Monday, April 14, 2014

Navigating Nursing Homes

I hate nursing homes. I'll just say that right off the bat. Of course, I don't know anyone who loves them, but unfortunately, many of us will struggle with placing a loved one in nursing care at some point. I understand they serve a purpose, but I have rarely seen the care match the cost. The basic rate in California is currently $250.00 a day (some cost more), which works out to over $7,000.00 a month per person. I realize there are costs involved in running a facility, but there is no excuse for poor care.

Recently, I was forced to put my grandmother in a nursing home. She has been staying with board and care operators who have treated her like family for the last few years, but I knew her money would run out eventually, and it has. In addition, her health has declined, so board and care is no longer an option. She needs around the clock care, and she doesn't have enough money to pay privately.

The information in this blog is about nursing homes in northern California. I can't speak for other states or countries, although, with the internet, it's easy to do research on nursing homes (long term care facilities) in your area.

Many of the nursing homes here have both short term rehabilitation care and long term nursing care. My grandmother has been in several nursing homes for short term rehab while she was recovering from bladder infections and a fractured hip. What I've learned from those experiences is what I want to share with you.

1.   Do your homework: A simple Google search for long term care facilities in your area will often give a listing of nursing homes in your area along with other basic information (address, phone, number of beds, etc.). Some will also offer a star ratings based on things like staffing, health inspection, quality measures, etc. I found this one from Medicare that was really helpful. Also, make a list of the top three facilities, so you will have alternatives, since they may not have openings in the place you want to use when you need to move your loved one in.
2.   Visit the facility: No matter what it may say on the internet, it's important to see for yourself. Talk to the staff and other residents. Does the place look clean? Does it smell bad? Are the other residents clean and dressed appropriately? Go around mealtime and see what they are feeding the residents. Ask for a tour of the facilities. This isn't a guarantee either. The last place I had my grandmother in was beautiful and looked fabulous, but they were horrible when it came to care, but it needs to be done.
3.   Personal belongings: The short answer - don't take in anything you don't want to go missing. The first time I had to put my grandmother in a nursing home, just about everything she owned disappeared, including her cell phone, her glasses, her dentures, and almost all of her clothes and shoes. For short term rehab, only take the necessities. Most places have phones, so don't bring a cell if the patient isn't aware enough to keep track of it. For clothing, label everything! I used iron on tape near the factory labels and put my grandmother's name on it in big letters with a permanent marker, so it can be easily seen by staff. I did the same for her blankets. Take pictures of everything you take in. Facilities have a personal items inventory list that they have you sign. Make sure it's accurate. This last time, I did my own inventory list, cataloging everything in minute detail along with pictures and the cost of each item. I had the staff initial each one and sign the bottom. Overkill? Maybe, but my grandmother's been burned too many times. Her stuff may still come up missing, but at least this time, I have the proof I need to make the facility reimburse her. They also want you to sign the personal items inventory list on the way out. Don't sign for anything you don't have on the list.
4.   Visit often: This is a must if at all possible. They are more likely to care for your loved one if they know people are watching. I definitely have experience with this. Trust me, the care will be different if you make sure they know you will be checking on them.
5.   If you think there is a problem, or you think your loved one is being mistreated, don't hesitate to talk to the facility administrators. If you don't feel like the problem(s) has been resolved, or you think there is true abuse, contact your local state licensing agency or your state's Ombudsman. Every facility my grandmother has been in has had me sign a paper saying that we can't sue them. However, that doesn't mean that complaints can't be made. I did make a formal complaint to the California state licensing department over the care my grandmother received in the last nursing home. I was really relieved to see that the licensing people followed up and called me back with the results. The nursing home was at fault and was cited and fined for over $10,000. That didn't really help my grandmother, but hopefully, they will try to improve their care for the other patients they have.
6.   If you don't like the care your loved one is receiving, and your complaints to the administrators have not been resolved, move him/her to another facility.

My heart goes out to every family member who is having to deal with this right now, or who has a loved one already in long term care. Please feel free to add any tips or websites you think might be helpful. Thank you!


  1. I totally agree Michelle, it was one of the hardest things I've had to do. My mother fell and needed care, it was the only thing she could afford. I go at least twice a week. Always go to the care meetings and ask questions. Watch the meds...she's doing fine but you never know.i have friends that work there, it helps. Then my brother who's a alcoholic fell and has brain damage, he's only 51, had to put him in a head trauma center, he had to learn to walk and talk again. I was the one to do all this, cried and felt guilty. I'm fine know, but two years was hell. Good luck sweetie.

    1. I'm so sorry to hear that Kim! Having to deal with your mother and your brother too must have seemed overwhelming at times. Hugs to you for standing by them and seeing to their care. It is so hard. Hugs! Thanks for adding in the information about the care meetings and watching the meds. I forgot to include those.

  2. I'm honestly not sure I could ever place a loved one into a nursing home. After having (and still doing) occasionally worked in various long term care/rehab facilities in my area, I have a stronger respect for Dr. Kavorkian (sp). I'm a Certified Nurses Assistant and generally when I work at one of these places, I'm given 12-18 patients to care for on my own. It depends on the facility and on the difficulty of care, but this is about average. The nurses are usually just med pushers and can't (or absolutely refuse) to help you with any type of patient care. What does this mean for your loved one? If I'm stuck in a bathroom with a patient who can't bathe themselves and 3 other people have crapped their pants, those people are sitting in shit for at least 15 minutes, or until I can get to them. And I'm one of the fast (good) CNAs. I hate healthcare and the bureaucracy that goes with it. I've been trying to get out for years, but am not "qualified" to do anything else.
    If you're going to place a loved one into one of these facilities, you HAVE to be the annoying person who shows up EVERY DAY and asks questions. Things need to be changed in these facilities and they're not going to until enough people demand it.

    1. Jean, thank you so much for your honesty. I know you and know how hard you work. That's the kind of staffing ratio I was worried about. I've noticed that when I've been there - the CNAs are left to do the bulk of the work while the nurses take vitals and do medications. Unfortunately, I don't have a choice. I can't care for my grandmother, so I do have to be that annoying person who shows up and asks lots of questions. You're right. More people need to show up and demand that these facilities provide appropriate care. Thank you so much for your comment!