Selecting a Nursing Home in Times of Crises

by Ron Lebovits, Esquire

One of the most agonizing decisions we face is the decision to place a loved one in a nursing home.  Often the decision is made during a health crisis, forcing us to make a hurried selection as a hospital presses to transfer our loved one to a long-term care facility.  However, there are a number of simple steps you can take to improve your selection.

First, through a website (www.medicare.gov/nhcompare) maintained by the federal government, you can access "Nursing Home Compare," which presents information in four categories.  It gives a description of the nursing home (number of residents; profit vs. non-profit status; Medicare/Medicaid participant, etc.).  It also provides a graph showing the percentage of residents who have certain conditions, such as pressure sores, eating dependency, etc. -- information crucial in projecting the time demands on the nurses aides and how that might limit the time available to your loved one in an industry that is notoriously understaffed.  A brief summary of the last inspection result (describing where care and services were deficient) is also provided, as well as a numerical listing of the nursing staff, so that you might roughly estimate the resident-nursing aide ratio.  You can also read survey results for the past three annual inspections.

Through a website (www.health.pa.us/facility/map.htm) maintained by the Commonwealth of Pennsylvania, you can review the results of investigations and care complaints.  Where the allegations are deemed substantiated, the regulation violated as well as the factual basis underlying the violation is included in a narrative form.  The website is designed to allow you to commence your search geographically by county, and it provides access to as many as 20 separate reports for each facility. 

Philadelphia public libraries, including most local branches, provide computers and free Internet access and they will offer, depending upon time constraints, some degree of assistance to you in locating information on the web.

Second, you can visit and/or tour the prospective facility.  On such visits or tours, do not limit yourself to the presentation offered by a facility representative.  Specifically, you should enter the facility during normal visiting hours and walk by yourself through the hallways, common areas and dining rooms.  Unless you are an invited guest of an existing resident, call in advance and request permission from the facility director to visit, an apparent requirement of the state regulations.

However, do not specify what day or time you intend to conduct your solo tour.  Any facility which hesitates to let you do so should be viewed skeptically.  And while you cannot enter into the rooms of residents, there is much that you can observe during such a walk through:  are the residents engaged in activities or are they left alone, lining the hallways in a convoy of wheelchairs?  Are activated call lights answered in a timely fashion?  Are gait-impaired residents offered assistance or left alone to struggle as they ambulate down a hallway?

Third, you should pose two questions to the facility's director of nurses: what is the typical ratio of nurses aides to residents maintained on each shift of the day; and, what is the facility's policy for using overtime or other methods for covering a shift when a scheduled nurses aide calls out sick or simply fails to report to work?  Nurses aides feed, dress, bathe, reposition and toilet the residents.  Depending on the shift of the day, each nursing assistant could be responsible for anywhere from 6 to 25 or more residents. Depending upon the degree to which the residents require any measure of assistance, each resident could require anywhere from 1 to 2 hours or more of direct, unskilled care each shift.  During an eight hour shift, nursing assistants receive one 30 minute as well as two 15 minute breaks, leaving only seven hours for patient care.  Therefore, if the ratios are large, some residents will not have their needs met.

As to overtime and absent nurses aides, facilities that routinely rely upon nurses aides working consecutive shifts expose residents to neglect and abuse.  Tired nurses aides are likely more inclined to be inattentive, to take short cuts and to be less patient with their charges, a condition that can lead to verbal and physical abuse.   Facilities that do not take steps to fill unmanned shifts overburden the nurses aides on duty, increasing their workloads and taxing their ability to meet the care needs of an increasing resident load.

Finally, request from the facility a copy of the most recent survey report as well as any citations or statements of deficiency, even if you have already reviewed them by the internet.  Federal regulations direct the facilities to make these materials available in a place readily accessible to the residents, such as a lobby, where people wishing to examine survey results do not have to ask to see them.  A facility which does not make this information available may have something to hide.

As news reports continue to reflect, nursing home neglect and abuse is a serious problem in our country.  There is no consensus on what steps should be taken to remedy the problem, and it will likely be many more years before Congress takes action.  In the interim, you can take some simple steps to help make sure that your selection of a nursing home is a good selection.

Ronald Lebovits is a senior trial attorney in the Nursing Home Litigation Division of Zarwin, Baum, DeVito, Kaplan, O'Donnell & Schaer (215/569-2800; rlebovits@zarwin.com). Licensed in Pennsylvania, New Jersey and California, Mr. Lebovits has represented victims of institutional elder abuse and neglect since 1998.