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Your guide to selecting the right nursing home

palm beach
Betty Gorman, center clapping, celebrates her 91st birthday with friends and other residents at the end of the month birthday bash at MorseLife Marilyn and Stanley M. Katz senior campus in West Palm Beach in January 2010.

By Susan Salisbury
Palm Beach Post Staff Writer
February 5, 2010

Even health care experts advise us to avoid putting a loved one in a nursing home if possible.
"People do so much better at home than in a skilled nursing facility," said Richard Hart, director of planning and customer services at the Area Agency on Aging Palm Beach/Treasure Coast in West Palm Beach.

But when services such as home health care, adult day care and home-delivered meals aren't enough and skilled nursing care is needed, families sometimes decide the time has come. A skilled nursing facility is for people who do not need the care provided by hospitals but cannot be taken care of at home.

"If you need help with showering or getting dressed, you could do that with an aide in an assisted living facility. But an assisted living facility will not get you the level of care you need if you have Alzheimer's, fall issues or incontinence," said Olga Brunner, founder and president of A Good Daughter Elder Care Management in Boca Raton. "All those things require a higher level of care."

Even in a crisis when a decision must be made quickly, there's no need to go it alone. Expert help is available to find the right place. But unless they hire a geriatric care manager, family members have to do their homework.

For starters, if your loved one is a Medicare patient and is in a hospital that doesn't give you sufficient time to find a nursing home, tell the hospital administration you want to appeal the discharge. That will give you two additional days.

After all, you're choosing where your loved one will live, it will be his or her new home, possibly for a long time.

Molly McKinstry, chief of long-term care at the Florida Agency for Health Care Administration in Tallahassee, said the agency regulates, inspects and rates the state's 670 nursing homes. Each nursing home is inspected, unannounced, about once a year. There are 255 areas of possible violations covering everything from visitation rights to meals and staffing.

"The ratings are one piece of information you need to consider in concert with visiting, talking to health care practitioners and other members of the community and looking at the needs of the individual. We encourage people to use it as a part of the information they are gathering," McKinstry said.

Nursing homes are required to post their ratings and inspection reports, which can also be viewed online. If you see a violation listed, ask the nursing home about it and what they have done to correct it, McKinstry said.

Visiting the facilities more than once is a must, and don't be afraid to ask questions, Hart said. If the loved one who will be living in the nursing home can go along, that's even better. Get the patient's input.

"It's being a wise shopper. If you do not have a good feeling about it, go with it," Hart said.
The Area Agency on Aging will help guide people through the process. Its Elder Helpline can connect them with such resources as counseling for caregivers and help answering Medicare questions.

Brunner advises just popping in to the facility you are interested in. Start out by sitting in the lobby and observing. How friendly is the staff? Do they greet you?

"If you smell a nasty smell, leave the place. Get out of there quick. They are not doing their job. A nursing home is the resident's home. You want to look for cleanliness," Brunner said.
Look at the activities and recreation room and see if the activity on the calendar is actually taking place, Brunner said. Ask if there is a residents' council.

Ask if any of the bed-bound patients have bedsores and what the facility does to prevent bedsores, Brunner said.

Judy Uzzi, clinical director and care manager at Joseph L. Morse Geriatric Center in West Palm Beach, also advises checking out the nursing home at different times in the morning, afternoon and evening and during meals.

"See how the residents are doing. Are they involved in the activities? How the staff is relating to the residents? What about the cleanliness? All those issues are very, very important," Uzzi said.

Find out if your doctor has privileges at the facility, or what doctors see patients there.
"It's the comfort level of the family. There are multiple, multiple issues," Uzzi said.
Once your loved one is in the nursing home, it's important to remain vigilant and visit often. Complaints can be made to the state's Long-term Care Ombudsman Program.

In 2007-08, ombudsmen across the state completed a total of 7,758 complaint investigations. The top three complaints from nursing home residents pertained to improper discharges; medication administration; and personal hygiene.

"Too often we see that residents are discharged for inappropriate reasons," said Brian Lee, state long-term care ombudsman at the Department of Elder Affairs. "People are dumped and put into psychiatric facilities then not accepted back into the facility."

A discharge can be appealed and a resident can stay in the facility for up to 90 days pending the outcome, Lee said.

"Families have a right to complain. If a resident complains about the food, he cannot be discharged for that. Our goal is to ensure the resident has his or her rights protected," Lee said.

Choosing a nursing home

The basic steps the Agency for Health Care Administration and Medicare and other experts recommend are:

1) Evaluate your needs.

Make a list of what you are looking for as far as location, special services, atmosphere, etc. Ask your doctor, friends, family, neighbors, clergy and others for recommendations.

2) Refer to the nursing home guides at and

Nursing homes are listed by county, along with phone numbers and addresses. Identify the facilities that best fit your needs. Check ratings and read the inspection reports online. Compare the quality. Select a few that sound promising. Call during business hours to speak to someone who can answer your questions, such as the administrator, admissions coordinator or social service director. Find out about costs and whether there is a bed available. How will you pay for the nursing home? What forms of payment do they accept?
Pay attention to how you are treated on the phone. Does this sound like a place where you would like to live? Make a list of those you want to visit.

3) Make appointments to tour the nursing homes you have selected.

Ask to meet such key staff as the administrator, the director of nursing, the dietitian, activity director and any specialists. Make a list of your questions. During the visit, be observant and take notes. Check out the food and ask to see the kitchen. Have a meal. Make note of the following:

Is there hot water in the bathrooms?
Do the residents appear happy, comfortable and at home?
Is the facility clean, odor-free and well-staffed?
Are residents being taken care of in a timely manner?
Are the rooms decorated with personal furnishings and belongings?
Do residents get to select their rooms?
Do the residents have adequate privacy?
Is staffing adequate, and does the staff seem to care?

If you liked what you saw during the first visit, make a second unannounced visit. Visit on the weekend, in the evening or at a different time of day than the first visit.

4) After evaluating the results of your research, talk about your selection with your loved one, family, friends and your doctor.

What is the average length of stay?

Long-stay patients:
386 days

Short-stay patients:
33 days

What are your chances of ever being admitted to a nursing home in your lifetime?

For men, it's 33%
For women, it's 53%

Sources: "Nursing Home Dilemma," The Ohio State University and Barrett, Easterday, Cunningham & Eselgroth LLP; National Nursing Home Survey


There is a common misconception that Medicare pays all the costs of nursing home stays. In fact, Medicare covers skilled care in a nursing facility under certain very strict conditions for a limited time. For example, to qualify, your doctor must have ordered daily skilled care.
If you qualify for Medicare, you pay the amounts below for each benefit period following at least a 3-day covered hospital stay:

Days 1-20: $0 for each day.
Days 21-100: $133.50 for each day.
Days over 100: 100 percent of the cost.
Medicaid takes over after personal savings and assets are exhausted.

Medicare: (800) 633-4227
Area Agency on Aging, Aging Resource Center Elder Helpline (Business hours 8 a.m. to
5 p.m., Monday - Friday):
(561) 684-5885
Hearing Impaired (TTY):
(866) 768-4550

*Calls made to the Aging Resource Center Elder Helpline after business hours, weekends, and holidays are transferred to 2-1-1 of Palm Beach and the Treasure Coast