LDHP Medical Review Services Additional Nursing Home Guidelines

Additional Suggestions for Nursing Home Selection

A secondary list of guidelines and suggestions for selecting a quality nursing home or other long-term care facility as prepared by medical professionals at L D H P Medical Review Services Corp.

These guidelines are not federal or specific state standards, but rather a composite of many standards and the experiences of our medical professionals. These suggestions were designed for the public to use in making their personal evaluations of a specific facility.

If your initial inspection was satisfactory, please proceed with this second list. Although the provisions of this secondary list are not always mandatory for quality care, if many of these services and provisions are present, it is often a reflection of a higher standard of care being provided. Most of these suggestions or guidelines apply to traditional skilled care nursing home facilities, but some of these principles are very appropriate for small facilities with lesser levels of licensed nursing staff.

ADDITIONAL SUGGESTIONS

Is there adequate staff on duty at all times? We suggest you visit twice in one day at least 12 hours apart. If some of the same staff members are still working, there are most likely some "double-shifts being pulled" and very likely a staffing shortage. (Staffing shortages are a prime contributing factor to the occurrence of negligence.)
Are a group of residents restrained in chairs and grouped around the nurse's station? The nurse's station is not a people parking lot. (This can also indicate a staffing shortage.)
Does the facility have a Respiratory Therapist (R. T.) for routine and emergency pulmonary care? Is there a provision for 24-hour emergency pulmonary treatment?
Does the facility have a Physical Therapist (P. T.) on staff, and does the therapist /staff maintain a regular exercise therapy program for all residents?
Is there a Dietitian on staff and does he/she regularly check on the nutritional status and food preferences of the residents? Are dietary preferences and religious dietary customs followed? Small non-skilled facilities may not have a Dietitian, but would be expected to address these concerns for their residents.
Does the facility have Social Services (social worker), Speech Therapy services, and Occupational Therapy services available?
Is there a program of psychiatric care for the disoriented residents and other residents in need of this service by a certified practitioner? Psychiatric care may be provided by a psychologist, psychiatrist, nurse practitioner or social worker. Does the facility have access to 24-hour emergency psychiatric care by someone licensed to prescribe medications ( physician, psychiatrist or nurse practitioner).
Are there any reports of disturbances, theft or incidents of residents wandering off? Check with local law enforcement agencies.
Does the facility have a satisfactory record with the local better business bureau?
Does the facility have a satisfactory referral from local hospitals?
Does the facility have a satisfactory record with the local health inspectors and government licensing agencies? Ask the facility you are considering if they have a copy of their state inspection on file for you to read.
Does the facility have a satisfactory referral from local physicians?
Are there lawsuits pending, prior malpractice suits or suits for unpaid debts? Are there any mechanic liens or any other types of liens or judgments against the owners of the facility or the facility itself? Check with the local county clerk’s office. Any of these could indicate a management problem or financial problem. (Management and financial problems may make the incidence of negligence more likely due to under-staffing and the inability to maintain the facility.)
Is the family permitted to assist in the resident's care unless it would be medically inadvisable? (Example-The spouse is permitted to feed the resident, but not made to feel that the resident would "miss a meal" were the spouse unable to be there.)
Is there easy access to the administration if a problem arises? Is an "open-door" policy maintained? When you select a facility, get to know the administrators, supervisors, and nursing staff members by name. One safeguard against neglect is a staff that is aware of the involvement offamily/friends.
Is there a policy for Hospice care for the terminally ill? Is there also support and counseling for the families of the terminally ill with follow-up support after death? This is part of a true Hospice program. Inquire with families/friends of other Hospice residents within the facility as to the quality of support they are receiving. Ask the facility for referrals. [Hospice services may be provided by an outside provider also.]
Is there an Activity Director? For the very disoriented residents who cannot participate in social activities, does someone visit with them regularly? Ideally this contact is in addition to regular care giving. (We never lose our need for voice and touch communication.)
Is a policy actively followed which permits any resident who is medically stable to leave with their family with a minimum of prior notice for an outing or "pass" or for a few hours or days? Is adaptive equipment loaned to the family while the resident is away from the facility [e.g., wheelchair, walker, cane, adaptive toilet seat (high john)]?
Is there a separate housekeeping staff who regularly maintains the facility? Even minor janitorial duties should not be not left up to the nursing staff. (The nursing staff needs to be free to provide nursing care.)
Some excellent facilities have child day-care centers nearby for the staff and community in general. Any resident who is physically able and interested is free to interact with the children. This is of great benefit to the children as well as the elderly.
Does your loved one have a diagnosis of Alzheimer's disease? The facility under consideration should be set up specifically for that disorder. The facility should have staff members familiar with the unique needs of the Alzheimer's patient. The setting should have specific physical safeguards in place, alarms on exits, locked supply areas, locked medication cabinets, etc. There should also be an increased ratio of staff members to residents to allow for more personalized supervision. Is the facility you are considering familiar with recent Alzheimer's developments and treatments? There are unique therapies geared specifically to the needs of the Alzheimer’s patient and his/her family.
Is a policy for open medical records actively followed to allow access to medical information?
Does each resident have a place to securely store personal belongings?
Are residents allowed to bring personal items such as a favorite chair, TV, tape player, radio, books, and pictures? All personal electrical items must be checked for safety prior to the resident having them in his/her room so as not to be a fire hazard. The amount and types of personal items depends upon the space available, but it is very important to have a few personal items in one's "home."
Are the residents clean and dressed in street attire when you tour the facility? (Residents need a home-like environment. This is "their home" and not a hospital.)
Are banking, mail service, shopping or a personal shopper (for those unable to do their own shopping) offered in some form? Is transportation to shopping, restaurants, outside religious services, libraries, etc., available for those who are able to participate? Note: Some of these services, such as a personal shopper, are often services performed by volunteers. Volunteers have excellent rapport with the residents and are usually a very welcome asset. The accountability of funds is important for whoever performs these services, be it a staff member or volunteer.
Does the facility have laundry facilities for those who are able to do their own laundry and personal laundry service for those who are unable to do their own laundry? Note: Some facilities have the families assume the responsibility for laundry, and this should be clarified in advance.
Are families and residents expected to supply medical supplies? What items are covered by insurance and what are not? For the families to supply specialty items that are not insurance covered is not unique, but full disclosure is important so families have no hidden costs.
Is there an ethnic mix in the resident and staff populations?
Are spouses permitted to share a room unless it would not be medically feasible?
When are visual examinations scheduled? Are glasses repaired quickly?
Is there a policy of regular dental care that is followed for the residents? Are dental visits scheduled every 6 months? Is there a means to quickly repair broken dental appliances?
Does the facility have a policy for providing, cleaning, servicing, and repairing adaptive equipment such as braces, walkers, wheelchairs, and adaptive appliances such as eating utensils for the residents with disabilities of the hands? Are the repairs done in a timely manner?
Is there professional and timely service available for fitting and repairing hearing aids? Are hearing evaluations regularly scheduled?
Are oxygen devices stored safely? Are they stored where they will not fall, ignite, or be in the way of other people moving about? (An example of an oxygen device is a small portable oxygen tank or cylinder for an ambulatory resident on oxygen therapy.)
Do residents have access to a hair dresser or a barber?
Do residents have access to a shoe repair service?
Do residents have access to a tailor for repair of clothing?
Do residents have access to dry cleaning?
Do residents have access to legal services?
Are reading materials available for residents? Are reading areas with suitable lighting available?
Are outdoor activities planned when weather permits?
Are holiday activities planned?
Do community groups visit the facility, especially during holidays?
Is there a resident/family council established for input in the determination of policies for the facility?
Is there accessibility to civic voting by absentee ballot and is voter registration available? This may be by a local volunteer group.
Are religious services available?
Is regular pest control maintained?

Specific questions and issues should be discussed with Social Services personnel of the various institutions and entities you are considering using and not L D H P Medical Review Services Corp.

L D H P Medical Review Services Corp. does not recommend any specific type of care or institution as this is a very personal matter. We hope this brief overview of services will be helpful to you.

Though our business deals with the negative side of institutional placement,many, many families have had positive and satisfying experiences, including those of us at L D H P Medical Review Services Corp. We anticipate your experience will be a positive one.

These guidelines are offered free to the general public and any interested Attorney for assessing the quality of a long-term care facility or for their client’s information and use in planning care for a family member. Feel free to contact us for a free publication-ready copy of this information. Feel free to copy and distribute this information to any interested party. We encourage the distribution of any information that will assist the public in caring for the elderly. We believe that an informed general public is an essential safeguard for the elderly. Our only stipulation is that these pages be reproduced in their entirety, including our name and address. This information was compiled by L D H P Medical Review Services Corp., and we prefer that it remain as one document for purposes of accuracy and as a representation of this firm. Thank you.