Looking for a Long-Term Care Facility for a Family Member with Dementia
1. There are key issues/concerns that the Ombudsman Program receives calls about from consumers regarding quality of care and quality of life in long-term care facilities for their loved ones.
- Resident hygiene
- Feeding issues
- Medication errors
- Falls and injuries
- Bathing methods & schedules
Lack of training:
- Communication problems – limited ability and understanding
Need for specialized training on
- Dementia care
- Difficult behaviors
- Transferring residents
Lack of individualized or personalized care:
- Food that is not appetizing to the resident or not individualized to their tastes
- Activities that are not tailored to the individual or to person’s with dementia
- Resident schedules not tailored to their life long life style
- Staff not spending time to treat the resident in a humanistic way
Facility management / corporation:
- Staffing ratios – not enough staff to provide the supervision and care
- Billing issues - overcharges
- Internal grievance procedures
- Fear of retaliation for complaints
2. Questions consumers could ask when looking for long-term care for someone with dementia:
- What is the philosophy of this facility?
Does the facility have a person-centered philosophy? Individualized care?
Concerning the Dementia Unit
- Does the facility have a special dementia unit?
- What are the criteria for admission to the dementia unit?
- Is there an increased cost for the dementia unit?
- Does staff on this unit have additional specialized training?
- What is the number of staff on each shift: Morning, evening, night?
- What is a “normal” day for resident on this unit?
- What happens if the resident doesn’t sleep all night?
- Do the residents have any opportunities to go outside of the unit for walks or events?
- Are visitors allowed access to a secure care unit after hours?
- What is the ratio of caregivers to residents for this facility? For each shift – morning, evening, night?
- What is the ratio of caregivers to residents for the dementia unit? For each shift – morning, evening, night?
- Does the facility have consistent assignments for caregivers?
- Is there a nurse available or on call at all times? (Assisted Living) What if that person is unavailable?
- Does the caregiver speak and understand the native language of the resident?
- Does the caregiver speak and read English?
- What amount of supervision do you provide?
- Does staff have any special training on mental health issues or handling difficult behaviors?
- What type of training does the medication staff receive?
- Are medications required to be packaged in any special way?
- Are residents required to buy their medications from the facility “preferred” pharmacy?
- What is the medication error rate?
Activities of Daily Living (Bathing, Eating, Dressing, Eating
- What is the bathing schedule handled?
- What does the shower room look like?
- Are there specialized activities for the dementia unit?
- Who coordinates them?
- Are there a variety?
- Are activities tailored to the resident?
- Does the menu have variety?
- Do they offer individual preferences for meals?
- Does the facility offer an alternative meal?
- Does the staff offer assistance to the residents?
- Is there an assigned activities staff person for the dementia unit?
- How does the staff ensure that residents are hydrated?
- Does the facility provide transportation for appointments?
- Does a staff member accompany the resident if they are out of the facility?
Contact with staff
- When will there be care plan meetings? When is the first meeting?
- Who should the family contact for concerns in the facility? For all issues?
- Is there a social worker? Who is assigned to my family member?
- How long has the administrator been at this facility?
- How many administrators have worked at this facility in the past 5 years?
- Is the administrator on site and available?
- Is there a Resident Council?
- Is there a Family Council?
- Is there a Volunteer Long-Term Care Ombudsman at the facility?
- Is the latest survey by the licensing agency out and available for you to see?
- What is the grievance procedure?
- Is there a procedure manual for the family/resident to have?
- What reasons would someone be transferred or discharged from this facility?
- Get a copy of the contract, take it home, and read it. Review it with someone if you need help understanding it.
- How is a billing dispute handled?
- Are there levels of care and are there charges associated with them?
- What is the procedure for assessment of the level of care needed?
- Is there an appeal process for an assessment of an increase in the level of care?
- Is there a time limit before the level can be increased?
- Are the charges for supplies included? Automatically charged? Can the family bring in supplies?
3. When touring a long-term care facility what issues would be of concern?
Observation of current residents:
Resident personal care does not appear appropriate
- Facial hair
- Clothing is soiled or not appropriate for climate
- Are residents being assisted with their needs?
- Are the staff including the residents while giving care or treating them as an object?
- Are residents eating their food and does it look appealing?
- Resident personal care does not appear appropriate
- Check if the home is clean and pleasant?
- What types of conversations are going on?
- What is the atmosphere like during meals?
- Is there a lot of noise, traffic? Is it hectic?
Licensing agency survey (inspection)
- What was the last survey result? Have they made corrections or changes?
- Is the facility unwilling to discuss the survey results or let you see them.
- Any rush to sign the contract before reading it or understanding it.
4. What special considerations/issues are there for Alzheimer’s units when choosing a nursing home?
Staff of the Alzheimer’s unit:
- Staff should have specialized training.
- Staff numbers should be adequate in any shift to handle residents that may be awake.
- Does the facility have staff that is awake during all 24 hours?
Specialized services for dementia care:
- Are there special activities for the dementia unit?
- Does staff use appropriate communication styles for this type of unit - use short sentences, concrete statements, or other methods when words aren’t understood anymore?
- Is staff body language friendly and non-threatening?
- Does staff know how to redirect inappropriate behavior?
- Are residents still treated with dignity and respect?
- Are drinks offered often?
- Is there an alert system that tells staff when a resident leaves the unit?
- Does staff react when the alarm goes off or just turn it off?
- How often does staff check on residents?
- Is lighting appropriate? Not too harsh and night lights in rooms and halls?
5. What suggestions would you give in choosing a long-term care facility?
When looking for a facility, research it! Don’t just go to one that is closest.
- Call the Long-Term Care Ombudsman Program.
- Research – on the internet. Narrow it down to a few facilities to do detailed research on and visit.
- Talk to others about their experience with facilities.
- Know your family member’s needs and history. Know what additional needs may come along with the progression of the disease.
- What type of payment sources does the facility take? Private pay only? Medicaid? Medicare? Grants?
- What services are included in the fee given up front and what additional cost of fees resident will have to pay and for what service?
- What happens if a resident’s money runs out? Does the resident have to move? Will the facility help to apply for Medicaid if appropriate?
- Is the facility certified? By what agency and what does that mean? Medicare and/or Medicaid?
- Look at past surveys (inspections) by the licensing agency.
- Talk to more staff than just the marketing or admissions person.
- If possible, take the potential resident for a visit and get their input.
- Don’t be fooled by expensive décor. This does not equate to mean better care.
- Look at all sizes of facilities. Sometimes the smaller (4-8 bed) facilities are more appropriate for a resident.
Visit more than once –
- Different times of the day
- Different days of the week – at least once on a weekend day
- Visit at least once unannounced and tour the facility unaccompanied by staff
- Are activity schedules posted and are they appropriate activities that are actually happening during your visit?
- Visit during meal time
Use all of your senses:
- Do residents look clean and attended to? Are they clean? Groomed?
- Is it a comfortable temperature for the resident?
- Is it a comfortable temperature for the resident? Are surfaces clean or sticky?
- Are there odors – either pleasant or unpleasant?
- Is it noisy? Is music appropriate for the residents? Are staffing talking with residents?
- Are staff talking to each other in a different language that the resident can’t understand? Are staff talking about residents where others can hear?
- If possible – eat a meal there. Is it appealing? Appropriate? Are staff assisting the residents – to open items and/or to eat? Are the residents served food or are they sitting and waiting for a long time? Does one resident get their food long before another at the same table?
- Read the contract before signing. Ask for a copy to take home and review. Make sure you understand it or take it to someone that can help you understand it.
- Get a copy of the Resident’s Rights and know them.
- Find the regulations for this type of facility on-line or call the licensing agency to get a copy.
- Review them and keep a copy for future reference.
Ask about the staff of the facility
- Who owns this facility
- Ask about the administrator – background and how long they have been with this facility
- What is the amount of staff turnover?
- What is the caregiver staff to resident ratio?
- Are staff consistently assigned to a resident?
- What type of training does staff have?
- Does staff have specialized training for the dementia unit? What is it?
- Does the facility provide the services that the resident needs?
- Ask if there is a Family Council – ask to speak with the Family Council Chair.
- Ask if there is a Residents Council – ask to speak with the Resident Council Chair which should be a resident, not a staff member.
6. Once you have selected a long-term care facility:
- Know all staff possible – the administrator, head of nursing services, social worker, direct caregivers
- Ask if they are not satisfied with the care or have a problem, how should this be handled? Who in the facility do they go to?
- Know if there is a Volunteer Ombudsman and how to contact them.
- Know the Licensing agency for the facility, that contact person and their number.
- Get a copy of the resident’s basic information sheet to ensure all the emergency contact information is correct. Review this at least quarterly.
- Make sure that know who the main contact person is and who should be contacted if that person is not available.
- Visit often and stay active in the resident’s life.