Assessing nursing care communities can be a very difficult task for family members. The environment is often more institutional and less home-like than an assisted living, and the physical needs of long-term care residents are sometimes tough to see. Here are some tips to help you as you go.

1. Staff and staffing ratios top the list of complaints of residents in a nursing care community.

As you explore your options, pay close attention and ask lots of questions. What are their staff to resident ratios? How many nurses are there per resident? How many aides are there per resident? Is staffing decreased in the evening hours and by how much? A key indicator of how well a care community is staffed is call lights. Pay attention to the call lights and alarms that are usually located over resident doorways and at the nurse’s stations. Are multiple call lights going off as you tour? If so, how long does it take staff to respond? If you see a call light going off while you are touring, look at your watch. Then time how long it is before a staff member comes to assist the resident. Also ask questions about the staff members themselves. How much turnover do they have overall? How long have the aides been with the community? How long have the nurses been on staff? Turnover can be high in this industry, but some are much higher than others. Low turnover is important in maintaining quality, continuity of care for your loved one.

2. How does the community look, smell and feel to you?

Remember, this will be your family member’s home even if only for a short-term rehab stay. Evaluate them from the first impression, including your first phone call to set up the appointment. Are you greeted with a warm welcome? Is the exterior of the building in good repair? Are things well-maintained inside and out? Is the facility clean? Older physical plants might not be as attractive as their newer counterparts but cleanliness is the real key. Is there an odor throughout the building? Is there a lot of noise throughout the building? Overhead paging is sometimes an issue. Is there a lot of it? Do staff members yell from one end of the hallway to another? Your family member needs to be able to rest (and sleep!) in this environment. Are there personal touches throughout the community to make it feel less like an institution and more like home? Plants, birds, a community dog or cat, and seasonal decorations are all good things to look for in choosing a home.

3. Does the community seem safe and secure for residents?

Nursing care community residents are some of our most vulnerable citizens. Does the community have measures in place to protect them? Ask about background checks on employees and on any vendors that frequent the community and have access to residents. Are exterior doors kept locked? Are call lights within resident reach? Is there a call light in the bathroom? Are windows in good repair with locks that work? Is there a system in place to prevent residents who wander from eloping? Is the exterior of the building well lighted? Are there sprinklers and smoke detectors? What is the area surrounding community like? Is crime an issue? What kinds of front desk procedures are there to prevent people from wandering in to the building and in to resident rooms? Does this procedure extend to weekends? Also ask how residents with difficult behaviors are handled. Do they use restraints? What is their policy on psychotropic drugs? What is the community policy on handling medical emergencies?

4. Visit the community at different times on different days including weekends.

When visitors are coming, everyone knows to look and act their best. But what happens when you aren’t expected? Sometimes things look and feel different in the evening and on weekends. Does the staffing still seem adequate? Are call lights being answered promptly? Are there increased odors? Families visit more during these times so stop them when you visit after hours and ask for their opinion. What works well and what doesn’t at this community? Most of them will be happy to share their experience –good or bad – with you.

5. Do the residents seem content and cared for?

Where are the residents as you tour the facility and what are they doing? Are they engaged in activities or enjoying a meal in the dining room? Do they look clean and well cared for? Are they dressed in clothing appropriate for the time of day and temperature? Is the interaction between staff and residents kind and respectful? Does staff greet each resident by name? Does the staff make eye contact with you as you tour? Are residents asleep in wheelchairs circled around the television or the nurses’ station? Depending upon the time of day that is a red flag to pay attention to when evaluating a community. Speak with the residents and ask them how they spend their days. Do they have the opportunity to go out in to their community to restaurants, movies or church? Is there a resident council that meets regularly with staff? Ask to see minutes of the last resident council meeting to see what issues are of concern to residents. Is the dining room clean and well maintained? Are healthy snacks and beverages available?

6. Survey says…

Nursing care communities are heavy regulated at the state and federal level. That means you have access to a lot of information about the community’s performance. Ask to see the book where their last state survey results are kept. They have to keep a copy for visitors to review. Your Care Advisor can also help you sort through the various rating systems when you narrow down your choices to pursue.

7. Ask questions about payment and incidentals.

Fortunately, payment in a nursing care community isn’t quite as complicated as assisted living can sometimes be. Just be sure to ask what is covered in the monthly fee and what incidental charges may be added on. Some charges and fees to ask about include phone services, cable, the beauty shop, and planned activities and community outings.

Download Skilled Nursing Tips (PDF)