Published April 23, 2001, Pawtucket Times          

           It isn’t easy operating a nursing facility these days.

           The high turn over rate of certified nursing assistants has drastically impacted the quality of care provided in facilities.  And this direct care staffing shortage is also financially hurting facilities too, reducing their financial stability, even pushing many towards bankruptcy.

          According to the Rhode Island Health Care Association, eight out of the state’s 105 nursing homes have filed for Chapter 11 Bankruptcy, two are currently in state receivership and two more were recently ordered closed by the Department of Health.

         In these difficult financial times for nursing facilities, especially with a state-wide shortage of certified nursing assistants, youmusts become a better shopper when seeking the most appropriate nursing facility to place your loved one.

       “Until there is a health crisis, families don’t often think about nursing facility care until it’s too late,” states Roberta Hawkins, executive director of the Alliance for Better Long Term Care who serves as the state’s ombudsman on the behalf of 10,000 Rhode Island nursing home residents.  “If  it’s possibly, just plan ahead,” Hawkins recommends.

      “Your state health department provides a comprehensive list of nursing homes and their survey results to help you determine if the facility is reputable,” states Hawkins.

       According to Hawkins, word of mouth or personal recommendations from family, friends, neighbors, hospital discharge planners, and her nonprofit advocacy group about a nursing home’s care are key bits of information to determine if the facility is well managed.

        “The Alliance also offers a free phone help line to assist matching the particular needs of a person with a specific facility,”  Hawkins adds.

       With more than 20 years of experience under her belt in assisting families find the right nursing facility for the loved ones, Hawkins gives simple tips on selecting a facility.

        Hawkins suggested that a need for upgraded services for residents requiring intensive medical care, special rehabilitation therapies and dietary requirements, along with religious and cultural needs should also be taken into account before selecting a facility.

       Location should not always be a deciding factor in selecting a nursing facility.  Carefully choose a facility that meets your loved ones medical, personality and social needs.

       In many cases, this critical decision is made only for convenience of family members or visitors.  If an elderly spouse can not drive, make sure that the selected facility is on a bus line.  Keeping a married couple close together is very important for their psychological well-being.

       Always have the older person in need of skilled nursing care, actively participate in choosing a facility even if they can’t physically visit the site.  Family members can also provide this person with brochures and admission materials.

      Don’t choose a facility on the basis of a beautiful physical exterior, fancy rugs, or glittering chandeliers, Hawkins says.  When visiting a nursing facility, always observe how staff members interact with residents and each other — look for laughter, a pleasant environment, and a strong activity program.

       For those frail residents who are bed bound, look for a stable nursing staff.

       Ask yourself, is the facility’s environment cheerful in appearance and clean?

        Are the bedrooms warm looking and do they reflect the residents individuality?  Or do they all look the same, like hotel rooms.

        Find out if residents are allowed to bring in personal belongings such as chairs, tables, lamps or even a television set into their rooms.

        For those persons who always loved nature and being outdoors, find out if the nursing facility has an outside area for sitting or walking.  Determine if this area is accessible to a wheelchair bound person who might want to roll outside to listen to the birds.  This simple amenity is very important.

        When touring a facility determine if a dining room is available for eating meals and space to allow residents to socialize with each other and participate in activities.

         Is there a real working activities room?  A resident who has always been involved in crafts and enjoys participating in group activities will want to select a facility with a well-run activities program.

         Also, be aware of how the nursing facility smells.  Sometimes you may smell strong odors of deodorants.  This might be covering up unpleasant odors.

        Listen for sounds of buzzers, rung by residents in need of help, and observe how quickly staff responds.

         When walking the halls, say “hello” to the staff you meet.  Do the staff pleasantly respond to you?  IF not, consider that they may not respond           well to your loved one.

         Walk in and talk with residents gathered in a community room.  In conversation, find out how long they have lived at the facility.  Ask if they like the facility and are they respected as individuals by staff.

         If you see residents in restraints lying or sleeping in a chair or wheelchair, this may be a red flag for poor care.  The facility may not have enough staff to allow the residents to lay down in bed for a nap in the afternoon.

         After you locate your facility, “put your name on the waiting list,” Hawkins recommends, even if the nursing facility admissions will occur months later.

         For those afflicted with Alzheimer’s and related dementia, it is wise for these individuals to be admitted earlier in the disease process to get them acclimated to the facility and for the staff to learn more about the resident’s habits, likes and dislikes.

        Herb Weiss is a Pawtucket-based freelance writer covering aging, health care and medical issues.  This Column appeared in the Pawtucket Times on April 23, 2001.