Nursing Home Questions and Answers

All the information here is general information and does not refer to a particular resident or particular nursing home. And I am sure it is not complete; but it may be used as a guide.

But I would like to emphasize that nursing homes have medical care comparing to assisted living facilities, which have no medical care. If a medical treatment is needed in an assisted living facility a home health agency

Are there licensed nurses, (RN or LVN), on dayshift/nightshifts?

There should be licensed nurses on all three shifts available: if not “in house,” then on call.

Is the same caregiver responsible for the same residents every day? Except her/his days off.

It should be. If a resident has the same caregiver each shift, the caregiver knows the residents well. It benefits the residents and the consistency of the care may improve the quality of life of the residents, as well, for early recognition of the resident’s health changes. And often in nursing homes the caregiver is the only person who interacts with the residents, especially when the residents has not regularly visitors.

Does this facility use staff from a temporary employment agency?

Temporary workers do not know the individual resident’s and their special needs, except if they work a longer time in the facility. Over reliance on temporary staff can cause problems. Occasional backup from an agency may be necessary, however, something is wrong if a nursing home routinely relies on temporary workers for regular staffing.

What is the resident / caregiver ratio?

A ratio means the number of residents each caregiver has to take care of.

There is no law to follow but a national residents advocacy organization recommends direct caregiver ratios of average 1:5 to 1:7 on days, 1:10 on evenings, and 1:15 on nights. One caregiver for 5, 7, 10, 15 residents, respectively.

But be aware that this ratio cannot be used for all care of residents. If a nursing home facility has more residents with respiratory problems, catheter care, or other treatments in using a high amount of time and staff, staffing will vary on the kind of care the residents need; recruitment; staffing policies at the facility, etc.

For more information about staffing: Ratios and Staffing

In time of special care needs for your loved one talk with the facility and you may bring your own caregiver from an outside home care business. Some nursing homes work together with a home care agency.

Is there a registered dietitian available?

In general, there is no dietitian on staff. But there is a supervisor for dietary needs available. And a licensed dietitian comes regularly to assess the needs of residents for their special diet, at least every month and after admission of new occupants.

Are physical therapists, speech therapists, and occupational therapists available?

Yes, in general, especially if the nursing home has a rehabilitation unit. If the nursing home has no rehabilitation unit then it may be that there are no therapists on staff. But if you like to have someone come into the facility and provide treatment for your loved one, ask your loved one’s physician for a prescription for this kind of therapy. The next step is to ask the facility if they work together with some therapists. If not, a therapist from a home health care agency may come and give the treatment. The physician may send the prescription to the home care agency.

One-bed or two-bed room? How are residents matched as roommates?

Rooms in nursing homes often have two beds in one room. If you share the room with a mate, the staff should try to match interests, healthcare needs, ability to get along, and other characteristics.

What happens if roommates do not get along?

Residents should have some recourse if they cannot get along with their roommate. The staff may suggest another roommate or move you to another room, or might arrange a meeting between the roommates and their families and a social worker to try to resolve the conflict. See also ombudsman/advocacy.

Are there other residents here who might be interested in socializing?

Very often after a time the staff becomes aware of other residents who may be a good social match for you or your loved one.

Is there a family advisory or support group?

There should be. Family groups can help residents and their families adjust to facility life.

Is there a resident council?

Nursing homes have a resident’s council where residents routinely meet with the staff (mostly under the umbrella of the activity department) to discuss care and the life inside the nursing home. It is a state requirement to offer a residents council.

Is there a family council?

Many nursing homes have family councils so families can routinely communicate with staff about care and quality of life issues inside the nursing home to improve different services.

Do families and residents meet routinely with the staff to discuss care concerns and share ideas to make the life even better?

You should be able to meet regularly with the staff to discuss care concerns and share ideas to make you nursing home life even better. (Not every suggestion is applicable and not every suggestion is possible to implement). Be reasonable: cooking just the food your loved one likes is not possible. The nursing home has to take care of many residents.

What do residents usually say about the food?

The staff should know if residents like the food in general or not. With so many food restrictions for residents in nursing homes it is sometimes not possible to serve the food the family think it is the best one, especially if the physician orders the food restriction.

What happens if a resident does not want to eat a particular meal?

Residents should be given alternative choices. Ask what substitute food are available to residents for this particular day.

Are residents able to request special food items?

Residents should be able to make special requests but sometimes it is not working, and sometimes it is not the right food for this person. Families may be able to bring special food to the residents, after consultation with the nurse.

In larger facilities more than one meal at each mealtime is available.

In smaller facilities the staff may suggest something else and prepare it for you.

Can I taste the food and observe a meal?

The staff should let you taste a meal prepared for residents. Watch meals being served. It should look and smell appetizing.

Is there a program to help residents regain their physical abilities?

There should be an organized program; sometimes it is part of the daily activities.

And if the residents have physical therapy then a daily routine is set up with the therapist.

Are residents assisted to the bathroom when they ask?

Oh, yes, the caregivers should assist residents to the bathrooms. And if needed: there should be set up a routine schedule to go “automatically” every few hours to the bathroom with incontinent residents or at least remind the residents if they are able to do it on their own.

Are there grab bars and other safety devices in resident’s bathrooms?

There should be, and state law requires it.

How does the staff help residents maintain privacy and dignity when they assist with bathing and other kind of care?

Staff members should tell you how important it is for them to maintain privacy and dignity of the residents, especially when a resident is bed-bound and need routinely changes with incontinent supply. They should have an orientation program to teach new staff how to preserve a resident’s dignity when providing care.

How long do residents usually wait until their emergency call is answered?

Although staff members cannot always respond immediately, residents should not have to wait long for help. If you have the chance to tour the nursing home -often it is a transfer from the hospital without you touring the nursing home at all- make a point of watching when you tour the nursing home facility to see if there are lots of lights on, or if you hear the call button sounding, how quickly the staff responds. And be aware: there are probably 60 to 80 residents there.

What activities are available?

There should be a variety of activities to interest a variety of people. Many nursing homes offer craft classes, music groups, exercise groups, small discussion groups, games like bingo and bunko. In addition, individual activities, such as reading or playing cards, should be encouraged. But there should be a consideration that activities are also set up for people with different cognitive abilities.

How frequently are activities offered?

Activities should be offered frequently so residents can socialize, explore new interests, and occupy their time. Occasional evening and weekend activities should supplement traditional mid-morning and mid-afternoon events.

Are religious services conducted for the residents? How often?

Religious services should address the needs of residents with different denominations. They should be offered frequently enough to meet residents’ interests and needs. Ask about services that meet the requirement of your loved one.

Can residents leave the facility for an outing or other leisure activities?

There should be opportunities for an occasional outing. Families should be encouraged to take their loved one out to a favorite restaurant, a wedding, or family celebrations, going to church, synagogue, or other places of worship but please sign out when you leave and sign in when you return.

Do residents have the freedom to say no when they don’t want something or would prefer not to do something?

Sometimes a resident does not want certain medical treatments, or prefer not to participate in some activities. They have the right to say no. Treatment decisions should be discussed, first with the residents, then with the residents doctor, family, and probably staff (nurse), so everyone understands what the residents want, and I repeat: what the residents want.

In my experience: residents often do not have all information to make a contentious decision, even if still able to do so.

How does the staff help residents who are depressed?

Staff members should be able to describe a number of techniques, such as talking frequently with the residents, trying to involve them in activities, spending extra time just with this residents, reporting to the supervisor, etc. But be aware all medications for depression have quite severe side effects: Just to name one side effect: drowsiness, which lead to fall risk.

Where is the Ombudsman, Advocacy for the facility? Does the Ombudsman, Advocacy visit regularly?

Nursing homes have an ombudsman, advocate who is part of the official state ombudsman, advocacy program. Ombudsman, advocacy, investigates and attempt to resolve concerns raised by nursing home residents, their families, or their friends. The staff should be able to tell you who the ombudsman, advocacy is and when he or she usually comes to the nursing home. Family members may also call the ombudsman, advocacy office any time with any concern, and the phone number should be available and visible, hanging on some wall inside the facility.

Additional information:

Nursing homes are regulated by federal and State (Health Department) and mandate a licensed nurse 24 hours/day, and specifies an RN at least 8 hours/day on premises. Nursing homes receive federal/State funds as Medicare/MediCal.

Each State has the own requirements. California mandates daily nursing staff coverage of 3.2 hours per patient day (PPD) which means every resident/patient receive at least 3.2 hours of nursing care daily. If there are residents/patients with enhanced medical needs the nursing home is bound by law to meet the needs of these residents/patients what may result in increased nursing staff.

Nursing homes (SNF) are required to provide dietary services monthly for new assessments; included here is the control of resident’s weight and reaction to food (skin), etc.

At nursing homes, there is a formal care plan conference after the admission of a resident/patient and must be held by law at least every three months> From my experience care plan conferences are held regularly if the health of a resident/patient changes.