Let’s Get Serious About the Nursing Home Tour

By Tammy Gonzales

To narrow down your choice between two or three nursing homes or just considering the only available nursing home to place your family member or friend, it takes two visits. Take someone with you and if at all possible take the person who will be moving into the nursing home.

Your first visit to the nursing home is what I call “THEIR PITCH”. Set it up for the morning anytime before 11:00 AM on a Saturday and plan to be there at least an hour. Get there 15 to 20 minutes early with a magazine or a newspaper and let the receptionist know you are there. Take a seat in the lobby and wait. This is not waisted time. Open up your newspaper or magazine and eaves drop without calling attention to yourself. Let your senses lead the way. Have you been offered refreshments? Does the facility smell? Does the interaction of others sound pleasant?

When you opened the front door into the nursing home did you smell urine, bowel movement, vomit or body odor? Did it to smell like flowers or antiseptic? Or like bad odors are being covered up by good odors. Broccoli, cabbage and brussels sprouts are the only offensive smells that come from the kitchen when they are being prepared.

After a short while close up your magazine or paper and reseptive to your visual surroundings. If there is someone else sitting there try to start a conversation about the nursing home and find out what they think. Listen to the tone of their voice, watch facial expression and body language. By now the admissions coordinator or someone is going to invite you into their office or take you for a tour and give you “THEIR PITCH”.

When they take you into the office they are going to ask you questions. Names, name of potential resident, age, diagnosis, who their doctor is, where are they now, do they have Medicare, insurance, are you the health care power of attorney, do they have a living will, have you applied for assistance, how soon do you plan to place them here, etc. They are going to try to emotional connect with you as well. They are looking for potential problems too. Pleasantly answer their questions. If you have a few questions ask and be sure to ask if you can have a copy of an information packet or pre-admission packet.

So on to the tour. The tour is about showing you the best of what they have to offer. They will introduce you to everyone and show you the facility. Let “THEIR PITCH” happen and go along with it. Don’t ask too many questions now because you will distract yourself from observations that you need in order to make a sound choice.

During the tour you will be introduced to the different department managers and shown their offices. You won’t be expected to remember names and it is more important how they respond and take an interest in you. Also, during this tour pay attention to the interaction between staff and residents in every area you are toured through. This is important.

Observe the residents. Are their clothes clean and in good repair? Are they wearing footwear? Do the men look clean and shaved? Does their hair look cared for or is it a mess? Do the women have appropriate hairstyles (I have seen them put pigtails on top of balding 90 year olds)? Do they still have bibs on from their last meal? Does any one look cold and not have a sweater? Do you see a number of residents that are wet or smell of urine or BM? Do the hands look clean especially under the nails? Do the wheel chairs look clean and cared for with no sharp edges or tatters? Do the residents in wheel chairs look comfortable? Are residents in wheel chairs being pushed too fast or backwards? Are residents that are being walked rushed or are they allowed to walk at their own pace? Is a resident yelling out the whole time you are there?

The flooring should be clean and free from any debris. The walls should be clean. The lighting should be good. Carpets free from spots. Decorative items should look well kept. Drapery should be open to allow the natural sunlight in.

You will be taken to the nurse’s station. The nurses should be pleasant and responsive to the residents and family members. Listen to their tone and responsiveness in their voice. Watch their body language as they acknowledge you or others at the nursing station. Is this representative of how you would like your loved one to be responded to?

One area you will be taken to, will be the Rehabilitation area where physical, occupational and speech therapies are provided. How are the therapists interacting with the residents? Are there residents in the area alone? Is privacy being respected? Is it busy with activity or is no one there? Listen to find out if they have at least a full-time physical therapist and occupational therapist, it is important to know, as your loved one may require these services from time to time. Do they mention at least a part time speech-language pathologist? It is always good to have one available to screen your loved one if they ever begin to have speech problems or eating problems like swallowing.

Once at the Activities Department, observe what is going on each time you pass by. Make it a point to stop for a few minutes and observe residents and don’t be surprised if not every resident in the activities room, is not doing something. Are at least 25% of the residents doing something like reading, watching TV, or doing the activity that is going on at the time? Ask to see or have a copy of the activities calendar. Observe interactions.

The dining areas are a very important area to make observations. Check to see if they have more that one dining room or area? If the nursing home that you are at has 120 beds and is not specific to only Alzheimer’s/dementia residents, then there is a mix of residents functioning at different levels. There are usually three functional levels of dining: residents that can dine independently, residents that require cueing, and residents that need to be fed. Observe for the different types of dinning rooms or areas. If residents are dining observe for a few moments. Are they socializing, smiling, having a difficult time with the food? This is important because as your loved one’s functional ability may decline and they may need cueing or to be fed from time to time. What is the facilities policy about reidents dining in their room?

The tour guide (admissions coordinator) will show you a few resident rooms. Most of the time they will show you the rooms of clean, fairly independent, and continent residents with good family support, a well decorated room, not the room they would be admitting your loved one into. Facilities are limited to the number of private rooms they have. Most of the rooms are semi private with a private bathroom for the two sharing the room or a bathroom that is shared with the adjoining room. Look in the bathroom if you can. There is much to consider.

During the tour they will hopefully show you outdoor areas for the residents. Is it shaded from the sun? Is it partially protected from the weather like rain, snow, and wind? Do they have an area outdoors for residents who smoke? Are there seating areas? Is it visually appealing?

This is usually what happens during”THEIR.PITCH”. They ask you for information and you ask questions and make observations. Just like when you are with a salesman they want you to get emotionally connected with their facility.

At the closing be sure to thank them for their time and let them know that you will be in touch with them soon.

Before your second visit, try and read the information related specifically to the nursing home and what their expectations are of you and the resident from the information packet or a pre-admission packet you recieved. Then make a list of questions for the next visit. If you can’t think of any questions, Medicare’s publication Guide to Choosing a Nursing Home has questions on several pages that you can tear out and take along with you to what I call the “YOUR Q&A VISIT”.

Try to make “YOUR Q&A VISIT” unexpected on a weekday. Ask to speak to the admissions coordinator or some one who can answer some questions that came up. I will just tell you now, that if they respond timely to you at this visit that’s how you will be responded to if your family member was in the nursing home. This is your opportunity to get your questions answered and to get any additional information that will help you make the best choice.

If you live in a small town this nursing home may be your only choice and you will learn to be a good advocate. However, if you live in a large town or metropolitan area you will have a choice of several nursing homes, pick the one that suits your loved ones needs and not your convenience. I wish you the best of luck on your search. Thank you.

Here are the valuable Resource Links that I promised. Just click on the title.

Nursing Home Compare – Will provide you data about a nursing homes most recent survey and compare it with other nursing homes you select for free. http://www.medicare.gov/NHCompare/Include/DataSection/Questions/SearchCriteria.asp

Home Health Compare – Will provide you data about home health agencies most recent survey and compare it to others you select for free. http://www.medicare.gov/HHCompare/Home.asp

Long-Term Care Counselor – Will help you make a determination of the type care and where the care can best be provided for you or for some that needs help or supervision. http://www.medicare.gov/LongTermCare/Static/LTCCounselor.asp

Publications - Guide to Choosing a Nursing Home, Medicare and You 2004, and

Medicare Coverage & Skilled Nursing Facility Care
http://www.medicare.gov/Publications/Search/SearchCriteria.asp

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