Whether you're there for rehab after surgery or due to a lifelong illness, here's what makes a nursing home great.
When Sue Johansen's husband, Chris, 57, was in a catastrophic car accident in 2014, she had just 24 hours to find a good nursing home in the San Francisco Bay area that could handle his rehabilitation. Sue Johansen was unusually qualified to do the search. A senior living advisor with A Place for Mom, a Seattle-based senior care referral service, she has done legwork for countless families in need of a top-notch facility for loved ones who are dealing with a host of health issues.
With her husband's discharge looming, Johansen, 54, refused to be rushed. "Everything unfolds day by day, and you're dealing with new information and ill-equipped [to do so]," she says. She stretched the search to six days until she was satisfied with the facility that suited Chris' needs.
Whether the goal is a nursing home for short-term rehabilitation following an accident, round-the-clock care after a stroke or long-term care for a disabling condition like the late stages of Alzheimer's disease, great nursing homes all have five qualities:
They make it all about each resident. A genuine focus on each person as a unique individual is critical, says Susan Reinhard, senior vice president of AARP's Public Policy Institute. A resident should never be defined by her illness or inability to grasp a fork. Treating residents like anyone else helps them feel like they're in a safe, home-like environment.
The right nursing home can be a wonderful place, says nurse practitioner Barbara Resnick, a professor in the department of organizational systems and adult health at the University of Maryland School of Nursing and past president of the American Geriatrics Society. "It's all about the love," she says. "It can be a million-dollar place with the newest renovations, but if there is no love, it's not a home."
When you visit prospective nursing homes, says Resnick, observe whether staffers greet residents and visitors with a smile. "The staff should be happy, and if the staff isn’t happy, you have a problem. Either you love working with older adults or you don’t. And if you don’t, it doesn’t make a happy home," Resnick says. The Alzheimer's Association recommends asking the manager what the staff will say to a person with dementia who constantly requests to go home. The answer indicates how the staff responds to challenging individuals.
Residents can make choices. They're not ordered to go to sleep and wake up at certain times, and they have a say about what they can wear, the type of food on the menu and where they can eat. "I should be able to wear my own clothes and not a gown," Reinhard says. "Does everyone have to get up at 7 a.m. if that's not what they did their whole life? When it comes to meals, there should be a nice place to sit and be with others." Ideally, for example, residents will have the choice between a big cafeteria and a smaller dining room. Some residents like to socialize at mealtime; others prefer to eat quietly by themselves or with one or two others at most. When visiting prospective facilities, shed light on this by asking: "Will Dad be able to share a meal with his family in private?" and "Can Mom eat alone if she feels like being left alone?"
There are lots of nurses and other professionals. There should be plenty of professionals, from physicians to registered nurses, family counselors, certified nursing assistants and aides, "especially for someone with pain medication needs or someone who requires a feeding tube," says Sue Johansen. Residents in a nursing home to rehab after a hip replacement, for example, will need regular physical therapy tailored to the surgery; a stroke patient, on the other hand, may need a variety of specialists from a speech therapist to an occupational therapist in addition to ordinary nursing care.
Adequate numbers of medical staff can also help stave off trips to the emergency room. "Let's say you were dehydrated," Reinhard says. "Ideally, you could get IV treatment in the nursing home and not get shipped to the hospital." In a study published March 24 in the Journal of Post-Acute and Long-Term Care Medicine, researchers found that almost half of all long-stay nursing home residents identified through records at Wishard Health Services (now known as Eskenazi Health Services) – a large public health system in Indianapolis – made at least one trip a year to the ER. That not only increases the risk for infection in seniors or people recovering from surgery, but adds stress for people with conditions like dementia.
They offer flexible extended visiting hours. The best nursing homes offer open visiting hours. "That's something worth exploring, particularly if it's important to the family member," Resnick says. "Some nursing homes will help facilitate an overnight stay for you. So, say mom or dad had surgery or is sick. How well will the nursing home adapt to that? Will they bring in a cot for you? Is there a special room you could use?"
Plentiful and meaningful activities are offered. Bingo can be fun, but mindless games shouldn't dominate the daily schedule. The best nursing homes offer myriad social, physical, interactive and educational activities and leave it up to residents to make choices. Is an outdoor area available for walking, eating or visiting family or friends? If your loved one has a disability, are activities offered for him? Some homes offer yoga classes for those in wheelchairs, for example. Will a staff member take someone in a wheelchair outside when a family member can't come?
Exceptional homes give residents opportunities to engage in the meaningful tasks they once did at home. They might help deliver mail, or bring water pitchers to residents' rooms, or read to others.
Some nursing homes bring in dogs or cats from local adoption or pet therapy groups. Others offer volunteer days, where community groups like the Boy Scouts visit. Or residents may be able to tutor young people in reading or sewing or model building. "For some, time spent in nursing homes is actually the best time in their life," Resnick says. "It's a community. That's what you really want to feel when you walk in there. It's a home."