There a number of things that people consider when looking to find a nursing home for their loved one, but most do not have a solid idea of the qualities that make up a great nursing home. Some people focus on the staff, while others focus on the living conditions in the nursing home to ensure that it is clean and safe for the residents. However anyone doing research on potential nursing homes for their loved one should take a more holistic approach to determine which facility is best. In order to make this process a bit easier, we have provided information below on the qualities that make a great nursing home and things that you should consider when conducting your search.

One of the first things to note when reviewing nursing homes is the overall well-being and happiness of the residents at the facility. Determine if they seem to be alert and happy, and see if they look to be clean dressed and properly groomed. If the residents do not look happy and well taken care of, then it may not be the right nursing home for your loved one. Additionally one should review the shared living space to ensure that it is clean, well lit, quiet, and set to a comfortable temperature for the residents. Another thing to note in the shared living area is the cleanliness of the hallways and doorways, as any obstacles in the way could be dangerous for a senior who is trying to move about in the nursing home. A great nursing home needs to be safe and do all it can to protect residents from getting injured.

There are other qualities to review when looking for a great nursing home for your loved one, like the food and menus offered at the facility. Not only do residents need a clean dining room to eat in, but they also need to have a choice of food items at each meal. Additionally, residents should be offered a menu which rotates, so that they have variety of the food in which they eat. Great nursing homes should also have the staff on hand to help residents as needed to drink or eat food. On top of good food, there should also be fun activities at the nursing home for residents to participate. This should include activities inside, outside, and in the community which are social, physical and educational. Some examples of activities that nursing home residents can participate in include taking classes, exercise, movie nights, games, and more.

Residents’ rooms are another area which you should review if you are searching for a nursing home for a loved one. Great nursing homes make sure that residents’ rooms are clean and have adequate storage. They also ensure that the rooms have nice windows to allow in light, and give seniors a way to look outside. When viewing a room, check to see that residents have beds that are set low to the ground, because this makes it easier for them to get in and also prevents falling. In addition to clean rooms, you should also pay close attention to the staff, as they can be key to making a nursing home shine. Nursing home staff should be well groomed with name tags, and have a respectful attitude towards each other and the residents. Staff should also have underwent a background check, to ensure that they do not have anything in their past that would prevent them from working with seniors. The staff should also include a full time Registered Nurse (RN) who is in the nursing home facility at all times. Additionally residents should have the same caregiver most of the time, as the caregiver can provide better help because they build a relationship with the resident. The last thing to look for in the staff of a great nursing home is that there is a licensed doctor on staff who visits regularly, and who can be reached at all times.

If the nursing home you’re reviewing is open, honest, and welcomes friends and family to visit, plus meets the criteria above, then you have likely found a great nursing home for your loved one.

About the Author: Ellen Geotz is a regular author for Guide to Nursing Homes, a website dedicated to helping seniors and their loved ones find nursing homes for retirement living.  Ellen grew up on the east coast and spent 10 years working in senior homes during her 20′s and 30′s before taking a break to raise her 3 children. Now that her children are in college, Ellen uses her knowledge of senior care to help her write about all of the latest industry news.

Updated with July, 2010 changes!

Elder Guru is offering the Minimum Data Sets (MDS) 3.0 Coding Manual for sale to assist clinical assessors, MDS coordinators, long-term care administrators, and others. The MDS 3.0 will be the successor to the MDS 2.0 and it will take effect in October 2010. The coding manual Elder Guru is offering represents Chapter 3 of the Center for Medicare and Medicaid Services’ Resident Assessment Instrument (RAI) manual, but with large, easy-to-read print and improved pagination for faster reference. The manual contains 400 pages of step-by-step instructions for completing the MDS 3.0.

Click Here to Purchase the MDS 3.0 Coding Manual

The MDS is a federally required, standardized clinical assessment form used for all residents in a Medicare and Medicaid certified nursing facility regardless of their payment source. The form is intended to develop a comprehensive look at each resident’s functional abilities and health problems for the purpose of developing a comprehensive care plan for the resident. The MDS is typically completed by a registered nurse in consultation with others as part of the larger Resident Assessment Instrument (RAI).

The information within the MDS is submitted by nursing facilities to the state in which they operate, which then goes to the federal database at the Centers for Medicare and Medicaid Services. The data is used to help determine a facility’s quality indicators and quality measurement reports, which are then made available to the public for view.

The MDS 2.0 was criticized because it failed to account for information derived from resident interviews, and concerns were raised about the form’s data quality and validity. The MDS 3.0 was developed to address these concerns, improve reliability and usefulness.

The Brown University Center for Gerontology and Healthcare Research has launched a new nursing home comparison website designed for professional nursing home researches, but which is readily accessible to consumers, advocates and administrators. Whereas the Medicare Nursing Home Comparison site compares survey data collected from each state, Brown University’s new site, LTCfocus.org, supported in part by the National Institute on Aging, crunches data from a variety of sources:

• State Policy Data – Brown University research team survey
• Online Survey Certification and Reporting system (OSCAR) – administrative data collected by the Centers for Medicare and Medicaid Services
• Minimum Data Set (MDS) – resident level data related to clinical and functional status
• Area Resource File (ARF) – a national county level health resources database maintained by the Health Resources and Services Administration
• Residential History File – a data resources developed at Brown University that tracks individuals as they move across the long-term care system

It’s an interactive database that lets the user create tables and charts to compare information about individual nursing homes, counties, states, etc. There is a wide range of variables accessible for comparison allowing greater research capabilities. Those variables include:

• for-profit versus non-profit organizational structure
• bed capacity
• percentage of Medicare and Medicaid approved beds
• Alzheimer’s specific units
• occupancy rates
• age ranges
• resident gender and race statistics
• staffing levels
• MDS quality measures
• resident admission sources (home or hospital)
• 30-day re-hospitalization rates

According to the LTCfocus.org site:

These data will allow researchers to examine the relationship between state policies and local market forces and the quality of long-term care. Researchers can use this website to examine care processes and resident outcomes within the context of their local markets and regulatory practices. Policymakers can use the information to shape state and local guidelines, policies, and regulations that promote high-quality, cost-effective, equitable care to older Americans.

They have plans to add additional information about other sectors of the long-term care industry at a future date.

Individuals looking to use the database to compare local nursing homes for purposes of long-term care decision making will find the site a bit cumbersome to navigate, but the savvy user should have no problem. The more likely impact for consumer-level decision making will be the downstream effects improved information sharing made available to policy makers and elder advocates. Consumers will likely still find Medicare’s Nursing Home Comparison site to be the most useful and straightforward. Contacting their Long-Term Care Ombudsman Program (contact information available through the Resources by State page) is an even consumer-friendlier method to gather information on area nursing homes.

There are a few publicly financed programs that help individuals pay for long-term care services, and each has its own specific set of rules and/or income criteria associated with it. Following are the largest publicly funded programs that help pay for long-term care.

Medicare

Medicare is a Federal program that covers health care for peopled age 65 and older, or for certain individuals with disabilities under the age of 65. While Medicare does not cover most long-term care services, it does help pay for limited skilled nursing services in a facility, hospice care and other home health care services under certain conditions.

Medicare pays for services in a skilled nursing facility when:

• you were just discharged from a hospital where you stayed for at least 3 days,
• you are admitted to a Medicare-certified nursing facility within 30 days of your hospital discharge,
• you need skilled services like wound dressing, physical therapy, occupational therapy, etc.

Medicare will pay 100% of the costs for the first 20 days, then a portion of your costs up to 100 days. You are responsible for the entire cost after day 100.

Home Health Care

Medicare coverage for home health care is limited to medically necessary, doctor ordered part-time nursing care, home health aides, physical therapy, occupational therapy, and speech-language pathology services. Coverage includes social services, wheelchairs, walkers, oxygen, and related medical equipment. Medicare will continue coverage so long as the service and equipment is medically necessary.

Hospice Care

Coverage for hospice services is available to people with a terminal illness that are not expected to live more than 6 months. Hospice services include drug coverage, medical support, social services, etc.

You can learn more about Medicare Coverage by downloading the Medicare and You Handbook.

Medicaid

Medicaid pays for long-term services in both institutional settings and in the home. Coverage begins when the individual meets Medicaid’s general eligibility, functional, and financial eligibility requirements. Services in the home are  covered so long as the individual would need those services in an institution if not provided in the home. The specifics of Medicaid coverage varies from state to state.  The application process can be confusing for some. Contact your Area Agency on Aging or your state’s Medicaid Office for more information, find them through the Resources by State page.

Veterans Affairs

The Department of Veterans Affairs provide long-term care services to veterans that are eligible, typically through meeting certain disability criteria, or to those who have service-connected disabilities. Visit the Department of Veterans Affairs to see what programs and services are available to you.

The National Association of State Units on Aging (NASUA) and the National Association of Area Agencies on Aging (N4A) have proposed a national long-term care service strategy that intends to save Medicaid and Medicare dollars while allowing elders to age in their homes longer through home and community based services. Project 2020 is quickly gaining the attention of aging professionals and elected officials in Washington. The demographic trends within the United States means more older adults using more services at higher cost, and Project 2020 is hoping to address those costs through nursing home diversion programs, programs that assist elders remain healthy and receive care in their homes. Project 2020, if successfully enacted, would not only save federal and state tax dollars, but ensure that people are able to age where they want, in their home and community.

The Project 2020 Overview of the Proposal states they are seeking $2.5 billion over 5 years to be administered through the Aging Services Network of State Units on Aging and Area Agencies on Aging. Thus, the funds would go to their own member organizations, which would cause any logical person to pause and question the proposal’s true intent. Is it to fund their own organizations or is it to save tax dollars and help elders age in place? Well, it’s both. They think their organizations can play an important role in lowering the costs of long-term care.

The Overview of the Proposal states:

According to our initial estimates, the program has the potential to reach over 40 million Americans and will reduce federal Medicaid and Medicare costs by approximately $2.8 billion over the first five years of the initial investment requested, resulting in a net savings to the federal government of nearly $250 million.

The program would also generate significant savings for state governments. Financial performance is expected to improve in years five through ten of the program, as all systems reach full scale operations nationally, with the net federal savings over ten years reaching over $1.1 billion.

What exactly is the 2020 strategy? It’s built upon a three-pronged approach:

1. Person-Centered Access to Information – The proposal calls for increased use of a “single entry point system.” This is technical jargon that means there would be one source for aging information, Aging and Disability Resource Centers (ADRCs), which people would go to. The advantage being that the persons working in those ADRCs would know about all aging services, thus better able to deliver information specific to the individual, and not specific to one service.
2. Evidence-Based Disease Prevention and Health Promotion – This approach calls for increased outreach to assist elders with preventable conditions that would otherwise lead to increased use of long-term care services. These outreach programs include falls prevention, promoting physical activities, nutrition counseling, medication management and effectively managing diseases like diabetes.
3. Enhanced Nursing Home Diversification Services – This entails increased use of home and community based services that extend the period an elder is able to remain in his/her home without the need of residential placement in a nursing home. Programs that help an elder remain home include: home-delivered meals, personal care in the home, medical transportation, home modification and adult day care.

Project 2020 approaches are not new, but they are gaining attention and traction as policy makers and aging professionals seek to address the coming elder wave that will put significant strains on social systems.

To learn more about Project 2020, contact NASUA or N4A, or visit the Project 2020 blog.

Adult day centers (ADCs) offer services directed at older adults with physical or cognitive impairments. They offer a planned, professional day care program that promotes social and health well-being. The center may be privately or publicly owned, not-profit or for-profit. According to the National Adult Day Services Association, there are over 4,000 adult day care centers across the United States.

There are essentially three types of ADCs:

1. Adult Day Social Care – provides opportunities for social engagement through planned activities, meals and recreational opportunities
2. Adult Day Health Services – provides social opportunities with medical services like medical monitoring and therapies through licensed health professionals
3. Dementia Specific Adult Day Care - provides social and health services specifically to older adults with Alzheimer’s Disease and related dementias in what are typically secure (locked) environments

The elder may benefit from:

• Social engagement with peers
• Delayed admission to a long-term care facility
• Personal care assistance: bathing, toileting, etc.
• Medical monitoring and therapies
• Appropriate exercise activities
• Nutritious meals and snacks
• Planned activities

The caregiver may benefit from:

• The ability to work full or part-time
• Respite from caregiving demands
• Cost effective care
• Support groups and counseling

In most cases the person attending must be able to ambulate on his/her own (not wheelchair bound). If the individual will have the adult day care costs covered by private insurance or a public benefit, he/she must be assessed to qualify for the service.

For more information visit the National Adult Day Services Association. To find an Adult Day Center near you, contact your Area Agency on Aging through the Resources by State page.

The phrase “long-term care” is general, but typically includes a range of health and support services that people that older and disabled individuals need. The services are typically for personal care, or help with activities of daily living. Family members typically begin providing this care, but as support needs increase, paid care are often needed to help caregivers, provide respite to family members, or to pay for more extensive, long-term services in a nursing home or assisted living facility, when the person can no longer be cared for in their homes.

According to LongTermCare.gov, the average 2008 costs in the United States were:

• $187/day for a semi-private room in a nursing home
• $209/day for a private room in a nursing home
• $3,008/month for care in an Assisted Living Facility (a one-bedroom unit)
• $29/hour for a Home Health Aide
• $18/hour for a Homemaker services
• $59/day for care in an Adult Day Health Care Center

Costs vary based on the type and amount of care needed, the provider used, and where the individual lives. Home health and home care services, provided in blocks of time referred to as “visits,” are typically more expensive in the evening, or on weekends or holidays (if available at all). The costs of services in community programs, like adult day services, are often provided at a per-day or hourly rate, but vary based on service and program costs. Facilities may charge extra for services beyond basic room-and-board charges, or they may have “all inclusive” fees.

These costs are not inexpensive by any means, but the services are expensive to provide. Medical staff are typically on hand, there is overhead, and regulatory costs. For more information, visit the Resources by State page and navigate to service agencies near you.

What is Culture Change?

Culture Change in long-term care settings is the movement toward person-centered care, where the resident’s values, wishes and practices are all considered in the delivery of care. There is a high value placed on individual choice, purposeful living, self-determination and respect. Essentially, the individual resident is able to help direct how the care he/she receives is delivered. Compare this philosophy to older methods where all residents operated on the facility’s clock, for example. Everyone wakes up with the first shift, people eat meals at the same time, shower routine is predictable, bed time comes as directed, etc. Culture Change means individually specific care – and respect; it means moving away from common care practices as they may exist.

Long-term care providers are increasingly moving toward changing the “culture” of their facilities. This trend is a good thing, and necessary if these providers want to stay in business, because more people are expecting individualized, respectful care – and can you blame them? Such change does not happen overnight, however. Changing a work culture means changing worker views, assessing organizational practices, physical environments, relationships with residents and families, etc.

The movement toward Culture Change is similar, in some regards, to the move toward Green House Projects.

How to Implement Culture Change in Long-Term Care Settings

There are a number of private individuals and businesses that provide training and insight on a contractual basis to assist facilities implement Culture Change, but it’s really something that could, and perhaps should, come from within the long-term care setting itself. Sometimes an outside source is best, however. It may depend on how deeply entrenched the facility is in the “old” methods of providing care.

The actual “how to” involves much more than can be described within this post, but there are a variety of professional resources available for use. The Pioneer Network is but one. Formed in 1997, it’s a group of prominent professionals that advocate for person-directed care. Their site holds numerous resources on Culture Change. State governments and advocates looking to incorporate policy driven incentives will find the State Investment in Culture Change Toolkit very helpful. It’s available for free download from the Commonwealth Fund, just click on the above link.

Lastly, Culture Change in Long-Term Care is a widely used book that I would recommend to any agency, advocate or individual that wants to become serious about implementing the change.

Parade magazine had a recent article on The Green House Project that has gained a lot of needed attention on elder housing trends. Innovations and changes to the way long-term care “facilities” look, feel and operate are long past due. Perhaps it’s the new wave of elders that’s promoting the change, their families, or savvy business owners looking for a marketing edge. Innovations are not limited to The Green House Project, but that project is largely the brainchild of Dr. Bill Thomas.

The intent here is to “de-institutionalize” long-term care settings. Don’t like regimented meal times? Don’t like the thought of CNAs and PCAs running around in uniform, racing through resident showers, and shuffling people to activities? Don’t like how some facilities feel a lot more like a hospital than a home? I don’t blame you. The Green House Project is promoting an alternative. Read from their web site:

The Green House model creates a small intentional community for a group of elders and staff. It is a place that focuses on life, and its heart is found in the relationships that flourish there. A radical departure from traditional skilled nursing homes and assisted living facilities, The Green House model alters facility size, interior design, staffing patterns, and methods of delivering skilled professional services. Its primary purpose is to serve as a place where elders can receive assistance and support with activities of daily living and clinical care, without the assistance and care becoming the focus of their existence.

Those are lofty words that sound good, but what do they really mean? Let’s get a little more specific:

• Housing for 6-10 elders, not 60-100
• It looks like a home inside and out, not an institution or dormitory
• Meals are served when YOU are hungry, not when management determines meal time
• Each resident has a private bedroom and bath
• Lots of sunlight and access to outdoor spaces

Fortunately, I’ve seen a number of elder homes taking on these characteristics whether they’re classified as “green” or not. The bullets above are becoming incorporated in many facilities, because 1) it’s the right thing to do, 2) the next generation of elders will demand it, and 3) it makes good business sense.

Egad!
Just when we thought swine flu was a problem, enter the mice!

MSNBC reported that a bed ridden 89-year-old Australian man was mauled by mice. Read from the article:

“An elderly, bedridden gentleman had the tops of his ears severely chewed, his head badly bitten and a very bad wound in the throat,” Hopper said. “His hands were covered in blood when they found him; he’d obviously been so distressed trying to get the mice away.”

Unfortunately, the reality is that care in many nursing homes is far from adequate. Whether it’s abuse, neglect, or simply unclean environments, elders that can’t advocate on their own behalf (or are afraid to) end up suffering in some long-term care facilities. We might expect to read a periodic article like this, but the stunner here is that this particular nursing home is government run!

Federal Minister for Aging Justine Elliot ordered a probe into what the government-run nursing home in Queensland state was doing to protect residents, saying in a statement that the attack was “extremely disturbing and traumatic for residents and their families.”

“Extremely disturbing?” Ya think!?

My wife read the headline of this post as I was writing and asked, “Was Stephen King there?” While it sounds like something from one of his novels, it’s unfortunately not.