Choosing a nursing home for your aging parent is a complex process. A number of factors could lead to a necessity of a full-care residential environment, and finding the best possible facility is challenging. A good nursing home promotes the quality of life and well-being of its residents as the highest priority. Many different aspects of care and the environment of the facility influence the quality of life your loved one will enjoy. The physical appearance of the facility and the number of staff are obvious concerns. A bright and cheery building with a landscaped yard or garden looks very inviting. However, it is critical to look beyond the bright facade and examine the day-to-day life inside each facility.
Why Does Staff to Resident Ratio Matter?
The number of residents assigned to direct-care staff is arguably the most critical aspect of full-care residential facilities. Most facilities will provide staffing ratios to comply with minimum provincial and federal regulations. These are good numbers to check, but families looking for a potential home for their loved ones should dig deeper.
Visit the facility at varying times throughout the day and at least once during the night shift. Pay attention to the staff providing assistance with personal care, meals, and other activities of daily living. Find out whether residents receive assistance with bathing or showering in the morning and evening, brushing their teeth, applying deodorant or lotion, washing their hair, shaving, and any other tasks they would be doing at home.
A designated contact person in administration or admissions will likely provide numbers and explain the staffing procedures, but you should take time to observe the facility operations and staff in person. Look at the number of personnel assigned to each wing or unit and compare it with the number of residents. How many residents are the personal support workers responsible for? How much time do staff spend with each resident throughout the shift? Is it within an acceptable range for the quality of care expected?
For example, a residential wing with 30 beds and two personal support workers would leave each staff responsible for 15 residents. When evaluating adequate time dedicated to resident care, do not consider licensed nurses who do not provide assistance with bedside care most of the time. A licensed nurse accountable for medications, treatments, charting, and various types of medical and non-medical emergencies for 30 residents does not have much time to provide assistance with bedside care.
Other factors to consider are the number of transfers with mechanical lifts, confused residents, or residents with extensive needs requiring large chunks of time from one or more personal support workers on a daily basis. All these factors quickly add up to a minimal amount of time for staff to assist each resident with activities of daily living.
Do Residents Complain of Feeling Hungry?
Residents should never feel hungry. If residents finish their dinner early in the afternoon or evening and have nothing to eat until the next morning, meal times should be adjusted. Residents should not be denied food upon request, and snacks must be available at all times. Is there a clear and simple protocol for providing favorite foods and snacks from family members? Are residents offered choices of meals and allowed to substitute items?
A quality menu has a wide and unique variety of entrees and side dishes for breakfast, lunch, and dinner. Fresh fruits and vegetables are not necessary for every meal, but the nursing home should provide them frequently. Staple goods such as cereal, bread or toast, soups, and other common foods must always be available.
Every meal should include at least two choices and accommodate those with religious or dietary preferences. For example, a vegetarian needs real menu choices, not just a fruit plate instead of a regular entrée. Residents requiring altered textures or thickened fluids should have the same variety available as those on regular diets. Limiting thickened fluids to pre-packaged juices and beverages is not acceptable.
Adequate dining room staffing is essential to allow residents to eat and enjoy their meals. Also, kitchen staff needs enough time and help to prepare a variety of dishes and safely adjust textures or consistency of foods and liquids when necessary.
A sufficient number of direct-care staff must be on duty during meals to prepare beverages, assist with feeding, transport residents to and from the dining room, and deliver meal trays to residents who prefer to eat in their rooms. Residents should never be rushed through their meals or forced to wait for assistance. They need to have enough time to eat and enjoy their meals. Residents should never be rushed or pressured to eat cold meals due to inadequate staffing.
Do Residents Receive Adequate Help with Personal Care?
Each resident needs adequate personal care and the ability to bathe or shower every morning, evening, and when needed throughout the day. Find out how often an individual receives scheduled showers or baths. Do they get enough time to wash their hair, use conditioner or body wash of their choice, and enjoy personal preferences? Many people appreciate a full shower or soak, especially when they are not free to have one every day, so residents should not get rushed through their bath time. Is there a sufficient level of staffing to provide assistance with toileting promptly, or do accidents occur frequently? When a resident is incontinent or has an accident, how long does it take for staff to help the resident change and wash?
If the odor of urine or feces is noticeable upon entering a facility or while walking through hallways and rooms, the care provided at the facility does not meet the residents’ needs.
Are Activities and Therapy Sessions Offered to Residents?
A wide variety of experiences dramatically improves the quality of life. Nursing home residents still enjoy, need, and deserve opportunities to socialize and participate in activities. An ice cream social in the outside garden or yard is a great way for residents to socialize. Off-site events are a source of excitement and anticipation. Organized games or movie nights should be planned and offered on a regular basis. In fact, bingo is the most popular activity held weekly in many facilities.
The events and activities offered are as important as their frequency and variety, so residents can choose what they like. Learning a new skill is fun and provides a sense of accomplishment. Even residents with cognitive and physical impairments can enjoy mental stimulation and learning. Pottery or art classes, lectures, and other opportunities to gain skills and knowledge have a profoundly positive impact on mental health. Libraries, both physical and electronic, a collection of movies and music, and art or stationery supplies should always be available.
Therapy is essential for residents on a short-term rehabilitative stay after surgery, illness, or injury. Speech, physical, and occupational therapy help regain and improve the skills they need to return home and feel independent. Whether to maintain their abilities or gain back strength and balance, long-term residents also benefit from therapy.
Residents should always be encouraged to complete tasks they are capable of performing, even though the tasks might be done faster with the help of staff. Allowing residents the necessary time pays off in the form of increased confidence and reduced depression. Physical therapy targets gross motor skills, including walking, bending, standing, and balance maintenance. Occupational therapy concentrates on performing daily tasks such as dressing, bathing, or cooking.
Speech therapy can help residents who have trouble swallowing so that they can resume eating a regular diet instead of pureed food and thickened fluids. Having difficulty communicating due to slurred or unintelligible speech is frustrating for residents, and they often give up. With the help of speech therapy, they can once again communicate effectively with staff, family, and friends.
How Important is the Level of Skilled Nursing Care?
Nursing home residents have prescribed medications, which only licensed nurses can administer. The process differs significantly from personal care or assisted living facilities. Every prescription medication, over-the-counter drug, or supplement must be approved and included in the resident’s medication record. Nurses cannot even administer Ibuprofen, Saline eye drops, or other common over-the-counter drugs without an order from a physician, so be sure the chart includes all medications, vitamins, or supplements taken at home.
Observe nurses administering medications and supplements. They should be staying with the resident and making sure the resident swallows every pill, supplemental snack, or nutritional drink. Watch for nurses who leave medications with the resident or in a cup on a bedside table. Confused residents may not take medications easily. However, a nurse should never force residents to swallow anything against their will.
Medication orders must be up-to-date and accurate. Regular evaluations are necessary to continue, adjust, or stop medications. It is especially important to determine how the staff treats pain. Opioid pain relievers require extra attention and documentation from nurses, and only after trying non-pharmacological interventions. Appropriate treatments, once implemented, continue until the pain is alleviated.
Nurses should frequently evaluate the residents’ discomfort and use available tools to treat it. If a time comes for palliative care, a reputable hospice agency can be of enormous benefit in getting the pain relief and other comfort measures. Choose a nursing home with a good working relationship with hospice agencies and nurses.
Such an array of responsibilities and aspects of care can be intimidating. Many issues leading to poor care and reduced quality of life stem from staffing shortages. A facility with staffing levels above the legislative minimum requirement is a great start. Adequate staffing naturally leads to improvements in almost every aspect of resident care.
Careful observation of daily staffing levels is the first and most crucial step in choosing a residential facility capable of providing excellent care and environment residents can enjoy. The administration and supervisors should be eager and cooperative when talking to families. Go over procedures and guidelines for contacting and updating family members, repeatedly if you must. Watch for attempts to change a subject in response to a question, and if there is any hint of avoidance or skimming over specific topics, re-visit those subjects until you get satisfactory answers.