Selecting a nursing home

Leah Beth Ward

Nov. 2, 2009 (McClatchy-Tribune Regional News delivered by Newstex) -- YAKIMA, Wash. -- Picking a long-term care facility for an elderly parent or relative is a complicated consumer project, experts say.

While there's plenty of advice and information to help with the decision, the work comes with wading through it all and advocating for your family member.

"You have to shop and you have to advocate," said Karen Hyatt, vice president of Yakima-based Hyatt Family Facilities, which owns a chain of nursing homes, assisted-living centers and adult family homes around the state.

"Health care is not a passive game anymore."

The good news is that there are many options in Yakima County. They include private-pay assisted-living centers; facilities that specialize in dementia; smaller, more intimate adult family homes that accept Medicaid; and skilled nursing facilities that offer short-term or longer-term care for those with special medical needs.

Assisted-living centers are also called boarding homes even though they are often high-rise apartment complexes, not single-family residences.

Experts say it's important to distinguish appearance from reality when assessing a facility. Lots of potted plants and artwork don't necessarily translate into quality service or care.

"People often make choices based on aesthetics, but remember, it's the marketer's job to get people into beds," said Keri Pollock, spokeswoman for the Alzheimer's Association Western and Central Washington state chapter in Seattle.

Baby boomers, in particular, are susceptible to the fluff because they want mom or dad to have the best.

"You don't know how many times I hear, 'Mom, it's so beautiful,'" said Stacy Kellogg, the regional long-term care ombudsman who works for the Yakima Valley Farm Workers Clinic in Yakima.

Kellogg recommends that shoppers give a lot of weight to state surveys and inspections as well as complaints that have been filed against the facility. All facilities must make them available to anyone who asks.

"Find out what the issues were. Were there medication errors? It allows you to go in with your consumer eyes wide open," Kellogg said.

It can be difficult to figure out exactly what level of care your family member needs. The facility wants to sell you a bed, but you want to buy quality of life and peace of mind.

At boarding homes, where residents have considerable independence, family members need to know up front what circumstances might lead the owners to say they can no longer care for your parent.

Said Kellogg: "You want to ask: 'What happens if Mom goes on Medicaid? At what point would you no longer be able to provide care?'"

Some facilities, for example, won't perform what is called a two-person assist, that is, providing two staff members to help a resident get out of bed.

Another tool is the federal government's Medicare Web site, called Nursing Home Compare. It's a five-star rating system taken from state surveys and inspections, which are conducted about every 18 months.

Hyatt cautioned that the site can be misleading because it's not up to date. For example, when a nursing home is cited for problems -- the technical term is "deficiency" -- it has the right to appeal. The state may then drop the negative finding, but that doesn't make it onto the Web site until many months later, Hyatt said.

Surveys are also subjective, she said: "There aren't a lot of ways to take that subjectivity out."

The best subjectivity is your own point of view. Kellogg and Hyatt both say there is no way to choose a facility without visiting at least once.

Watch how caregivers interact with residents. Talk to other visitors you might see in the common areas. Eat a meal. Check out the rehabilitation facilities.

Mandy Trujillo, community relations coordinator at Highgate House in Yakima, said it's wise to find out how a facility treats its staff by talking to the caregivers as well as the administrators.

"How they treat staff is going to be reflected in the quality of care," Trujillo said.

Finally, involve your loved one in the decision, advised Kellogg.

"If they can be part of the process, that's great. Often times people feel things are being done to them."

That's not always possible, especially when the parent is being discharged from a hospital to a nursing home and decisions are made rapidly.

Even then, however, Kellogg said it's reasonable to ask for some time to make the right choice.

"It's an overwhelming situation already, and on top of that your mom just lost her independence. Hospitals should be respectful of this."

--Leah Beth Ward can be reached at 509-577-7626 or lward@yakimaherald.com.

Types of long-term care facilities

There are three types of long-term care facilities licensed in the state of Washington:

--Nursing homes are the only type of facility required to provide 24-hour supervised nursing care, specialized therapy services and nutrition management. Licensed nursing homes are rarely called "nursing homes," however; often they are called rehabilitation or care centers. Ask what type of license the facility has. The cost of staying in a nursing home can range from $3,000 to $6,000 per month. Most of the time, residents in nursing homes share a room with another resident.

*Boarding homes (often called "assisted-living" facilities) are an option for a more independent population. These facilities provide room and board at a base price and personal care services at additional cost. Those services include assistance with the activities of daily living such as bathing, dressing, and medication management. Boarding homes are not required to provide nursing services. The cost of a boarding home ranges from $1,500 to $4,500 per month. Many boarding home residents have a single room or apartment; some also have roommates.

--Adult family homes are residential homes licensed to care for up to six residents. They provide room, board, laundry, necessary supervision, assistance with the activities of daily living, personal care, and social services, if necessary. The cost of an adult family home ranges from $1,500 to $5,000 per month. Single and double rooms are available.

-- Source: State long-term care ombudsman

Tips on picking a nursing home

--Visit at least three facilities in order to make comparisons.

--Talk to staff members, taste the food, participate in activities.

--Look for staff members who interact well with residents.

--Once you decide, visit at least one more time, preferably unscheduled and at night or on the weekend.

--Don't discount personal feelings about a facility. If you think it seems dirty, that's valid.

--People in homes with regular visitors get better care.

--Inspection reports are posted for anyone to see. Remember, most homes are cited for minor problems. Pay attention to nursing and/or medical errors.

--Find out if the facility can handle a sudden deterioration of health and what medical conditions could require your family member to move out.

-- Source: AARP

Newstex ID: KRTB-0407-39352422