What are Questions for touring a Skilled/Nursing Home Facility

One of the biggest things to keep in mind when touring a skilled/nursing home facility is that it is not about the “bricks and mortar”.  There are a lot of beautiful, new facilities that have poor care and some of the older facilities have the best care.  

FIRST OBSERVATIONS

• Smells. Is there a strong smell when you first walk in? (My pet peeve!!)  Take notice! Pay attention to any urine smells, but also the time-of-day matters.  Don’t judge if they are all changing and walking around with linen bags.  You will be able to tell this.

• Sounds and activities. Listen for sounds of life or activities and engagement happening. You want to see residents out and about.  Depending on the time of day there should be some activities going on somewhere.  If not, ask!!  Ask to see an activity calendar.

• Cleanliness.  Pay attention to not just the common areas, but pictures on the wall.  Check the resident bathrooms.  Look in an occupied room, if they allow, and just pay attention.  Look under the beds.  You can tell if housekeeping is sweeping and mopping.

Questions to ask:

• Is the building clean and well cared for? (You can see this for yourself.)

• Ask to see the room your resident will be staying in. 

• Ask to meet the roommate if possible.

• How many residents per room?

• Is there a main dining room?  

• Can residents choose from a couple options at each meal? 

• Where are the menus posted?

• Is it possible to have favorite meals/foods? (Do they provide a resident choice meal each month?)

• Is there an outdoor space? Are residents allowed to access this without staff with present?

• Does the outdoor space have sun protection and is it secure?

• What security procedures are in place? (Doors are all have keypads, etc.)

• What are the fire safety procedures? 

• How does the facility handle an emergency?  Will they notify families and if so, how?

• Are families able to reserve a conference room or the dining room for private family events, such as the resident’s birthday?

Staffing:

·      Ask about staff turnover. Is it high?

·      Ask if they utilize agency staffing.  If so, how much?

·      When was the last time they utilized agency staffing?

·      Are they using cnas only or nurses as well?

·      What is the staff-to-resident ratio? 

·      Does the facility have RN coverage or a Supervisor 24/7?

·      Is there a registered nurse on site 24/7?

General Daily Activities

·      Does the staff check on residents by doing rounds?

·      Is there training for dementia care?  How often?

·      Do doctors come to the nursing home?  How many?

·      Who is the Medical Director?

·      How does the staff (nurse management) assure the residents actually eat? 

·      Can they be assisted with meals if needed/fed?

·      What is the full range of medical care services available on-site? (IV therapy, wound vac, assigned treatment nurse, cath care, pacemaker care/checks)

·      Does the facility have a doctor or on-call physician?

·      Does the facility utilize any telemedicine? 

·      How are medication management and physical therapy needs addressed? 

·      Are mental health services available?

·      Are there social activities provided that encourage resident engagement?

·      Are there religious and/or cultural accommodations?

·      What are the daily schedules and meal times? 

·      Does the facility provide assistance with dressing, bathing and other daily living tasks? How is that determined?

·      Are meals flexible for dietary restrictions and preferences?

·      Is transportation offered for appointments? And if so, is there an extra fee for this?

·      Does the facility provide a cna or staff member to attend physician appointments with the resident?

·      Who is the Ombudsman for the facility?

Finances:

·      What is the overall cost for private pay, private room and semi-private? 

·      If you are there for short-term rehab, will you be charged a co-pay for Medicare at any point?

·      Are there any fees for extra services, such as a beautician/barber? 

·      How often does the beautician/barber come?

·      Which payments are accepted, including coverage through long-term care insurance?

·      Does the facility accept VA benefits?

·      Does the facility assist in completing the Medicaid application?

One final thought….ask to meet the Administrator.  I always liked meeting families touring, but the Admissions team doesn’t always remember.  The Administrator is what sets the tone daily in the facility.  You should also ask to meet the Director of Nursing.  He or She will likely be your first “go to” if issues arise. 

Try to work things out with the staff on the floor and/or Supervisor, but if you can’t then go to the Director of Nursing or Administrator.

I hope this list is helpful!  You can never ask too many questions!