Hi, I’m Paul.
Deciding to enter a nursing home and then choosing the right one can be very difficult—both practically and emotionally. This page provides some suggestions for selecting the right nursing home for residents’ specific needs and for making sure that residents receive good care once they have moved into the facility.
If you have questions about the nursing home process, I’m here to help. There is no commitment and we provide free initial 15-minute phone calls. We look forward to meeting you.
Tour the Facilities
When to visit
Activities and Events
Staff and resident interactions
Carefully observe how the staff and the residents relate to each other. By paying attention to the way the workers interact with the residents, you can determine if the staff is caring, sensitive and responsive to the needs of the resi–dents. Another indication of the relationship between the staff and the residents is the appearance of the residents. Just as the appearance of the home indicates whether it would be a nice place to live, the appearance of the resi–dents shows whether they are well-groomed, dressed ap–propriately and cared for by the staff.
Talking to Current Residents
If possible, you may also want to attend a resident council meeting. Nursing homes are required to allow residents to form resident councils to address issues that affect them.
In some homes, resident councils include family members. The administrator or the social services director should be able to tell you how to get in touch with the resident coun–cil to determine if you may attend a meeting.
Meeting with the staff
After visiting unannounced, it would be wise to arrange a mutually convenient time to meet with some of the staff. Those at the nursing home with whom you want to meet are the administrator, the director of nursing and the social services director. These members of the staff should be willing to meet with you to go over the home’s policies. The staff should also be willing to discuss the home’s inspection reports openly and honestly.
Nursing Home Regulations
Georgia nursing homes are regulated by the government in two ways. First, nursing homes obtain their licenses from the Department of Human Resources’ Office of Regula–tory Services (ORS). Then, the Centers for Medicare and Medicaid Services (CMS) and the Georgia Department of Community Health certify and reimburse nursing homes participating in Medicare and/or Medicaid programs.
To be licensed or to receive Medicare or Medicaid reim–bursements for services, nursing homes must meet and maintain certain minimum requirements found in federal and state regulations, which promote and protect the health, safety, welfare and rights of residents.
To ensure compliance with both federal and state regula–tions, the ORS staff inspects nursing homes. Generally, the ORS staff inspects a nursing home before it begins operation and then once every year. If violations or defi–ciencies are found, the ORS inspector makes a record of the infractions. The nursing home must then file a plan of correction demonstrating how it will correct each viola–tion. After receiving the plan of correction, the ORS staff usually conducts a follow-up inspection to make sure the nursing home has remedied the deficiencies.
During an inspection, the ORS staff looks at the care given to a representative sample of residents at the home.
They do not inspect the care given to every resident, but they do look at the physical condition of the home, they talk with residents and staff, they observe the activities at the home and they review medical records.
If the ORS staff inspector finds that a nursing home is not meeting regulatory requirements at any time, the govern–ment can revoke the home’s license and reimbursement or impose another sanction, such as a fine. Any imposed sanctions against a nursing home are based upon the defi–ciencies recorded in the inspection reports.
Inspection Reports
The Medicare/Medicaid Statement of Deficiencies and Plan of Correction and the Report of Licensure Inspection identify each violated regulation as a deficiency. For every deficiency, a summary of the facts detailing how a particular regulation was violated is provided. The home’s plan of correction is also detailed. If the facility disagrees with the cited deficiency, it may dispute the findings.
If a complaint is made against a nursing home, the ORS staff will investigate the allegations and make a Complaint Investigation Report. If no violations are found, a report is still made to reflect what steps were taken to investigate the complaint.
All inspection reports and cover letters accompanying them are public information. Any person may read these reports and obtain copies of them. These reports offer a great deal of insight to a person in the process of selecting a nursing home.
The ORS also provides lists of all nursing home facilities during the past month. The list should detail whether any deficiencies were found. Information on obtaining these documents are listed at the end of this page.
Interpreting Inspection Reports
The statement of deficiencies and plan of correction
For nursing home facilities receiving Medicare or Med–icaid, the Statement of Deficiencies and the Plan of Cor–rection form (2567) shows violations based on failures to meet certain regulations.
To read the form, start on the left side with the identification number used by inspectors (ID Prefix Tag Number). The federal regulation violated is cited next. Then, there is a summary of the topic of the regulation. Finally, the summary of facts supporting the deficiency finding appears under the citation to the regulation.
On the right side of the 2567 is the home’s plan of correction for each deficiency. A statement disputing the deficiency may also be there as well.
The nursing home federal regulations are found in the Code of Federal Regulations (42 C.F.R. Part 483). The Code may be found in law school libraries, the State Law Library in Atlanta and online at the Government Printing Office website (www.gpo.gov).
The report of licensure inspection
This report has a format similar to that of the 2567. How–ever, it also contains deficiencies based upon a facility’s failure to meet state licensure regulations. These reports are made for every nursing home licensed in Georgia, regardless of whether they receive Medicare or Medicaid.
How to Use the Reported Information
Seriousness of deficiencies
The severity of a deficiency or violation is an indication of the harm that could come to residents. Likewise, the number of deficiencies and the number of residents adversely affected by them give an indication of how widespread problems are in a particular home.
While all nursing home regulations are important, some are more directly related to health, safety and welfare of residents. For example, it would be of greater concern to find a problem with medication errors in a facility than one with failure to keep patient statistics properly, as administrative requirements are not directly related to patient care. Also, close attention should be paid to violations of regulations that are designed to protect patients’ rights.
Further, if a nursing home facility has had fines or other sanctions imposed against it or if it has been threatened with license revocation or decertification by Medicare or Medicaid, you should carefully consider those infractions.
A facility’s plan of correction sheds light on its ability and willingness to solve its internal problems and provide good care for residents. If a nursing home has been cited repeatedly for the same or similar deficiencies in the past, its commitment to addressing and fixing its problems should be questioned. This is especially true if the facility files a similar plan of correction in response to the violation each time. If a facility is cited over and over for numerous or serious deficiencies, this may indicate real problems within the home.
Isolated events or widespread problems?
It is rare to find a nursing home with no deficiencies whatsoever. So, whether a deficiency is a one-time or a common occurrence is of particular importance. Isolated events that have been addressed through a well-thought plan of correction indicate a high level of responsiveness on the facility’s part. Problems that present themselves repeatedly and problems that have the potential to become larger as time progresses are an indication of pervasive issues within the facility.
For example, if a facility is short staffed, improper care may be or may become widespread throughout the home. As another example, a medication error rate of 16 percent reflects a broad and potentially extremely serious problem that could affect a large population within the facility. However, while a medication error rate of 6 percent should not be ignored, it is important to note that this rate is just one percentage point over the allowable federal regulation error rate of 5 percent.
Obtaining Inspection Reports
The ORS keeps copies of all federal and state inspection reports for at least three years. Any interested person can review the reports and obtain copies from the ORS by sending a written request. The request should clearly state what records are sought. The ORS may charge a reasonable amount to cover copying costs. Similarly, the CMS keeps copies of 2567 reports and must make them readily available upon request. Before releasing any re–cords, the ORS and CMS are required to delete information that would invade a person’s privacy, such as names and medical conditions.
Additionally, the federal deficiencies cited in the most recent annual inspections are reported online at www.medicare.gov by selecting the “Compare Nursing Homes in Your Area” search option. Local Social Security Administration and Departments of Family and Children Services offices also have copies of reports.
After a Home is Selected
Some residents may be afraid to voice concerns or questions for fear that they would be causing trouble. They may be worried about retaliation if they ask too many questions or complain too much. But, at all times re–member that you should feel free to ask questions and express concerns to the administrator, the director of nurses or any other supervisory staff members. Nursing home facilities are prohibited by law from retaliating against residents. There are also outside resources avail–able to look into concerns and complaints on behalf of a resident without revealing the identity of the person who made the complaint. These resources can also help with general questions. These outside resources are the Long-Term Care Ombudsman Program and the ORS.
The Long-Term Care Ombudsman
The Long-Term Care Community and State Ombudsmen take complaints, investigate the complaints and attempt to resolve the problems on behalf of the residents. Whenever possible, the ombudsmen use informal means in attempting to resolve complaints. Though the ombudsmen has no regulatory authority, they are very effective and helpful advocates for nursing home residents.
The Office of Regulatory Services (ORS)
The ORS is another useful resource for nursing home residents and their families. As discussed above, the ORS has a legal duty to investigate complaints and require facilities to take corrective actions to remedy deficiencies.
It is important to note that if ever you make a complaint with the ORS, you should follow up with the office to determine the outcome. You will want to know if the com–plaint was deemed valid. If so, it is beneficial to find out what action the ORS took to ensure that the facility corrected the identified problem. If the complaint was found to be invalid, it is still helpful to know what actions were taken by the ORS to investigate the complaint.
Before the ORS staff can discuss the findings of an investigation with anyone other than the resident involved or the resident’s representative, they must have the resident’s permission.
Local Resources
To find out more about your local Long-Term Care Ombudsman Program, contact the Georgia Long-Term Care Ombudsman Program, the Legal Services Developer or your local Georgia Legal Services Program. You may receive additional assistance by contacting your local Department of Family and Children Services office.
State Resources
To assist you with any questions or concerns you may have regarding nursing home residency, please contact the resources listed below for assistance and information.
Georgia Long-Term Care Ombudsman Program
1-888-454-5826
Division of Aging Services
2 Peachtree St. NW, Suite 9385 Atlanta, GA 30303-3142 404-657-5258
Office of Regulatory Services Long-Term Care Section
2 Peachtree St. NW, 31st Floor Atlanta, GA 30303-3142
404-657-5850 or 1-888-454-5826
Federal Resources
Centers for Medicare and Medicaid Services
Atlanta Federal Center
61 Forsyth St. SW, Suite 4T20
Atlanta, GA 30303-8909
404-562-7150