Thoughts on Choosing a Nursing Home for a Loved One

I have been representing families in lawsuits against nursing homes since 2002. This section contains my thoughts and observations on nursing homes.

It’s a nightmare for every family to have to put a loved one in a nursing home. Many times it is emotionally devastating for both the loved one going into the home and the family members who make the decision that they have to put their loved one into the home. The reason that people fear nursing homes is that there are nursing homes that put profits over people. In other words, when choosing between maximizing corporate profit or improving resident care, the bad nursing homes choose maximizing corporate profit to the detriment of the residents.

The first thing that you should do when deciding whether to put your loved one in a nursing home is to research the nursing home. Visit the federal government’s web site at This web site provides links to general information about nursing homes, and information on over 17,000 specific nursing homes nationwide, including results from inspections of the nursing homes. If the nursing home received poor inspection scores, you need to avoid that nursing home. Although inspections are not announced, nursing homes have an idea when they can expect inspectors based on the date of the last inspection. Nursing homes tend to put on their best face when  they expect inspectors. So if the nursing home still received poor inspection scores, it is probably a bad place for you to put your loved one.

Before putting a loved one into a nursing home you must also personally visit the nursing home. I cannot over emphasize the importance of this. Most people assume that all nursing homes are the same. This assumption is wrong. There are huge differences in  the care provided at nursing homes and you need to personally investigate the home before you entrust them with the care of your loved one. Do not take the recommendation of a doctor, nurse or hospital without visiting the nursing home yourself. When you visit the nursing home you need to walk around the entire facility using your nose, eyes and ears, as discussed below.

Nose: One of the first question I ask a family who calls me about possible abuse or neglect by a nursing home is how did the nursing home smell. When walking the halls of the nursing home does the facility always or often smell like urine and feces? If the answer is yes, it’s a bad nursing home. Many people in nursing homes need assistance getting to the bathroom or no longer have control of their bowel and bladder. Good nursing homes have enough staff to assist residents to the bathroom and change residents who are soiled. Good nursing homes are kept clean and smell normal. If there is usually a foul smell in a nursing home, the facility is poorly managed and the residents are being neglected on a systematic basis. In many cases the nursing home is understaffed and the employees simply do not have enough time to provide all of the care that the residents need.

Eyes: The saying that you can’t judge a book by its cover applies to nursing homes. Some nursing homes that look new from the outside take horrible care of their residents. By the same token, some nursing homes that look old and run down on the outside take good care of their residents because they have enough dedicated staff members to provide care to the residents. You must go inside the nursing home and look around. Are the employees helping the residents or are taking smoke breaks or talking at the nurses station? Are there residents who look like they are being neglected, such as sitting in a wheelchair with urine dripping on the floor. Are there enough employees in the dining hall to assist every resident who needs assistance eating? Are food trays dropped off in residents rooms, but no one is there to feed the food to the resident? If the answer to any of these questions is yes it is a hallmark sign that the nursing home is understaffed and you should not put your loved one in the nursing home.

Ears: The environment inside the nursing home should be calm. It should not sound like a battlefield hospital. Ask the residents who can talk what kind of care the facility provides them. Ask them if it ever takes too long for staff to respond to call for help. Look for whether there are residents who are asking for help, but who are not receiving assistance.

Before putting your loved one in a nursing home you will have the opportunity to sit down with someone from the nursing home. You should ask this person pointed questions. How much money per day does the facility spend on food for each resident? At bad nursing homes they are often spending less than $5.00 per day on food for each resident in order to save money. Also ask what the staffing levels are and whether they can verify that the facility in complying with Mississippi law that requires a minimum of 2.8 hours of direct hands on care per resident per day.

After putting your loved one in a nursing home you must remain vigilant. I believe that nursing home residents who have an involved family who visits often the facility provides better care to the resident. If you have many family members living in the area, it’s a good idea to have a visitation schedule so that there is a family member visiting the nursing home on as many days as possible. But the time of your visits should not be on a schedule. Visit at all different times of the day to see what care is provided at different times of day by the different shifts. Sometimes you need to visit more than once a day. At bad nursing homes residents are most neglected on the 11:00 p.m. to 7:00 a.m. shift. You need to occasionally visit during this shift. I know it’s the middle of the night, but you have to do it to make sure that your loved one is not being neglected. The bottom line is that your visits cannot be predictable to the nursing home. If they know when you will be there, they will have the resident presentable for your visit. But what about the rest of the time? You need to get it into the minds of the employees of the nursing home there is no telling when someone from your loved one’s family might show up.

You need to be particularly vigilant at the end of the first one hundred days that your loved one is in the nursing home. Residents who entered the nursing home from a hospital are eligible for Medicare reimbursement for the first one hundred days of the residency. Nursing home make a lot of money during this period by providing a bunch of services like physical therapy, speech therapy and occupational therapy. The nursing home gets to bill Medicare for these services. But  at the end of one hundred days Medicare reimbursement expires. For many residents this leaves Medicaid as the only pay source. Medicaid reimbursement is much different from Medicare. Medicaid pays a flat rate and does not pay for individual services like therapy. The practical affect of this for residents is that they get therapy for one hundred days whether they need it or not. At the end of the one hundred days their therapy is stopped, even if they need it to continue. This means that many resident who get good care when they first go into the nursing home receive terrible care after one hundred days. Family members need to mark the one day mark on their calendars and pay special attention to the care after one hundred days. If continued therapy will benefit the resident, then demand that the doctor not discontinue it.

If things start out ok in the nursing home but later get bad, then you need to think about looking for another nursing home. There is a lot or turnover in ownership, management and employees in a nursing home. Turnover in any of these areas can turn a good situation into one of neglect and abuse. There have been many times where I have seen a good situation go bad because the one nurse’s aide who always looked out for the resident quit working at the facility. Things can go bad in a hurry in a nursing home, so you must keep a close watch at all times.

And by all means, if there is a problem with the care that your loved one is receiving in the nursing home you need to complain. Complain to the shift leader, the director of nursing, the administrator, the Department of Health and the Attorney General’s office. Complain verbally and in writing and keep a record of who your complaint was to and what they told you.