How To Choose A Nursing Home
||Dr. Jodee Graifman Meddy, DO, MS, LNHA|
Co-founder of SeniorSite.com.
Dr. Jodee Meddy is a nationally acclaimed Doctor, Licensed Nursing Home Administrator and an expert on Long Term / Extended Care issues and Nursing Homes.
So, here it is, the official Jodee Meddy all inclusive guide on what you
MUST know in order to make an intelligent and wise decision on
choosing a nursing home for yourself or someone you care for.
Included are links to related material and resources to better help you
with your homework. Some very helpful forms and questionnaires to help you
have been added as well. Try to print out all these articles and forms to
take along while doing your research. They are posted here on SeniorSite.com
just for this reason. To help you help yourself.
The decision to enter a nursing home is a difficult one. The purpose of
this guide is to help you obtain the information and guidance you need to
choose the best and most appropriate nursing home available.
Other Long Term Care Options
Long term care options, other than nursing homes, should be explored
depending on the medical condition and personal preferences of the
individual in need of care.
The directory of nursing homes includes examples of these long-term care
options with a brief description of services provided.
The Placement Process: Medical Eligibility for Nursing Home Admission
The first step in the selection of a nursing home is to establish the
medical and nursing needs of the individual to see if he or she medically
qualifies for admission to a nursing home in New York State.
To determine an individual's medical eligibility, a Patient Review
Instrument and Screening Instrument--generally referred to as the PRI and
Screen--must be completed according to the state's Department of Health
The PRI measures an individual's ability to perform activities of daily
living such as eating, dressing, bathing, transferring from bed to chair and
vice versa, and toileting, as well as the level of nursing care needed.
The Screen, based on this assessment and other social factors including
whether or not the individual has access to help from family or friends in
the community determines if the individual can be cared for in the community
with home care services or is in need of nursing home care.
How to Get the PRI and Screen Completed
If the individual is to be transferred directly from the hospital to the
nursing home, hospital social service or discharge planning staff will help
you obtain a completed PRI and Screen.
It is important to work with the hospital social worker as the nursing
home process unfolds. If the individual is at home, you must call a
certified home health agency that has staff qualified to complete the PRI
and Screen. During the home visit, it is essential for the caregiver to be
present during the evaluation to help provide a realistic picture of the
individual's medical, nursing, and social needs and to help ensure that the
assessment is comprehensive.
Next, you need to review the individual's
financial resources to determine how the nursing home will be paid. It is
important that prior to signing an admission agreement with a nursing home, you
carefully review the financial conditions specified and the services provided.
There are three general types of payment:
Medicare - Medicare may pay for a limited period of time for
skilled nursing and rehabilitation care, provided that certain conditions
have been met. The final determination of Medicare coverage is not made
until the person is admitted to the facility.
Medicaid - In New York State, Medicaid will pay for nursing home
care if the individual qualifies for Medicaid according to income and
resource standards. Information about such eligibility may be obtained
either from the hospital social worker or, if the individual is currently in
the community, from any of the organizations listed in the Community
Resources section at the back of this guide.
Private Pay - Individuals who have income and resources that
exceed Medicaid limits must pay for nursing home care themselves. It is
important to note, however, that private pay rates vary from nursing home to
nursing home, as do the different services covered by these rates. Nursing
homes may also request a pre-payment deposit, which according to New York
State law cannot exceed the rate for three months of care.
When an individual has used up most of his or her monies - a situation
often referred to as "spending down" - he or she may apply for Medicaid
coverage. The nursing home can provide assistance with this process.
Determining Individual Needs
Personal likes and dislikes are critical in determining the nursing home
most appropriate for each individual. Take time to discuss the services,
activities, and atmosphere that the individual would prefer. For instance,
some homes may be more flexible in meeting certain food preferences, others
in providing social activities.
Visiting the Nursing Home
Although there may be pressure to choose
a nursing home quickly because of government regulations or changing health care
needs, you are strongly urged to tour the facilities under consideration before
making your final selection.
Before you visit, call the admissions department to make an appointment
and make sure you have completed the necessary forms. Many facilities, for
example, require that the PRI and Screen be completed before the application
is considered and you are allowed to visit.
During your visit, try to speak to anyone and everyone who can give you
information family members, residents, nurses and aides, and so on in order
to develop as full a picture as possible of the day-to-day operation of the
It may be useful to focus on the following 10 aspects of a nursing
home when you visit:
Medical Services - How many physicians are on staff? Are residents
assigned a physician upon admission to the facility? What is the procedure
if you wish to choose your own physician? To which hospitals are residents
transferred in case of emergency?
Nursing - Are residents grouped according to nursing needs? Is
staff coverage adequate on evenings and weekends?
Therapy - What kinds of therapy are available--for example,
physical, occupational, and speech? Is there a special room set aside for
physical therapy or occupational therapy? If so, ask when it is used and
look for residents receiving or waiting to receive treatment.
Recreational Activities - Are residents actively engaged in
activities during your visit? Ask for a copy of the activities calendar,
which should also be posted for residents' review. What are the special
programs offered for residents with special needs, such as those who are
blind or deaf? Are residents able to get out into the community for shopping
and other activities? Is transportation provided? When does the residents'
council, which looks into residents' problems and complaints, meet? Are
family members welcome at meetings? What are the in-room activities for
bed-bound residents? How do bed-bound residents participate in unit
Volunteer Services - Does the nursing home encourage the
involvement of volunteers from the community? What types of services do they
Social Services/Admissions - Who coordinates admissions? Are short
stays accepted? How are the rooms assigned? Is there an orientation program
for new residents and/or families? How do residents obtain individual
counseling or participate in group programs? Is there a family council that
provides support to families and reviews problems in the home? What are the
Resident Profile - Is the atmosphere of the nursing home
institutional or homelike? Are there personal belongings in residents' rooms
such as quilts, plants, and photographs? Are the residents dressed, well
groomed, and out of bed? Is there interaction between staff and residents?
Do the staff address residents by name?
Food - Stay for a meal and observe. Is the food hot? Does it look
appetizing? Are special diets respected? Are residents assisted in eating?
By whom? Do the staff talk to residents during meals? Does anyone notice if
a resident does not eat?
Physical Plant - Is the building clean and well maintained? What
are the security provisions? Is the entire home air-conditioned in summer
and heated in winter? Is it odor-free? Is there any evidence of insects or
rodents? Do secure railings line the walls?
Location/Size - Is the home large or small, and would that make a
difference to the resident? Is the nursing home located near any family or
friends? Is it accessible by public transportation? Are there shops or other
When visiting a nursing home, ask any questions
that come to mind as you tour the facility. You can also call the home later if
you have other questions. While it may not be possible to find the nursing home
that fully satisfies all of your requirements or preferences, it is helpful in
making this most difficult decision to consider both the individual's most
important needs and concerns and your own.
New York State Department of Health Requirements
According to the New York State Department of Health, every nursing home
must have a Resident's Bill of Rights posted visibly in the entrance lobby
and on resident floors.
The Bill of Rights is aimed at ensuring that residents are treated with
dignity and their rights respected, and that they receive basic care and
It is also required that the summary of inspection of the New York State
Department of Health, which ensures compliance with state codes and
regulations, be posted.
The New York State Department of Health Office of Health Systems
Management Hotline phone number must also be posted visibly for any
complaints or reports of suspected abuse.
That number is (212) 613-2500 and the 24-hour number is (518) 445-9989.