Reality checklist for the caregiver shopping for a nursing home

Elizabeth Flood, HCA, Retired

“Often a nursing home placement is done at a time of crisis, and families are then not good shoppers.”
James Wessler, Chief Executive Officer for the Alzheimer’s Association of Massachusetts and New Hampshire.

As a former private health care aide (HCA) with over 25 years of experience, 13 of which were spent working for a client who resided in a nursing home, I have seen too many families become disillusioned with the poor quality of care offered to their loved ones after a placement decision was made when they were ill-equipped to make the best choice. DO YOUR HOMEWORK, and below are some tips to help you.

When touring nursing homes, leave your rose coloured glasses at home, and try to take in the sights, sounds and smells with your eyes, ears and nostrils wide open. It would help you adjust your expectations to the sad reality that has become long-term care today, and it would also help you avoid disappointments as you care for a loved one for whom you may not have any other alternative but admission to a nursing home.

In my early years of working daily at the nursing home, my client’s room became the preferred stop during weekly tours of the home given by volunteers. Her room was a wise choice on the part of the volunteers, because it was always tidy, and despite its limited space, I made sure it felt airy, warm and inviting. Not only did I take special care to keep our area clean, but my client’s clothing was never soiled with food bits, and she never smelled of urine on my watch.

At one point, I asked a volunteer to stop using my client’s living space as a showroom, because I felt she was deceiving visitors into thinking that the standard maintained for her personal care, and the state of her room, was the same as that provided by home staff to all the other residents on the floor. It also bothered me to have the volunteer let on that my client’s knitting supplies were provided by the home as it only added to the deception. Budget restraints being what they are in nursing homes, residents can’t be kept supplied in whatever materials they require to pursue their favourite hobbies while in care. I was glad when the tour guides found another room to show visitors as I didn’t want to have any further part in giving people the wrong impression.

If a caregiver asks to see another room than the designated show space on a home tour, it might be disallowed on the pretext that special permission from a family would be required, but even in this case, there is nothing preventing you from paying particular attention to the state of the other rooms on the tour, and the appearance of their occupants. In many cases, the differences between a show room and the others will be very obvious to you.

Most nursing homes offer the same type of food served in hospitals. It’s never good, in my opinion, and in my lifetime I have never heard anyone praise hospital food. I read in the paper recently that the residents of a Toronto nursing home filed a class-action lawsuit against the home for serving them food of an unacceptable quality. Good for them! No changes will ever happen if no one reports problems with the food.

I remember one occasion when the home’s administration entertained dignitaries in the main dining room where seafood hors d’oeuvres were served in abundance and the wine flowed while the residents ate canned beans mixed in with green beans, also canned. Ask about the quality and the variety of the food at a home you’re considering. Ask about the cleanliness of the dishes the food is served on. If a loved one is diabetic or has allergies, will any precautions be taken?

A nursing home may provide some toiletries. Ask what those may be. If your loved one has preferences, you may have to ensure a supply of products, all of which should be labeled. If you notice that your supplies disappear too quickly, they might be used for other residents as well, forcing you to do what you can to discourage the practice.

Dentures need to be removed at night to prevent gum sores. Ask if home staff will take the extra step to soak dentures in a cleaning solution overnight. A few months before my client passed away, her dentures mysteriously disappeared. They were nowhere to be found, and one staffer even accused me of purposely misplacing them! Days later, my client was wearing her dentures when I arrived at the home. No one could tell me where the dentures had been, but I suspected they might have found a home in another resident’s mouth. If your loved one wears dentures, pay attention to their dental hygiene.

My client also required oxygen, more regularly during the last couple of years of her life. Ask about home staff expertise regarding the provision of oxygen and proper care of the equipment. Does the home use an external service to ensure that the equipment is functioning properly at all times? In the event of a malfunction or a shortage of oxygen supply, how quickly would the home respond to this type of emergency situation?

Most seniors bruise easily, and special care is required when handling them or helping them with a transfer from chair to bed or vice versa. My client was often bruised unnecessarily and I made sure that her bruises were recorded on her medical chart. Staffers gave her black eyes because they were too rough with her when administering eye drops, and they also caused serious bruising of her arms when they transferred her too briskly in my absence. Bruising of the residents in any nursing home is not allowed, and this is one issue for which the Ontario Ministry of Health inspectors have the authority to intervene provided of course that the information about the bruises has been recorded.

I should mention that the reason I was able to ask home staff to record events in my client’s medical file was because I had also been appointed as one of her co-power of attorney authorities for personal care. If you hire an external service to help care for your loved one in a home, it might be helpful to arrange for your private help to share this type of authority. This may well be the best tip I can pass on as many families may not be aware that it is possible to appoint a co-power of attorney authority for personal care only. Based on my experience, that legal document became THE essential requirement to communicate and interact with nursing home personnel. My client knew what she was doing when she planned for her golden years!

Bed sores may occur in residents who are bedridden, but those can be avoided with regular repositioning of the sufferer by staff. Ask how many times a bedridden patient will be moved daily if this situation applies to you. If your loved one already has bed sores, ask what the home is prepared to do to treat and prevent an aggravation of the problem.

According to recent news reports, nursing homes are fast becoming a dumping ground for residents with a variety of serious conditions. Existing staff are not always adequately trained to care for these individuals. For example, Methicillin-resistant Staphylococcus Aureus (MRSA) and Clostridium difficile colitis (C-difficile), are two severe and potentially life-threatening infections occurring most frequently in healthcare settings. If you notice home personnel gloving and gowning to care for a resident, an infectious disease is likely the reason. If your loved one is assigned to a room close to an infected resident, inquire about the necessary precautions the home is prepared to take at all times to prevent contamination.

Violence caused by residents who suffer from dementia is also on the rise. It is far more common than you think. One recent televised report stated that there were 1,788 incidents in 2010. The statistics included everything from shoving and pushing, to choking, punching and even sexual assaults. After an analysis of the available data, the reporter concluded that the rate of assault in long-term care facilities is four times greater than in the population at large. What is the nursing home you are considering prepared to do to protect you and your loved one from potentially violent residents suffering from dementia?

You need only google “dehydration in nursing homes” to learn that it is a serious problem in long-term care facilities everywhere in North America. Experts and researchers involved in current studies write that inadequate staffing and lack of professional supervision is the most significant contributing factor to this completely preventable problem of dehydration in nursing homes. As in the case of malnutrition, dehydration is a common sign of nursing home neglect that can lead to serious medical issues such as urinary tract infections, bed sores, pneumonia, confusion, disorientation and death.

The potential for death resulting from dehydration should not be taken lightly. On October 8 and 9, 2012, Ottawa Citizen writer Pauline Tam reported on stories she investigated about three elderly women who died from dehydration after they were admitted to “interim” long-term care facilities. Will your loved one get help with drinking the recommended fluids during and in between meals? Will the task of monitoring your loved one’s intake of fluids be assigned to the kitchen help or a full-time medical professional employed by the nursing home?

There are many more questions you should be asking when you tour a nursing home on your list of possibilities, but I believe the most important one is: “How often will your registered nursing staff be checking on my mother, father, wife or husband during a shift? If you find the response unsatisfactory, visit often.

More importantly, remember that just because the Ontario Ministry of Health dictates the rules and regulations to be adhered to by all nursing homes in the province, it is not a guarantee that the home you select will comply. BE VIGILANT.