NY Times Article:
The news that eight Florida nursing home residents died in the aftermath of Hurricane Irma has prompted a criminal investigation and spurred widespread outrage.
But it also poses unsettling, difficult questions for people selecting a nursing home for themselves or a loved one. This emotionally fraught choice often must be made at a chaotic moment when a relative is sick, his or her time in the hospital is running short and the options seem confusing.
Experts in nursing home quality say there are some steps families can take that will improve their odds of picking a well-run place.
“You have more time than you think,” said Tony Chicotel, the staff attorney at the California Advocates for Nursing Home Reform, a nonprofit group.
Hospitals may have an incentive to save money by discharging patients, putting pressure on families to make a decision quickly, but consumers should know they can ask for more time. “I tell people this may be one of the most important decisions you ever make regarding this person’s life,” Mr. Chicotel said. “Don’t feel pressure to go to a place that you haven’t vetted.”
Do your homework.
Investigate the track record of the facilities you are considering. A federal website, Nursing Home Compare, is the most comprehensive source of data on nursing homes and allows consumers to sort and compare facilities based on geography and other factors. The site includes information about a home’s staffing levels, recent inspection reports and measurements of the quality of residents’ care. Another website, Nursing Home Inspect — run by ProPublica, the nonprofit investigative journalism group — allows visitors to dig more deeply into facilities’ inspection reports and any citations they have received from regulators.
The federal website is not perfect — some key information, like staffing data, is reported by the nursing homes themselves, for example — but changes in recent years have improved the site. Nursing Home Compare also does not always include state-level reports or penalties. To view those, families must search the websites of individual states, such as the one run by the state of Florida.
Taken as a whole, the websites can provide an overview of a nursing home’s quality and identify potential red flags. A facility that has been given only one or two stars on the federal website, for example, should likely be ruled out, advocates said.
Florida officials are still sorting out who is to blame for the death of residents this week when the facility’s air conditioning stopped working, but the nursing home in question — the Rehabilitation Center at Hollywood Hills — had a federal rating of two stars (out of a possible five). Inspection reports show that in 2016 and 2014, it was cited for problems with maintaining its emergency generators, though this year, a follow-up inspection concluded that the issues had been corrected.
Some experts also recommend asking a nursing home you’re considering for the minutes of meetings of its residents council, which can reveal quality-of-life problems that may not show up elsewhere. Others warned that the nursing homes themselves often run these councils, so the minutes may not be that revealing in all cases.
Even so, try to get copies of the minutes before you visit, “so you can clue in on those problems and see if those have been fixed,” said Brian Lee, who was the Florida state nursing-home ombudsman from 2003 to 2011 and is now executive director of Families for Better Care, an advocacy group based in Texas.
Visit all homes you are considering, ideally in the evening or on weekends.
Scheduling a tour or making an appointment is fine, but many also advised visiting during a shift change, a busy hour like dinnertime, or on weekends when staffing levels are lower, to gain a sense of how the facility operates when conditions are not ideal.
If a nursing home resists — or advises against making an unannounced visit — consider that a red flag, Mr. Chicotel said.
As you walk through the nursing home, use all your senses. If you smell urine or feces, that is a sign that staff members are not attending to residents’ needs quickly enough. Are residents parked in wheelchairs in the hallway? In front of the television?
“You don’t want them to be potted plants sitting in the corner,” Mr. Lee said.
He also advised eating a meal at the nursing home if there is time. Food is often one of residents’ top complaints, Mr. Lee said. “The quality is bad, the temperature is bad, the choice and selection,” he said. “If people don’t eat, they become malnourished, so you want to be able to sit down, have a meal, and it should be palatable.”
Richard J. Mollot, executive director of the Long Term Care Community Coalition, a New York-based advocacy group, recommended asking about quality-of-life issues that are often overlooked in the rush to find a nursing home, such as what religious services are available.
To get a sense for how well-staffed a nursing home is — and staffing levels are considered the best measure of a facility’s overall quality — Mr. Chicotel advised looking at residents’ hair, fingernails and teeth. “Those are the shortcuts that understaffed facilities make,” he said. “Those are less visible — those things don’t go in the chart.”
Ask for the facility’s emergency management plan.
While natural disasters are rare, people who live in vulnerable areas like Florida may want to pay extra attention to a nursing home’s emergency management plan. All facilities are required to have such a plan and to file it with local emergency management officials, Mr. Lee said.
The trouble is, he said, the plans often receive little scrutiny and end up gathering dust in a government office. “Many of these plans are just rubber-stamped, and it becomes this bureaucratic paper push,” he said.
Families might also want to ask whether a nursing home has a backup generator to power its air-conditioning system. A new federal rule, set to be enforced in November, requires nursing homes to have “alternate sources of energy” to maintain safe temperatures in facilities, but does not specifically require backup generators for air-conditioning systems.
Asking questions about the plan allows you to evaluate whether it is adequate, but it also keeps staff members on their toes. “It’s a training system for the nursing home,” said Mr. Lee, who weathered four hurricanes during the time he was the state’s nursing-home ombudsman.
Ask for help.
If you’re having trouble sorting out your options, contact the local nursing-home ombudsman. Every state has a network of ombudsmen whose job is to investigate residents’ concerns. Many can also help families evaluate facilities.
“It’s a free service, they’ll sit down with people, and if there’s a problem, you’ve got someone you know is in your corner,” Mr. Lee said.