How to Choose a Good Nursing Home for Your Family

Pam: So, Barry what advice do you have for families that are trying to decide which nursing home to admit their mother or father to?

Barry: So, the thing to keep in mind is that these are never easy decisions and they're often not made under the best of circumstances. You make the best decision that you can with the information that's available to you. It's important to keep in mind that bad things happen even in good nursing homes, although they tend to happen a little more frequently in the really bad ones.

So, if you have some opportunity, in advance to scout out the nursing homes that are in your area before the need is really acutely arises, it certainly makes sense to do so. If you don't have that opportunity, for example, if your parents are admitted to the hospital and need to go to a nursing home for rehab, very unexpectedly, one of the things that would be very helpful to you is to get online and check out the consumer level reviews.

The more recent ones are certainly going to be more helpful. Management and ownership in nursing homes turns over much more frequently than you would think and a change in management or ownership can make a big, big difference in the quality of care that's being provided for good or for bad. So, the really current reviews tend to be the ones that are the most helpful.

Supposed to be aggregate star rating that may have accumulated over years. Past that, there are some government websites that are really incredibly useful. There's a website called Medicare Compare, which is run by and it gives a star rating to various nursing homes, which, it certainly isn't foolproof or fail proof but it is a good guide for quality of care indicators. The higher the star rating is, the better the nursing home is scored, with regard to the quality indicators. It tends to indicate a little bit better nursing home. The other place that's really helpful is a place that I look at frequently, is the Illinois Department of Public Health, has it's own website regarding nursing homes.

It has an incredible amount of information. Some of the pieces that are really valuable on the Illinois Department of Public Health website would include the surveys. And what a survey is, it's the results of the inspection by the Illinois Department of Public Health. There are two kinds that get done. There's an annual survey which is done once a year and then there are complaint surveys.

The frequency of complaint surveys is helpful, even if they aren't necessarily founded, if there isn't a citation that's associated with it. Just the fact that there are incidents that are happening that are resulting in complaints being made to the Illinois Department of Public Health, should be one of those things that serves as a little bit of a warning sign to you.

When the Illinois Department of Public Health issues a citation, whether it happens during the annual survey or the complaint survey, you can actually read what the nursing home has been cited for and sometimes it's really pretty innocuous but sometimes it's really very disturbing, as well. So, you want to read those with some understanding as to how serious is the citation.

A citation for having broken exit lighting is very different from a citation that involves the staff abusing a resident. Those are two very different animals, as far as I'm concerned. One of the things that you can get when you look at the Illinois Department of Public Health website is the primary diagnosis for the residents. And one of the shocking things about nursing homes in Illinois is that there are large numbers of mentally ill people who are admitted to nursing homes that aren't necessarily specializing in caring for the mentally ill.

So, there'll be two different diagnoses. There'll be Alzheimer's or dementia, which is your standard dementia that's associated with Alzheimer's or with old age but then there'll be mental illness, which is the bipolar, paranoid, schizophrenic. The more acute mental illnesses. And a lot of times these residents will be considerably younger than your typical geriatric patient population.

So, you may have somebody who's in their mid 30's with some significant mental illness being admitted to a nursing home alongside 80 year olds and a lot of times that sets the stage for, what in my business we refer to as resident on resident assault cases, where you have the younger resident with a history of mental illness, essentially attacking somebody who's a geriatric patient.

It's not to say that this happens all the time but when you see a relatively high percentage of residents with that diagnosis, it's something that you certainly want to be wary of. The last thing that you would probably look at is the percentage of patients who are admitted as Public Aid patients. I feel like an elitist saying this but having a large number of public aid patients in a nursing home is not necessarily a good indicator for the quality of care that they're going to be getting because public aid, on average, pays much less than the various other payer sources, whether it's Blue Cross/Blue Shield, private payment, Medicare, what have you.

When we look at the business model that nursing homes operate under, this is a nursing home that doesn't have a lot of revenue. So, the issuers regarding how the profit model impacts care tends to be fairly acute in those kinds of facilities where there's a lot of public aide patients. It's one of these things I feel awful saying but on the other hand, it's something I'd certainly want to be aware of if I'm looking at a facility as being someplace where I would admit my mother or father to.

It's information that's publicly available. It's available out of the Illinois Department of Public Health website. It's certainly a resource which I would rely strongly on in trying to decide, is this the kind of facility that I want to look at admitting my mother or father to. Last thing is, obviously you should go there. You should talk with the staff about your parents, about what their problems are and if you get the slightest inclination that they may not be able to take care of your mother or father, it may be a good time to look at a different facility.

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