Nursing Home Evaluation Checklist   

Choosing a nursing home for a family member is one of the most difficult decisions in life. While every potential resident's situation is unique, there are some common criteria that can be used in selecting a nursing home that best suits the needs of a resident. The summary page on each nursing home highlights some primary pre-placement issues to consider when seeking a nursing home.

Method of Payment

Unless a resident can pay privately for an indefinite period of time, even if the initial stay is covered by Medicare, choose a Medi-Cal certified facility. While the majority of nursing homes are certified for Medi-Cal, such certification is not mandatory and some facilities are private pay only. Even someone with $100,000 in liquid assets can spend that down in two years in a nursing home, and private pay only facilities can and will evict someone who converts to Medi-Cal. Given the average private pay rate in a California nursing home ($4,500 - $6,000 per month), few people can afford private pay on an indefinite basis. Once a resident is admitted to a Medi-Cal certified nursing home, however, he/she cannot be evicted simply because of a change from private pay or Medicare to Medi-Cal.

Although "duration of stay" requirements, i.e., making a resident pay privately for a set period of time, are illegal, California nursing homes have a right to review potential residents' finances prior to admission. Since the Medi-Cal program pays less per day than the private pay rate, the longer you can pay the private rate, the more options you will have when looking for a nursing home.

Location

It is important to choose a nursing home that is close and convenient to the person(s) who will be visiting the resident most often. Most studies of nursing home residents have shown that residents who are visited often may recover more quickly, may be happier and healthier for the love and attention received and may receive a higher quality of care if staff knows that visitors come often and unannounced. In addition, when family members and friends are close enough to visit frequently, they can monitor the resident's condition, participate in care planning and respond quickly to emergencies.

Special Needs

Special care needs of the resident should always be considered: whether the resident will require a ventilator, psychiatric care or extra supervision due to wandering or combative behavior. Although the majority of nursing homes are licensed as "skilled nursing facilities," they generally provide both skilled and "custodial" care. There are a number of different types of 'nursing homes' in California, however, and levels of care, costs and admitting requirements will vary.

Services Provided

Religious and cultural preferences, including offering special religious or ethnic dietary choices, can be particularly important if the stay in the nursing home is likely to be permanent. Whether the staff or any of the residents speak your primary language is also an important consideration, as otherwise, the resident will be unable to communicate his/her particular needs.

Quality

While quality of care should always be a primary consideration, it doesn't do the potential resident any good to choose a "fancy" nursing home if the resident can't afford it, if it can't meet the needs of the resident or if it is too far away for family and friends to visit. Do comparative shopping. When evaluating a facility, take into account the following factors:

Enforcement History

Information on a nursing home's compliance record under state and federal laws, including citations issued, penalties assessed for violations, deficiencies and consumer complaints are important indicators of what the quality of care is likely to be. This information is included for each facility, with details of the types of citations issued. The history of compliance should be considered as well, if there has been no recent change of ownership.

Objective Considerations

Nothing substitutes for a personal visit to the facility. Once you have identified one or two nursing homes that seem (on paper at least) to be affordable, to have the services necessary and to have a vacancy, visit the facility. Ask to see the entire facility, not just the nicely decorated lobby and one wing or floor. Try to get a feel for the quality of care provided and how the residents are treated by the staff. Resident appearance, use of restraints, residents' rooms, quality of food and activities are all important factors in evaluating a nursing home. Nothing, however, is more important than the quality and quantity of nursing home staff.

Subjective Feelings

How do you feel when you visit the facility? How does it compare to others? How did the administrator and staff treat you? Remember that you'll be depending on these people to take care of your family member. If you don't like visiting there, imagine what it would be like living there.

Choosing a nursing home can be an emotionally wrenching experience. However, the criteria listed above can give you the guidance needed to make the best possible placement and can alleviate many future problems.