How Your Clients Can Pick the Right Long-Term Care Facilities: LTCI Insider

Basic Information

• Is the LTC facility Medicare-certified? (Common for nursing facilities [NFs]; uncommon for assisted-living facilities [ALFs])
• Is the LTC facility Medicaid-certified? (Common for NFs; uncommon for ALFs) (Note: "Certified" means the LTC facility passed an inspection conducted by a state government agency. Medicare only covers care from certified facilities.)
• Are the LTC facility and current administrator licensed in your state?
• Does the LTC facility have a bed available?
• Does the LTC facility offer specialized services such as a secure unit for residents living with dementia or ventilator care?
• Is the LTC facility located close enough for friends and family to visit?
• Are there resident policies you must follow? And will you get a written copy of these policies?
• Are there extra charges for other services, such as salon services?
• Will the LTC facility share in writing their services, charges and fees before you move in? (Note: Medicare- and/or Medicaid-certified LTC facilities must provide this information in writing. Get a copy of the fee schedule to find out which services are available, which are included in your monthly fee and which services cost extra. Then, compare LTC facility costs.)

Safety and Care

• Have you checked the LTC facility's ratings? (See, for example, Medicare's Care Compare site, or the Texas nursing home comparison site.)
• Is the LTC facility taking action to improve quality and/or staffing as needed?
• Can residents still see their personal doctors? If needed, does the facility help arrange transportation for this purpose?
• Does the LTC facility have an arrangement with a nearby hospital?
• Are care plan meetings held with residents and family members at times that are convenient and flexible?
• Does the LTC facility's inspection report show quality of care problems or other citations? (Example: Failure to meet one or more state/federal requirements) (Note: The LTC facility must have a survey book available for you to review. This will include reports on recent state or federal surveys and investigations of the facility. These reports tell you how well the LTC facility meets state and federal health and safety regulations. Reports can also be found on most state survey agency websites and Medicare.gov.)
• Has the LTC facility corrected all citations on its last state inspection report?

Preventing Abuse

• Does the relationship between staff and residents appear to be warm, polite and respectful?
• Does the LTC facility check the state nurse aide registry to make sure they don't hire staff members with a finding or history of abuse, neglect or mistreatment of residents?
• Does the LTC facility have policies and procedures on prohibiting and reporting abuse and neglect?
• Is the LTC facility taking action to keep residents safe from abuse, neglect, mistreatment or exploitation?
• Is there information about how to report concerns about the care and safety of residents?
• Is there information about how the facility responds to concerns that are reported?
• Has the LTC facility been cited for issues related to abuse in the last two years? (Note: LTC facilities cited for abuse will have a symbol next to their name on Medicare.gov.)

Facility Appearance

• Are residents clean, well-groomed and appropriately dressed for the season or time of day?
• Is the LTC facility free from overwhelming unpleasant odors?
• Does the LTC facility appear clean and well kept?
• Is the temperature in the LTC facility comfortable for residents?
• Does the LTC facility have good lighting?
• Are the noise levels in the dining room and other common areas comfortable?

Facility Living Space

• Is the furniture sturdy yet comfortable and attractive?
• Are exits clearly marked?
• Are there quiet areas where residents can visit with friends and family?
• Does the LTC facility have smoke detectors and sprinklers?
• Are all common areas, resident rooms and doorways designed for wheelchairs?
• Are handrails and grab bars appropriately placed in the hallways and bathrooms?

Menus and Food

• Do residents have a choice of food items at each meal? Do they serve foods you like?
• Can the LTC facility provide for special dietary needs (like low-salt or no-sugar-added diets)?
• Are nutritious snacks available?
• Does the staff help residents eat and drink at mealtimes, if needed?

Staff

• Do staff knock on the door before entering a resident's room?
• Do staff refer to residents by name?
• Does the LTC facility offer a training and continuing education program for all staff?
• Is there licensed nursing staff 24 hours a day, including a registered nurse (RN) present at least eight hours per day, seven days a week?
• Do certified nurse aides (CNAs) help plan the care of residents?
• How many nurses, including CNAs, will be available to help you during the day, at night and on weekends? (Note: The LTC facility is required to post this information.)
• Is there a person on staff assigned to meet a resident's social service needs, and can you meet with him or her?
• Will staff call your doctor if you have a medical need?
• Has there been a turnover in administrative staff, like the administrator or director of nursing, in the past year?
• Is your primary language spoken by staff? If not, is an interpreter available, or is another system in place to help you communicate your needs?

Resident Rooms

• Can residents have personal belongings and furniture in their rooms?
• Does each resident have storage space (closet and drawers) in their room?
• Does each resident have a window in their bedroom?
• Do residents have access to the internet, a computer, a personal phone and television?
• Do residents have a choice of roommates?
• Are there policies and procedures to protect residents' possessions, including lockable cabinets and closets?

Activities

• Can residents, including those who are unable to leave their rooms, choose to take part in a variety of activities?
• Do residents help plan or choose the activities that are available?
• Does the LTC facility have outdoor areas for resident use?
• Is staff available to help residents go outside?
• Does the LTC facility have an active volunteer program?
• Do you get to choose what time to get up, go to sleep or bathe?
• Can you have visitors at any time — even early or late hours?
• Would you be able to leave the facility for a few hours or days if you choose to do so? Are there procedures for leaving?
• Does the LTC facility offer the religious or cultural support you need? If not, what type of arrangements will they provide to meet your needs?

Caring For Residents with Dementia

• Does the LTC facility have specific policies and procedures related to the care of residents living with dementia?
• If so, does the policy include the use of non-medication-based approaches to care as a first attempt to respond to behavioral symptoms (which are often a means of communication) for residents living with dementia?
• What percentage of residents who have a diagnosis of dementia are currently being prescribed an antipsychotic medication?
• What is the LTC facility's current rate of antipsychotic medication use, and why?
• Does the LTC facility participate in any efforts related to reducing antipsychotic medication use in LTC facilities? (Example: The National Partnership to Improve Dementia Care)

Resident and Family Councils

These are usually organized and managed by the residents and families to address concerns and improve the quality of care and life for the resident.

If you're able to attend a resident and family council meeting, ask:

• What improvements were made to the quality of life for residents in the last year?
• What are the plans for future improvements?
• How has the LTC facility responded to recommendations for improvement?
• To whom does the group report?
• How does membership work in the group?
• Who sets the agendas for meetings?
• How are decisions made? (Example: By voting, consensus or one person makes them)

Visit Again

It's a good idea to visit the LTC facility a second time. It's best to visit on a different day of the week or at a different time than your initial visit. Staffing can be different at different times of the day and on weekends.

Interview the Experts

When choosing an LTC facility, residents offer the following observations:

• "Look to see if residents and staff both appear to be happy. In order for residents to be happy, the staff has to be happy."
• "Pick an LTC facility that is as close to family and friends as possible."
• "Check the beds for comfort! The bed I had was so uncomfortable that I had to bring in my own mattress."
• "When considering a specific LTC facility, ask people if they have heard anything good about it."
• "Find out if there is an active activity department. That's really important. See if the kitchen tries to provide residents with food they like and will eat."
• "Find out where the LTC facility is with culture change."
• "Are reading materials, like books and a computer, available for residents?"
• "Observe whether wheelchairs are the right size for residents. There is one woman here in a wheelchair that is too big for her, and it is very hard for her to get around."
• "Ask if the LTC facility is responsible for lost or stolen items. If something is missing and can't be found in this facility, they give you a check for $10, no matter how much the item cost."

My Own Indicators

And last, my own personal observations based on when my mother was in a nursing home:

• Check the phone in the resident's room to make sure that the voicemail works. It took a week for me to realize that although I could leave a voicemail, the system didn't let her retrieve the messages. When I complained (several times), and they finally checked into it, it turned out that a new phone system had been installed several months before and did not include that service.
• Is there a big clock on the wall, and does it show the correct time? In my mother's room, there was a clock that only showed 5 p.m. (I finally climbed on a chair and took it down and bought her a smaller clock for her night table.)
• Are the clothes marked with the resident's name? Her clothes kept disappearing, and I was making constant trips to buy more clothes.
• Does the resident have warm-up suits to wear? These were the most comfortable but still looked presentable.

I hope you and your clients never have to use this list. But if you, or they, do, it will be invaluable.

Margie Barrie, an agent with ACSIA, has been writing the LTC Insider column since 2000. She is blogging about long-term care planning with Chris Petillo, and preparing to launch an LTC podcast series, at Faegre Drinker's LTCi Summit website.

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(Photo: Katarzyna Bialasiewicz/iStock)