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Evaluating and Selecting the most Suitable Nursing Care Facility

Unless one can afford continual nursing care in the home, nursing and care facilities commonly referred to as nursing homes are the best option for seniors who need continuous nursing care but who don't need to be hospitalized.

Nursing homes provide 24-hour nursing and personal care to individuals with a variety of medical and memory conditions.

Selecting a nursing home is no easy task. You need to be re-assured that your loved one is taken care of properly and that the nursing home provides a relaxing and steadying environment for him or her during this stage.

There are over 50 nursing care facilities in the Sacramento area. These facilities provide a wide variety of options including living environments, care and therapy services, dining and cuisine options, room arrangements, onsite services and activities.

Nursing care facilities are a form of senior housing that provides daily medical, health and personal care. Services can be largely grouped into two as itemized below.

Skilled Nursing Care pertains to around the clock medical attention provided for a certain period of time (e.g., when someone has suffered a stroke and needs medical and rehabilitation care afterwards until he or she is able to live alone, with a family member, or is moved to another type of senior housing and care facility).

Personal or Custodial Care pertains to long-term assistance for seniors who are not perform daily tasks such as meal preparation, eating, bathing, using the toilet, personal hygiene, getting in and out of bed, taking medications, etc.

Nursing homes have generally had a hospital-like in layout (although some of the modern facilities look more like apartment or assisted living complexes) and provide either private or semi-private rooms for residents. Even with the government regulation and oversight of licensed nursing care facilities, selecting one can be difficult.

How to Select a Nursing Home:

The following suggestions provide you with a start in identifying, evaluating and selecting the most suitable nursing care facility for your loved one.

  • Look. What choices are in your area? Is there a facility close to family and friends? What's important to you-nursing care, meals, a religious connection, hospice care, special care units for memory, dementia and Alzheimer's care?

  • Ask. Talk with friends, relatives, social workers, and religious groups to find out what places they suggest. Ask doctors which nursing homes they feel provide good quality care.

  • Call. Get in touch with each place on your list. Ask questions about how many people live there and what it costs. Ask out about waiting lists.

  • Visit. Ask to meet with the director and the nursing director. Here are some positive and negatives that may influence your decision:

    • Medicare and Medi-Cal certification

    • Handicap access

    • Strong odors (either bad or good)

    • Variety of food choices

    • Residents who look well cared for

    • Sufficient staff for the number of patients

  • Talk. Don't be afraid to ask questions. Ask how long the director and department heads (nursing, food, and social services) have worked at the nursing home. If key staff changes a lot, that could mean there is a problem.

  • Visit again. Make a second visit without first calling. Try another day of the week or time of day so you will meet other staff members and see other activities. Stop by at mealtime. Do people seem to be enjoying their food?

  • Understand. Once you choose, carefully read the contract. Check with your state's Ombudsman for help making sense of the contract.

Resources to Help you Choose:

The Federal government has developed a number of comprehensive resources designed to help in the selection of a nursing home. The following resources are available at

  • Guide to Choosing a Nursing Home - includes a tear out checklist to compare nursing homes.

  • Summaries of recent nursing home inspection reports.

  • Information about State Health Insurance Counseling and Assistance Programs (SHIP).

  • Information about what Medicare covers.

  • Information about Medigap insurance.

  • There is also an online tool to help compare nursing homes.

Points to Consider:

The following are the most important issues to consider when selecting a nursing home.

Quality of Life: Does the staff treat residents in a respectful way? Are there a variety of social, recreational, religious, or cultural activities? Do the residents have choices about their schedule and living space? Do the residents have privacy for visits or personal care?

Quality of Care: Are there more than the mandated minimum of staff member to residents ratio? Are residents getting the care they need? Can residents still see their personal doctors? Does the nursing home's inspection report show quality of care deficiencies?

Location: Is the nursing home close to your family and friends so they can visit often? Frequent visits are the best way to make sure that you or your loved one does well in the nursing home. Having visitors can make the transition to the nursing home easier for you and your family. Visitors can also help support you or act on your behalf by bringing concerns to the nursing home's resident council and/or family council.

Availability: Is a bed available now, or can you add your name to a waiting list? Remember, nursing homes don't have to accept all applicants, but they must comply with Civil Rights laws that prohibit discrimination based on race, color, national origin, disability, age, or religion under certain conditions.

Staffing: What is the staffing level for Registered Nurses and supervisors? Do the Certified Nursing Assistants (CNA's) work with a reasonable number of residents on each shift (day, evening and over night) and during meals? How often is the medical director on site? Are appropriate physical and occupational therapy staff available?

Religious and Cultural Preferences: Does the nursing home offer the religious or cultural support you need? Do they provide any special diet the senior's faith practice requires?

Language: Is your primary language spoken at the nursing home by staff or residents? Being able to communicate with others is important.

Policies: Policies are rules that all residents must follow. They may be different in each nursing home. Are you comfortable with the policies? For example, smoking may not be allowed or may be allowed in certain areas.

Services and Fees: Does the nursing home have the services the senior needs? Nursing homes should disclose in writing their services, charges, and fees before the individual moves into the home. Get a copy of the fee schedule to find out which services are available, which are included in your monthly fee, and which services cost extra. Then you can compare the costs of different nursing homes.

Security: Does the nursing home provide a safe environment? Are the doors monitored, especially during evening and overnight? Is the nursing home locked at night? Are there special personal monitoring devices to alert staff if a resident becomes confused and wanders in the facility?

Preventive Care: Does the nursing home make sure that residents get preventive care to help keep them healthy? Does the nursing home have a screening program for immunizations such as flu (influenza) and pneumonia?

Hospitals: Does the nursing home have an arrangement with a nearby hospital for emergencies? Can your loved one's doctor care for him or her at that particular hospital?

Licensed: Is the nursing home and current administrator licensed by the State?

Certified (certification): If the senior is getting skilled care paid for by Medicare, make sure the nursing home is Medicare certified. This means the nursing home has passed applicable inspection surveys. Medicare and Medi-Cal will only pay for care provided in a certified nursing home. Some nursing homes set aside only a limited number of beds for Medicare or Medi-Cal residents.

In conclusion, while a nursing home is not the most desirable option of senior housing, sometimes it is the most suitable option. Do your research, following the suggestions in this article, and don't be timid about asking questions, requesting documents and talking to residents and their families. Remember there is a very wide range of nursing care facilities and that with diligent research, you can find the best one for your friend or loved one's needs.