Many people dread the thought of nursing homes because they think nursing home residents have a poor quality of life. People often think of nursing homes as dreary, dismal places where residents are neglected or merely tolerated. Fortunately, there are many ways to compare nursing homes and choose those that offer a better quality of life.
Definition
Quality of life is a measure of how well a nursing home resident is cared for and how much he or she is encouraged to live life in a way he or she chooses. Because everyone's personality and tastes are different, quality of life is difficult to measure.
Five-Star Quality Rating
To help nursing home residents and their families compare facilities, the U.S. Department of Health and Human Services' Centers for Medicare and Medicaid Services (CMS) offers a Five-Star Quality Rating System. Each facility is rated on a five-point scale, with five stars being the highest rating. In addition, each nursing home receives separate ratings for each of three areas:
1. Health inspections from the previous three years. Inspectors judge how well the facility has met Medicare standards, determined by on-site inspections, standard surveys and complaint surveys. Recent findings are weighted more heavily than older surveys during the same three-year period.
2. Staffing. Each facility is rated based on the average number of hours of care each resident receives each day. Facilities for those with more severe needs are expected to have more staff.
3. Quality measures (QMs). Each facility is rated on 10 physical and clinical measures, self-reported by each nursing home. Each facility reports the prevalence of the following factors.
For long-term patients:
• (Activities of Daily Living) ADL change
• Mobility change
• High-risk pressure ulcers
• Long-term catheters
• Physical restraints
• Urinary tract infection
For short-term (i.e., rehab) patients:
• Pain
• Delirium
• Pain
• Pressure ulcers
Consideration
While the Five-Star Quality Rating System compares data from many nursing homes, it should not be the only factor considered when choosing a facility. For example, CMS notes that "it may often be better to select a nursing home that is very close, compared to a higher rated nursing home that would be far away."
Other Factors
CMS also recommends consulting local advocacy groups and the state ombudsman program to find out about specific nursing homes, including any complaints or litigation.
Touring the Facility
The best way to determine the quality of life at a facility is to visit it, preferably several times at different times of the day. During the tour consider whether:
1. There is a pervasive urine smell (signaling that patient toileting needs are ignored).
2. The patients seem largely listless, angry, withdrawn or agitated (signaling possible abuse or neglect).
3. There is a large staff-patient ratio (Staff members who must care for many patients may not have time to provide quality care.).
4. Staff turnover is high (high turnover may signal that staff members are largely dissatisfied with working there and that the facility may not be able to retain high-quality workers).
5. The facility feels crowded (facilities that have been approved to take in additional patients may be housing three residents in rooms intended for two people or even four in rooms intended for three).
6. The overall atmosphere feels comfortable (are the buildings, grounds and people pleasant? or is there a dreary, prison-like mentality?).
7. Are there gloves, hand sanitizers, appropriate lifts and other equipment in each room (poor-quality facilities may try to cut corners by not supplying these items)?
Tips
While cost is a major factor in choosing a nursing home, the most expensive facility may not necessarily provide the best care. Smaller, "mom-and-pop" facilities often provide a homey, comfortable setting in which residents thrive, even if the facility may appear shabbier compared to a large facility.
If you see evidence of abuse or neglect, document your findings and consult nursing home administration, local abuse hotlines or police, as the situation warrants.
Visit the facility during several shifts. Afternoon, night and weekend operations may be vastly different from daytime, weekday shifts when administrators and potential new customers are present.
Tags: nursing home, nursing homes, Each facility, quality life, Each facility rated, facility rated