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How to choose a nursing home!

Sam Perlin

How to choose a nursing home!
ADVICE ON HOW TO CHOOSE A NURSING HOME AND REALITY! shows 271 books under "How to choose a nursing home."  Not all are on "how to choose" but a related with how to deal with the subject.

Comment:  It's a good idea to find out how many people work there and what the usual staffing pattern is. "

Reality: Impossible except by auditing the payroll books.  Looking at the daily roster at each station does not reflect the true picture.  It might show 5 CNAs on duty but one or more might be absent or sent to another station that is short.  Even if you find the CNAs it does not mean they have a realistic work load unless you know who their residents are.

Visit the nursing home at different times of the day and form a good relationship with the certified nursing aides who provide the bulk of the hands-on care

Reality:  CNAs won't talk with you in fear of their job.  If you ask a question you will get an avoidance answer. 

Shop around for nursing homes that are certified for Medicare and Medicaid.  

Reality:  This is good advice.  Medicare is for 20 free days, the other 80 days are CO-payment $100+ per day.

Comment: Medicare provides information about Medicare and Medicaid certified nursing homes throughout the United States on its Web site.

Reality:  “Medicare Nursing Home Compare" is the site. It tells the results of survey deficiencies both in care and fire safety.  Then it shows "correction" which is a plan to correct, not necessarily done, but part of the game.  Because of the high staff turnover the data has little impact on decisions.

Comment:  Medicaid does pay for long nursing home stays for those whose income and savings can't cover the cost

Reality:  When it comes to eligibility there is the Miller Trust for income over the cap and spousal impoverishment for the remaining community spouse.  Best to be poor.

Comment:  As your parent's advocate, you should know your rights.

Reality:   Impossible to know the State and Federal published  rights which are full of loopholes; change frequently.  The RIGHTS are those YOU think you should have. When you are told by facility staff that a decision is based on corporate policy you can disregard it. 


When a law is passed it usually says "the department shall make rules to correspond with the intent of the legislation."  The rules can change with proper input from concerned persons.

          Menu in the kitchen.  When questioned by residents/families it was changed to menu in the dining area with substitutes for all to see.
          Diet: A State nutritionist speaker told a resident who wanted bacon with her breakfast that it was up to the doctor to agree.  Not true.  She is her own boss and got bacon.
          Podiatrist: Only can be seen if the person is diabetic.  Not true.  Tell the doctor your foot problem, ask him to order a podiatrist if the nursing staff isn't doing their job.  If doctor won't do it pick another doctor or ask to talk with the facility medical director.
          Medical director: Each facility has a medical director who is charge of all the doctors and the care. Eighty-six percent of responding medical directors report spending 8 hours or less per week at the facility.   Diapers: Company policy might be cloth diapers to save money.  If you feel they are inadequate or dirty you have the right to demand disposable diapers or others that are more appropriate.  You only have to pay if you want a diaper that is more deluxe rather than adequate.

          Eviction: Formerly a facility could inform the family they could not meet the resident's needs therefore the resident had to be removed.  If not, the resident was sent back to the family by ambulance or cab. 


          Advocates questioned the concern.  The facility contracts with the State to provide designated services. Therefore, they should be more specific as to which needs they cannot meet and where those needs can be met.  Once the facility accepts the person they should be responsible for the continued care.  The regulations were changed so that now the facility has to identify the needs, where they can be met, see the person gets there with appropriate medical data. 

          Medication: Nursing home residents on Medicaid get unlimited prescribed drugs.  Many studies say they are overmedicated or wrongly medicated.  Family should monitor the drugs by watching for necessity and side effects.  The consulting pharmacist gives his findings to the doctor and director or nurses.  Neither one has to follow his recommendations; most don't. 

Comment:  More than half of residents don't have anyone to visit them on a regular basis for whatever reason.

Reality:   Visitors have the right to speak up on behalf of any abuse/neglect they see regardless if it is their loved one or not.  The law is specific to everybody: 



(a) A person, including an owner or employee of an institution, who has cause to believe that the physical or mental health or welfare of a resident has been or may be adversely affected by abuse or neglect caused by another person shall report the abuse or neglect in accordance with this subchapter.

      (b)  Each institution shall require each employee of the institution, as a condition of employment with the institution, to sign a statement that the employee realizes that the employee may be criminally liable for failure to report those abuses.

      (c)  A person shall make an oral report immediately on learning of the abuse or neglect and shall make a written report to the same agency not later than the fifth day after the oral report is made.

Acts 1989, 71st Leg., ch. 678, ?1, eff. Sept. 1, 1989.                   


Comment:  Community resources such as religious organizations, social workers and nursing home professional associations can provide you with general advice when choosing a nursing home.

Reality:  Forget about this.  Most don't know beans about nursing homes and what they do know usually is misinformation given out by the nursing home industry.


Comment:   Corporate always use the excuse of low reimbursement for their lack of quality care. 


Reality:  The reimbursement is based on the average money spent by the 1100 nursing homes in the State.  Averages reward the least spenders.  Example:  If one spends $100 on care and another $50 the average is $75.  The $100 loses $25, the $50 gains $25.  So the focus is to spend less to get back more.


A deputy commissioner at nursing home regulatory asked me to tell him if I ever find out how much money nursing homes really get.  Even he doesn't know.

The therapy department in the facility charges Medicare for what they do. You should be getting the report from Medicare when it pays for some of the work done.  So the nursing home is not paying for everything. 

Comment:  A family council can help everybody concerned. These councils arrange educational programs on reducing stress and even plan holiday events involving the nursing home staff. One council recognized a deserving nurse aide and also sponsored a garage sale to pay for a new garden for the residents.

Reality:  This is why most family councils don't work.  Recognizing an aide or raising money to beautify the facility should not be the function.  This should be the responsibility of the facility with the cost as an allowable expense. It is good worker relationship and property improvement.

Family councils should have a board made up of community people.  They should know where to find the real answers to problems.  They should interact with Regulatory, Ombudsman, Legislators of the facility district, Media.

But most IMPORTANT is for the families to have input to the Board with their concerns.  Telling the facility staff without board oversight usually gets the answer in favor of the facility with the wrong information.  So when dealing with facility staff made sure a copy is given to a board assigned member for follow up.


(c) Sam Perlin 2008    email:

All material copyrighted 2010 - Sam Perlin