Selecting a Nursing Home

Making visits to several nursing homes before you settle on one is a great way to figure out what type of facility will be the best fit for you. You would never buy a home without first taking a tour of it, and the same practical philosophy holds true for a nursing home. When making your visits, it is important to respect the privacy of the residents and to not interfere with the care being given by the staff.

The activities schedule should be posted. Planned events and the activity level of the residents give an indication of how engaged the residents are and whether the staff encourages meaningful interaction. Keep in mind that resi–dents can choose to abstain from participating in activities.

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.

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.

To make good use of the inspection reports, be sure to look at several items. It is important to pay closest attention to those aspects of the report that deal with the health, safety and welfare of residents.

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.