LDHP Medical Review Services Nursing Home Guidelines

Minimal Suggested Guidelines for Nursing Homes

A 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 are not federal or specific state's 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. We believe these 10 items must be met to your satisfaction before considering any long-term care facility. There are many excellent facilities, however there are a few that should be avoided. Please do not be intimidated about "looking" carefully at a facility. Your loved one deserves the best of care. Similar guidelines are now available on www.Medicare.gov.

TYPES OF CARE:

--Skilled Nursing Home
Most facilities describe care as skilled vs. non-skilled care. This is not a reflection on the level of skill of the staff, but rather a classification of payment reimbursement based on the type of care the resident requires. Skilled care includes services provided by a licensed professional such as physical therapy or interventions medications. Non-skilled care primarily is ongoing daily care involving assistance with meals, bathing, dressing and routine medication administration. This would be long-term care in most nursing homes.

---Long Term Care
Long term care often refers to extended care in a general nursing home. However there are many other types of long term care, assisted living, boarding homes, private care facilities to name a few. Many of these guidelines will also apply and be very appropriate for facilities of a lesser level of licensing (those without 24 hour/day licensed nursing staff).

Minimal Guidelines for Nursing Homes

[as compiled by L D H P Medical Review Services Corp.]

The facility has valid and current licenses from all state and local licensing agencies REGARDLESS of the level of skilled care!
Does the facility accept Medicare as a payer source? (This is important even if this is not your payer source as this creates a minimum standard of care that must be met. This applies primarily to skilled care facilities.) The facility should also maintain liability and malpractice insurances, regardless of the level of skilled care being provided.
Is there a physician on staff or on call? Is there access to a physician 24 hours a day for emergencies? Is there physician back-up coverage if the first physician is not available? Does the physician maintain regularly scheduled visits at frequent intervals for all residents? All residents should be seen by the physician at least twice a year, even if they are medically stable. If the individual is not medically stable, the frequency of physician visits would need to be increased. (Physicians visits may be within the institution or the person may be seen in the physician's office.)
Is there a licensed nurse on duty at all times (RN/LPN/LVN)? Ideally, one RN per shift and one or more LPN/LVNs per shift depending upon the size of the facility. Does the licensed nurse do direct resident care? A licensed nurse doing some direct resident care makes for better supervision of all residents. (This applies only to skilled care facilities; see above explanation.)
Are all staff members trained in basic first aid? Is there an emergency equipment cart in plain view and easily accessible if it is a skilled care facility? This equipment would include oxygen and suction machines. C.P.R. (Cardiopulmonary Resuscitation) is not always part of a nursing home setting as the majority of nursing home resident s have requested to not be resuscitated. This is something you will need to discuss with your loved one/family and the facility in question. It would be nice for this equipment to be available for staff/visitors but it is not necessarily mandatory.
Is the facility free of any strong or unpleasant odor? Give it the old "take a deep breath and sniff test." You will know if it passes! If it does not pass, suspect a lack of staff to keep the residents clean and/or a lack of appropriate janitorial services. A strong odor is a strong clue to investigate further especially if this is not an isolated incident.
Tour during a meal! Are the residents well nourished? Is there a staff member present to assist the residents who need help cutting up food, opening containers, etc.? Is the food appealing? Is the amount of food appropriate? Is the meal served in a manner in which you would want your meal served? Are residents who need to be fed receiving assistance in a relaxed and pleasant manner? If the manner is rushed, the residents are at risk of choking or not receiving adequate nutrition. Walk down the halls. Are the bed-bound residents being assisted? Is there sufficient staff to assist all of the residents before their meal is cold? Do residents have water available at their bedside?
Are all medications and emergency equipment locked to prevent disoriented persons from gaining access to them? Are there alarms on the exit doors to alert the staff if a disoriented resident wanders off?
Are fire and safety codes met? Is there easy emergency escape access and plenty of fire extinguishers, smoke detectors, sprinkler systems, etc.? Also, are the halls reasonably free of clutter in case of an emergency? If the building is multi-level, are there fire escapes for the upper level? Are emergency exit routes posted? Are fire drills held regularly? Check with the sate licensing boards and local fire Marshall to see if safety standards are met.
Are families permitted to visit freely, including children? Are areas set aside for family visitations in a private setting which would be safe for small children as well as not create a disturbance to other residents? Are small children welcome and able to visit their elderly relatives (unless medically unwise in a particular situation)? Are families/friends encouraged to visit during and participate in activities such as Bingo night? An excellent way to assess the quality of care is to visit at an unexpected time to observe any irregularities either in staff or your loved one. Frequently elderly persons will be lucid during the daytime and confused in the early evening, commonly called “sundown syndrome”. Visitations that need prior arrangements are a "RED FLAG" for most care facilities.The exception to randomized visitation would be some specialized care units, for example geriatric psychiatric units, which may have set visitation hours due to the nature of their treatment programs. We stress that frequent, family/friends visitations is an important safeguard for quality care.

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.

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.

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.

ADDITIONAL SUGGESTIONS FOR NURSING HOME SELECTION is a secondary check list if this initial list has met your satisfaction. This was also prepared by medical professionals at L D H P Medical Review Services Corp.

Also see ALTERNATIVES TO NURSING HOME PLACEMENT and POTENTIAL FINANCIAL RESOURCES