How to Pick a Nursing Home in Maryland
One of the most important choices to prevent nursing home injuries is the decision about what nursing home to select for your loved one. This is not a decision to be made lightly—not all nursing homes are the same, and not all nursing homes are equally safe.
The first question to ask is whether a nursing home is the best choice. It may be that your options are not just between staying in your current living situation or to go into a nursing home. There are a variety of options to be considered, such as adult day care and retirement communities that provide varying degrees of assistance.
If you are locked in on the idea of a nursing home - which may well be the most viable option - and are considering a nursing home or assisted living as a place for your loved one to live, there are several important questions to ask the nursing staff to get a picture of how they handle skin issues and how responsive the staff is overall.
First, be sure to speak to a head nurse, a floor nurse (the one who gives out medicines) and a certified nursing assistant (provides the most hands-on patient care) if you get a chance. Visit the nursing home before admitting your loved one. If you ask for a tour, chances are it will be guided by a manager or marketer. You will only see what has been prepared for you to see.
Try to sneak away to the bathroom or go into the center during “off hours” to speak to staff and patients or other visiting family members to get a truer sense of what goes on when the marketers and managers are not present. This will reveal the true identity of the home to you, beyond the fa & ccedil;ade staff puts on when they are trying to sell the home to you. Remember, without your loved one, they don’t have a job! Here are some more thoughts worth considering. Remember, the nursing home is not on trial. Just ask these questions in an off-hand "I know you will have the right answer but I have to do my due diligence" kind of way:
- How many of their patients are bed bound? This is a trick question of sorts because the answer should be none. Unless a patient is actively dying, they should be getting range of motion movement therapy and should be offered time out of their bed every day. Some patients will refuse to get out of bed consistently, but that is not what qualifies them as bed-bound. A bed-bound patient should have a doctor’s order not to get out of bed for a health-related condition, not for the convenience of staff because the patient refuses to get out of bed.
- Ask the nurses directly what their turn and reposition program consists of for the prevention of bed sores. They should ALL be able to answer you with detail, considering they are the ones responsible for carrying out the program by doing the turning and repositioning.
- After your loved one is in the nursing home, ask what their Braden Scale number is and what interventions they have put in place to address the risks the Braden Scale predicts. This question serves two purposes: to provide information on how at-risk your loved one is for skin breakdowns, and to show the staff that you are involved and informed.
- Ask how often the staff does skin assessments – another good question for the certified nursing assistants and floor nurses since they are in charge of this task.
- What kind of training does the floor staff receive on recognizing and preventing pressure sores?
- Ask about their activities program and how often they offer activities – do they have weekend programming and specialized care plans? For example, if your loved one enjoys jazz, do they offer jazz CDs to listen to or if you bring in their favorites from home will they be played for them?
- How do they encourage resistant patients to get out of bed? The techniques should be gentle, rewards-based, and not abrasive or frustrated. The center should engage it’s social workers and activities staff in engaging patients and encouraging them to get out of bed.
- How often is the patient showered? What happens if they refuse to shower? A patient should, at least, get a bed bath every day and should have lotion applied afterward to protect their skin.
- How often are the patients offered fresh water? Is the water put within reach (if not, this is considered neglect) or, if the person cannot help themselves to the water how does the staff assure they are hydrated? Staying hydrated is key to preventing skin breakdowns. Water should be at every bedside unless a patient has a doctor’s order for a fluid restriction. Intakes should be monitored by the staff to assure a patient is taking in enough water. If a nursing home patient is diagnosed with dehydration, the nursing home is in jeopardy of being temporarily closed to admissions by their regulatory authority while an investigation is performed. Dehydration is to be prevented at all costs. Any issues with your loved one not receiving proper hydration should be addressed by the staff immediately. Issues with hydration signal inadequate staffing and neglect.
- How many skin breakdowns did they have last month? Over the last three months? Did the center notice a pattern and what interventions did they put in place to decrease these numbers? Most nursing homes monitor these numbers closely as part of their quality control programs. If the center is guarded about giving away this information, a red flag should be raised.
- If, after admission, treatment is ordered for your loved one, be sure that it is explained to you fully and ask questions if you do not understand. Then, when visiting, make sure the treatment is actually in place, and the bandages are fresh and changed as ordered (some are daily, twice a day, or once every three days so pay attention to when the treatment was ordered and when it should be performed by the staff). Missing treatments are a big reason wounds do not heal or worsen and is a sign of neglect.
- What is the turnover of the administrator and director of nursing? The administrator and director of nursing are in charge of the whole facility operations and nursing staff operations, respectively. If there is high turnover in these positions, there is instability within the center. Preventative programs and quality measures will not work without a stable management to oversee them and ensure their success.
- When you visit the center, pay attention to the staff. Are they smiling? Slumped over and shuffling down the hall? Do they greet you warmly or with trepidation? Do they welcome your questions? Are their clusters of nursing assistants hanging out in hallways gossiping instead of interacting with patients? What does your gut say? Chances are, you know what is best for your loved one. So trust your instincts. (That said, you can't expect
Disney, either. Seeing more than one nursing home helps you put this in proper context.) - Is the nursing home actively engaged in culture change? The culture change movement is sweeping long-term care to change the ways of the past that have dragged nursing homes down. The idea is that nursing homes are supposed to be changing to provide “person-centered” care – care that focuses on the needs of the patient and not the convenience of the staff.
Here are some more resources to help you choose the best Maryland nursing home for your or your parent(s):
To research a particular nursing home, and to see how it compares to the Maryland averages, go to Services Search to search by location, click on your facility and click the tabs at the bottom of the page. Here, you can see:
- Facility characteristics: number of beds, recent changes in ownership, type of services
Resident characteristics: demographics (age, gender, functional status) - CMS Quality Measures: criteria evaluated by the Centers for Medicare and Medicaid Services
- Quality Indicators: evaluation of falls, fractures, dehydration and other factors
There is a lot of information on these websites, and it can be difficult to digest them all before picking a nursing home facility—particularly if that decision must be made on an expedited basis. Even so, this is not the end of your analysis—talk to friends, residents of the facilities, and even lawyers (we can tell you about the really bad ones) to find other information that will help you to make a decision.
Hiring a Nursing Home LawyerIf someone you love has injuries of unknown origin, bed sores, a broken hip or frequent falls and you are suspicions of elder abuse or nursing home negligence, a personal injury lawsuit may be filed on their behalf. If you believe that you or someone you love has suffered a serious injury as the result of nursing home abuse or nursing home neglect, call our nursing home attorneys at (800) 553-8082 or get a free Internet consultation to discuss a potential lawsuit. There are no fees or expenses unless a recovery is obtained.
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