The idea of nursing home placement can bring up some strong emotions from your loved one and family members. It can be hard to face the idea of heading to a nursing home, but circumstances might make it unavoidable. Before all of that, however, it is important to recognize what you need to know. what you need to be prepared, and what questions you should ask the nursing home.
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Long-term care options can be a real jungle to navigate, and making decisions about your loved one’s care can be overwhelming and confusing. Going through our questions and considerations will give you the confidence to make the right choice for your family.
Questions to Ask Before You Start Choosing a Nursing Home
Before jumping into a decision about choosing a nursing home, take a deep breath, and consider these questions. By going through a carefully thought out process, you can make a more informed decision.
If your loved one is ready for a nursing home, there might be some urgency depending on where they live, but do what you can to think things through. Consider the pros and cons of a nursing home.
1. Is there any other alternative?
Consider augmenting care for your loved one. If your family member is in assisted living, chances are you may have already been told their staffing cannot adequately care for them. Private caregiving, even with the extra cost, may still be less than a nursing home. If your loved one has nursing needs, you could hire a private nurse, but those costs could skyrocket.
If your family member is at home, identify the tasks they need help with. Use home health to the fullest extent possible to provide support and rehabilitation once home health is finished. Look at continuing therapy services outpatient. It is worth figuring out if you can pay for private caregivers to assist with bathing, grooming, transfers, meal preparation, transportation, and medication reminders.
Don’t rule out assisted living as a viable option. Talk with the admission coordinator about your loved one’s circumstances and if assisted living is a possibility.
If your loved one has dementia, would a memory care community be able to meet their needs? Memory care units have a higher staff to resident ratio and can manage challenging behaviors. If you are a family caregiver, you may have reached the end of your rope, and nursing home care may be the only option.
2. What’s the long-term prognosis?
Talk to your loved one’s physician about their long-term prognosis. See if you can get some answers about whether there is a chance for rehabilitation to the point where a less restrictive community might work.
A physician might be hesitant to give you directives, but get as much information as you can about your loved one’s condition so you can plan accordingly. Their health may change or diverge from your expectations, but maintaining contact with your loved one’s physician can better prepare you to respond with the appropriate levels of care.
3. How will you pay for care?
Nursing homes are the most expensive care available because they are like small hospitals. Many nursing home facilities feature 24-hour nursing care and provide medical interventions like IV medications, catheter, wound care, and x-rays. The availability of that kind of care is expensive.
Many people exhaust their financial resources and look to other sources to pay for a nursing home. In most cases, that means qualifying for state Medicaid. The prudent thing to do is take a good hard look at your loved one’s financial picture if you haven’t already. Meeting with an estate planning professional who specializes in asset protection might be a good idea.
Compare the cost of in-home care or supported assisted living compared with the monthly cost of nursing home care.
4. What criteria is important for you?
If you have decided to pick a nursing home, make a list of essential criteria for you and your loved one before going to our next series of steps. You may not fulfill your entire set of priorities, but it is a good place to start. Consider these criteria and think of some of your own.
- Does your loved one have dementia, and if so, what specific care you would like to see given?
- Is a smaller nursing home better than a larger one?
- The state Ombudsman program will have complaints about any specific nursing home. If you have a couple of places in mind, contact the program to inquire about any safety investigations.
- Is the nursing home Medicaid certified in case your loved one needs to qualify for Medicaid?
Questions to Ask the Nursing Home Itself
Putting together a list of questions for the nursing home will give you some confidence going into a very challenging decision. Keep in mind that the answers you get may not always be completely accurate, but use your intuition, backed up by facts from the Ombudsman program, to get a clear picture.
5. What kind of protocols do you have for infection control?
Considering the devastating effects of COVID on nursing home residents, there may be no more important question to ask. According to the U.S. Government Accountability Office
Infection control problems in nursing homes were widespread before the pandemic. Find rates of COVID infections per county at the Centers for Medicare and Medicaid Services website. Even without the pandemic, the annual flu can be devastating for those with fragile health conditions. Check with your state health department for other infection issues at the nursing homes under consideration. Beyond the COVID data, it is worth asking the following questions:
- What are the specific safety protocols currently in place?
- What is the status of personal protective equipment for staff?
- What is your quarantine policy if a resident or staff member contracts COVID or another illness?
6. What is the visitation policy?
It is important to ask about the visitation policy for two reasons. Number one, can you visit the nursing home before making a decision? Number two, can you see your family member after they are admitted? If visitations are limited or unavailable, ask about access using video conferencing to check in on your loved one. If you are allowed to visit before admission, look for the following clues regarding the care they provide for their residents.
- Observe cleanliness throughout the facility.
- Notice staff interactions with residents. Does the staff seem hurried or patient? Do they show respect and compassion?
- Note odors such as a strong smell of urine, as that may be an indication that the staff is not attending to a resident’s incontinence needs.
- Ask to see the rehabilitation room. This is the space used for physical and occupational therapy.
- Look at the activities schedule. Is it filled with options or is it scant?
7. What do the care plan meetings look like?
Care plan meetings are required to take place every three months in any Medicare or Medicaid certified nursing home. The importance of these meetings cannot be overstated, especially if visitations are rare or prohibited because of a pandemic. The care plan meeting goes over your loved one’s physical and mental status, goals of care, and adjustments to care.
When considering a particular nursing home, ask these questions about care plan meetings:
- If you can’t be at the meeting in person, is there flexibility in scheduling?
- Is there the possibility of a video conferencing option? That way, you can see your loved one as well and get their input during the meeting.
- Who specifically will be present at the meetings? Request attendance by the director of nursing, therapies, and the aide supervisor.
8. How are complaints handled?
If you have an issue with care or some other complaint, ask who and how to contact that person.
Make sure to write down their contact information, as you don’t want to get lost in a maze of people without getting results. Also, request a copy of the most recent state survey.
9. How do they handle food requests and choices?
Inquire about special diets or other individual dietary needs, and if these requests be accommodated. Nursing homes are accustomed to providing medically necessary dietary prescriptions for swallowing issues like soft or pureed diets.
But what about vegetarian or gluten-free options or other food likes and dislikes? It is important to ask about that especially if your loved one is a picky eater or has had a long-standing diet in place.
10. How many personal belongings can fit in a room?
Many nursing homes have shared rooms. A shared room can oftentimes leave little room for personal furniture and belongings. Ask about the size of the room and how many personal items can be accommodated.
Your loved one may also have possessions that are comforting and reassuring. Is there room for these items?
11. What kinds of activities and therapies are provided?
Activities might be an afterthought in your mind, but they are a valuable part of everyday life in a nursing home. When there are a lot of activities available, your loved one can make sure to stay mentally fit and avoid depression as well as becoming frail. Ask to see the activities schedule and the possibility of one-on-one attention, if necessary.
It is also important to ask about physical and occupational therapy schedules. In long-term care settings under Medicaid, therapy services may be limited, but find out what they are and how they are scheduled for your loved one. What do the therapy options specifically entail? Are you able to communicate with the therapy staff about your family member’s needs?
Keeping Questions in Mind to Ask a Nursing Home
No matter when you make the choice, it can be difficult to assess what nursing home is the right one for your loved one. Like all living choices, this choice is not one you want to make quickly.
Asking the right questions and taking your time to review all the available options out there can make the difference between a nursing home that just meets your basic needs and one that exceeds your expectations.
If you're looking for more on long-term care planning, read our guides on dementia home care and how to decide if your parent's ready for a nursing home.
- “Infection Control Deficiencies Were Widespread and Persistent in Nursing Homes Prior to COVID-19 Pandemic.” U.S. Government Accountability Office. www.gao.gov/assets/710/707069.pdf
- “COVID-19 Nursing Home Data.” Centers for Medicare and Medicaid Services. data.cms.gov/stories/s/COVID-19-Nursing-Home-Data/bkwz-xpvg/
- “What’s a Care Plan in a Nursing Home?” Medicare.gov. www.medicare.gov/what-medicare-covers/what-part-a-covers/whats-a-care-plan-in-a-nursing-home