Is That Nursing Home Safe? How to Tell

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Deciding that it’s time for someone you care about to move into a nursing home is never easy. Worrying about whether or not they’ll be safe there makes it even harder. And there are real safety concerns: One report found that, over two years, one in three nursing homes were cited for violations of federal standards that caused harm or could have caused harm to a resident. Nursing home abuse is a major worry too: In another study, more than half of nursing home staff admitted to mistreating (neglecting or physically or mentally abusing) residents in the previous year, according to the National Center on Elder Abuse.

“There’s no question that if you put a parent, spouse, or even a close friend into a nursing home, you’ll have to stay on top of things,” says Janine Finck-Boyle, Vice President of Regulatory Affairs at LeadingAge, a non-profit dedicated to education and advocacy on issues surrounding aging. “Mistakes always happen, even in the best facility, and residents need an advocate to look out for them.” Here’s what you can do to help keep your loved one safe:

Steps to take when choosing a nursing home

Visit several times 

When touring nursing homes, it’s important to see your top contender (or contenders) more than once. “It’s a good idea to go stop by on a weekday, once in the evening, and once on the weekend,” says Finck-Boyle. “That way you can get a sense of how well-staffed the facility is at different times, and what residents are up to both during the day and at night.” While you may have to make an appointment in advance, ideally at least one of these visits should be unscheduled.

Speak to staff  

If many have been there for several years, that’s a good sign, as it indicates a low turnover rate, says Finck-Boyle. Avoid facilities where most staff seem to last only a few months. Be wary if they say they work a lot of overtime and double shifts, as that may indicate staffing shortages that could impact your loved one’s care.

Watch how staff members interact with residents. Do they spend free moments chatting with co-workers, or do they sit and talk with residents? Do they barge into people’s rooms, or knock first? Are they courteous to other staff members? If they’re disrespectful to each other, that’s a sign that they may be disrespectful to residents, too.

Check out stats 

Nursing homes have to undergo regular inspections from the Centers for Medicare and Medicaid Services (CMS). CMS also has a site, called Nursing Home Compare, where it gives each facility a one to five star rating, based on health inspections, staffing, and quality of resident care. This information should also be readily available at the facility.

Look for signs of patient-centered care 

Ideally, the nursing facility should let residents have as much autonomy over their lives as possible, says Finck-Boyle. For example, do they have the freedom to choose when they take their meals, or are they on a strict schedule? Can they go to bed when they want, or is a lights-out time enforced? Are there flexible visiting hours? If your mom wants to go see your daughter in the school play, is there transportation readily available?

Be wary if residents seem to wander the halls aimlessly, or if they’re all crammed into a common room together watching TV instead of being up and around the facility doing different activities. “Everyone should look presentable—dressed and well-groomed, and most should be engaged, either with each other or with a caregiver,” adds Finck-Boyle.

Connect with the family council 

Many nursing homes have a family council, which is a way for family members to meet regularly to discuss any concerns they have with the facility, as well as to push for improvements and support new families. It’s an invaluable way to ensure open communication with nursing home staff and administrators, says Finck-Boyle. (The right to form a family council is guaranteed by law, and the facility must act on its recommendations.) Most facilities will agree to put you in touch with a few members, to talk about their loved ones’ experience there.

Study security 

When you walk in, there should be a visitor’s desk where you’re required to sign in and provide photo ID before entering. “You want to see the same security measures in place that you’d see at say, your child’s school,” says Finck-Boyle. “That means they have procedures in place to prevent strangers from entering.”

Warning signs of bad care

Once your loved one is living in a nursing home, visit often and be on the lookout for these red flags:

  • Poor personal hygiene. If Mom never went outside without her full face on, and now she looks like she barely pulled a brush through her hair, you should be concerned. This may indicate that the facility doesn’t have adequate staff to help her get dressed and groomed.
  • Filthy bathroom or bedding. Nursing homes are required to provide residents with safe and sanitary living conditions. A smudge of dirt on the edge of a blanket is probably okay. If the sheets don’t look like anything you’d want to lie in, it’s not.
  • Unexplained weight loss. Research suggests that about 20 percent of nursing home residents suffer from malnutrition. “The staff should keep specific food logs indicating how much your loved one eats every day,” says Finck-Boyle. If your loved one has been turning up their nose at meals, or simply expressed disinterest in eating, you should have already been made aware of it.
  • Bedsores. If your loved one isn’t mobile, it’s the nursing home’s responsibility to make sure they’re moved around frequently to maintain good mobility and prevent pressure sores, aka bedsores. There should also be some sort of exercise program in place for residents to help preserve muscle strength and improve circulation.
  • Unexplained injuries. About 1,800 older adults die in nursing homes each year as a result of falls, according to the Centers for Disease Control. While these and other injuries such as bruises, cuts, and welts can occur as a normal accident—for example, Dad bumped into his night table and he’s more susceptible to bruising since he’s on a blood thinner—if there’s not a clear explanation from staff, you should be concerned. The nursing home should also have created an incident report, detailing the injury, how it happened, steps to treat it, and what they are doing to prevent it from happening again.
  • Personality changes. If your loved one was always gregarious but is now withdrawn, or they suddenly seem depressed or fearful, they could be experiencing emotional abuse from care providers. But some of these changes are inevitable when dealing with certain conditions such as dementia, making them tough to pinpoint. “If a parent seems unhappy, the nursing home should be proactively trying to find ways to deal with the situation, asking you what their favorite activities are, what music they like to listen to, what they like to eat, etc.,” says Finck-Boyle. If they seem indifferent, that may be a sign your loved one isn’t getting proper care.

What to do if you suspect a problem

If the issue is relatively minor—say, bed linens aren’t being changed as frequently as you would like, or your loved one is complaining about being bored—then speak to the aides directly involved in their care to see if all of you can put your heads together to find a solution. “The staff may not even realize that it’s an issue until you tell them,” explains Finck-Boyle.

If you notice a serious lapse in care—for example, bedsores, weight loss, or a loved one in physical restraints or seeming overmedicated—you should first immediately speak to the unit supervisor on their floor. If you’re not satisfied with their response, insist on speaking to the Director of Nursing immediately and follow up with a grievance or complaint form.

If the issue isn’t resolved—or on its way to being resolved—within 48 hours, call your state’s Long-Term Care Ombudsman program. These programs advocate for residents of nursing homes, assisted living facilities, and similar residences. “They’re specifically trained to act as patient advocates and resolve problems,” says Finck-Boyle. You can also file a complaint with your state’s department of health. 

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