.
It will be important to determine whether the nursing home
accepts insurance coverage, Medicare (for more information on Medicare
coverage), Medical Assistance, or is private pay. It is important to consider
whether a nursing home will be able to continue providing service if you run
out of financial resources necessary for private pay placements. You may wish
to discuss this with a financial advisor familiar with long-term care
After you have determined the distance and financial status
of the nursing homes on your list, it is time to review the types of services
that each provides. Consider whether the nursing home offers services in-house
such as physical and occupational therapies, counseling, activities and
recreation, pharmacy, podiatry, specialized medicine, etc. Research which acute
care facilities (hospitals) are nearby and with whom the nursing home has
transfer agreements. Again, it is important to ask what services will be
covered by insurance and what is paid for privately. For instance, television
cable services, hairdressing, and telephone service charges often vary widely.
Once you have completed these preliminary steps, your list should be down to a
more manageable level.
Reviewing Survey Results
With your list in hand,
return to our web site to review the latest survey results on these nursing
homes. Surveys record only the deficient practices that have been identified
within the nursing home. All surveys will show the reader how serious the
deficient practices are based on the frequency (how many residents are
affected) and the severity (potential for harm vs. actual harm); this is called
Scope and Severity. Please keep in mind that surveys do not identify the strengths
of the nursing homes, only the deficient practices. Examine what has been
identified as a problem in the nursing home, determine whether this issue is
important or relevant to you and your own care needs. Remember that
deficiencies are only one indicator of the care rendered at a nursing home and
that many other factors should be taken into consideration. Each nursing home
responds to the statement of deficiencies by writing and carrying out a plan of
correction. These are also on the web site for your review. Beware of
facilities that are continuously unable to correct deficiencies and have
repeatedly received severe penalties for their non-compliance. Penalties for
deficient practices are generally progressive unless the practice placed
residents in extreme danger, which is considered immediate jeopardy.
Using a Checklist when
Selecting a Nursing Home
After reviewing the survey
results, it is time to visit the nursing homes that remain on your list. Most
nursing homes have admissions workers who will be happy to schedule a tour for
you. Be sure that you are also welcome to drop in after your tour to review
your first impressions. It is often helpful to visit in early evening so that
you have observed the caregiving activities on both daylight and evening
shifts. Checklists are a recommended way of recording your observations when
you visit a nursing home. You can design your own, use our sample checklist or use one of the many
checklists available on the internet. Any checklist you choose to use should
include some basic information. These are not all-inclusive but
should rather be viewed as a starting point. Remember to put the date and time
of your visit on each checklist as you visit nursing homes. A photograph of the
outside of the facility can also be a good reminder. If the facility offers you
a brochure be sure to attach this to your checklist.