How to choose a nursing home for a loved one

It’s a common scenario: A loved one is no longer able to live independently and needs 24-hour skilled nursing care.

“I’ve lived it myself,” said Colleen Pino, executive director of Cape Cod Healthcare’s JML Care Center in Falmouth, which has the capacity for 80 long-term care patients. “If you’re lucky, you have the luxury of making the choice as a family…. What’s the next step? But more often than not, it’s a hospitalization that moves it along.”

So how can you choose the right facility to suit the patient and the family, especially when that decision might have to be made quickly? What questions can patients and families ask the facility or themselves to help make the decision about a nursing home?

The following are Pino’s suggestions:

What kind of care does the patient need?

Long-term patients vary widely in their care needs and some places might be a better fit than others. A patient with advanced dementia, for example, might require a certified dementia unit.

“They have specific training for that,” Pino said. “No longer can someone hold themselves out as offering dementia care unless they’re trained for it.”

What beds are available near to family or potential visitors?

“I think first and foremost is what’s available in your community because you want to be close enough to be able to visit,” Pino said. “You want someone in your [area] so visiting becomes part of your daily or weekly routine.”

Can you visit the facility?

This is tricky right now with COVID-19 restrictions – some facilities are not allowing tours of patient areas. But Pino suggests asking to see as much of a nursing home as possible.

“You want to get a look-see. You want to go in and talk to somebody about it; get in touch with the admissions coordinator, if not in person then by phone.”

What’s the buzz in the community about the facility?

Ask the hospital social worker as well as your doctor, friends and neighbors, and senior center staff if they have experience with the facility.

“If you have friends in the area who have family members there, ask them about their own experience,” Pino said. “And, if you have concerns after talking with your friends, don’t hesitate to bring it up (with the facility.)”

What’s the official assessment of the facility?

You can compare nursing home ratings as established by the federal government at medicare.gov. Facilities are given an overall rating based on health inspections, staff ratios and quality measures such as percentages of patients who suffered urinary tract infections. The Commonwealth of Massachusetts also has a nursing home performance tool allowing you to search information about specific facilities and compare state scores. More information is also available from the long-term care ombudsman program of Elder Services of Cape Cod and the Islands, which does regular surveys of local nursing homes and takes complaints.

JML Care Center recently earned the U.S. News & World Report designation of Best Nursing Home for 2021-22 in their annual review of skilled nursing facilities. JML earned this recognition through U.S. News & World Report’s evaluation of more than 15,000 nursing homes nationwide and is among the elite 13 percent of skilled nursing facilities that received a “High Performing” rating for long-term care and short-term rehabilitation. The national accolade is given only to those homes that satisfy U.S. News’ assessment of key services and consistent performance in quality and safety measures.

Should the patient have documents prepared for end-of-life care?

As Pino says, you don’t always know when things might take a turn. If possible, it’s important to know the patient’s wishes and to have the proper documentation in place. That should include a health-care proxy, which designates someone to make medical decisions, and a Massachusetts Medical Orders for Life-Sustaining Treatment (MOLST) form, which allows patients to specify, for example, under what conditions they would want to be resuscitated.

What steps will the facility take to get to know the patient?

“If someone’s going to come to live with us, we should be doing all the homework we can do,” said Pino. “I’ll use myself as an example: What kind of interest does my mom have? Is she a card player? Does she like group activities? Does she like music? Would she be a gardener?”

The onus should be on the facility to learn all they can about a patient, Pino said, because “I want my mom’s life to continue at the best caliber it possibly can, and these are the things she loves.”