Month: March 2017

After touring the facilities on my list, I needed to make a decision on the place I thought would be best for my mom.  Mom was still very early in her stroke recovery and it was a big question mark as to how much she would improve. I tried to consider what I believed she wanted, since she was really unable to communicate to me in this stage. I was needing to choose between what seemed to be two very different options.

The first place seemed to be a homey environment with a small wing dedicated to stroke patients.  There were only 8 rooms in this wing with 2-3 caregivers and one nurse.  There were 3 beds in each room.  They did have a therapy room, but it was about the size of a small bedroom and had a couple of pieces of gym equipment inside.  No one was in therapy at the time and no therapists on the premises to meet.  The facility was older and it had not been updated in years. The vast majority of the residents in the entire facility were mentally-impaired or severely disabled and the range in age was from adolescents to seasoned life people. I walked away from this place thinking that Mom would probably get good care there and be comfortable, but unsure how much she would be able to improve and recover from her stroke.

The second place was a large, updated facility with three wings.  There was a nice porch out front where you could find residents sitting and enjoying the outdoors. You walked into a big reception area and then a large living room where the residents and family can sit and visit, watch TV, play games, eat, or participate in social activities.  The nurses station was the central hub between the three wings.  Two were for long-term care residents and one for short-term rehabilitation residents.  There were probably about 120 beds in this facility. (Two beds in a room.)  Each wing had one nurse and 2-3 caregivers.  If you do the math, you will figure out that that was about 1 caregiver responsible for 15-20 residents.*  They had a very nice therapy room and a large staff of therapists that provided physical, occupational, and speech therapy. The rehabilitation aspect of this facility was impressive. I did talk to a nice gentleman who said he had suffered a stroke and was brought in there in almost the same condition my mother was in at that time.  He said he had been there a couple of months and he was walking, talking, and showed very little signs of his stroke trauma. He was hoping to be released in a few weeks, he said.

I knew that, in all likelihood, this last place was a good option for Mom’s recovery due to the rehab capabilities, but I was very concerned about the quality of care she would receive.  I saw residents sitting in the wheelchairs in the common areas, unattended, and sleeping or just existing. I heard the call buttons buzzing at the nurse’s station constantly and seeming to go unanswered for long periods of time.  After discussing all these findings with my family, we collectively agreed that we thought we should send Mom to a place that would have the best therapeutic services.  We wanted her to recover as much as she could.  We had hoped, like the gentleman I met, she would only have to be there for a few months.  I thought that if I was able to be present everyday and keep an eye on her, I could make sure she was getting the proper care.

I told the social worker at the hospital that we had selected option two, which I will call “SOS Skilled Nursing Rehab”. (This is not the real name.) The social worker at the hospital then contacted the facility and sent them the medical records and documents needed to get her approved.  Within a day, she was approved and we scheduled the transfer from Dallas/Ft. Worth to Austin via private ambulance.  Due to mother’s condition, feeding tube, IV’s, and paralysis, this was the only option.  (FYI, Medicare does not pay for private ambulance transfers.  Get bids.  I got quotes from $1800 to $3500.)  Exactly one week from her stroke, she was on her way to the skilled nursing rehabilitation facility in Austin.  I was there waiting for her arrival…..

*If you would like more information on the staffing ratios, check out this website: http://www.texasbabyboomers.com/texas-nursing-home-staffing-ratios/ .

It is important for readers to know that both my grandmother and my mom owned and operated a private nursing home in East Texas.  I grew up with an understanding of these places and saw how a well run facility functions and looks. I learned what inspectors want and do not want to see. The industry has changed substantially in recent decades.  Most of the changes have been through increased regulations and the fact that very few facilities are private-owned anymore.  They are part of a corporation, hospital, or chain. They are profit-driven. It would not be a stretch to say that a large number only do the minimum amount needed to pass state standards in order to keep getting Medicare or Medicaid. There a few good ones, but even the best have their issues.

Below is a checklist you can print out and take with you, if you ever find yourself in the position of making a decision to move yourself or a loved one into a skilled nursing facility, retirement home, assisted living facility, memory care facility, acute rehabilitation hospital, or a nursing home.

Checklist for Evaluating a Nursing Facility or Assisted Living Facility

There are three key things I would suggest you keenly observe during your tour:

1.  Are there plenty of common areas for socializing and activities? Are they occupied with patients, care-givers or hospitality personnel? What are they doing? Do the patients look like they are having a good time? I would even find a person who lives there that might be willing to talk to you. Ask them if they like living there. Listen to what they have to say. If they have a visiting family member present, ask them about their experience.
2. As you are walking down the halls, observe the cleanliness of the rooms, floors, and common areas. What does it smell like? It is normal to run across bad odors sometimes, but not everywhere or all the time. Cleanliness and avoiding “a hospital smell” was always important to my mom in her nursing home. She made sure the floors were spotless and shined.
3. As you go by the nurse’s station, listen for whether the button calls from patients are being answered timely. If you hear constant buzzing that is not being answered within a couple of minutes, that is a sign that there is a slow response to needs. Most facilities have lights above the doorways into the patient rooms.  If these lights are lit, it means they have pushed the call button and are waiting on someone to respond. Observe how long they stay lit.

There a many other things of which you should inquire and observe, but if you see problems in any of these three things, I would give it great consideration in your decision. Other things would be:

1. Menu/Food – Is it nutritious and tasty? Do the patient’s get a choice?
2. How many caregivers per patient?
3. Observe the rehabilitation area. What kind of equipment do they have? How many therapists? How much time per day do they spend with patients?
4. What are the residents doing?  Are they active and participating or just sitting in their chairs sleeping or unattended?

The next post will go over what happens after you pick a place and guidelines for getting the best possible care for yourself or loved one.