It is a fact that abuse and neglect happens daily in thousands of Nursing Homes across the country. Understaffing, budget constraints, and hiring direct care workers with little or no training are all key factors.
Any Long Term Care facility you interview with for placement of a family member is going to put their best foot forward and tell you all the great things about their facility. How do you look past the welcoming smiles to see what’s really going on?
1- Love at First Sniff
Upon entering the front door of any Long Term Care facility sniff… yes, with your nose. Do you smell clean fresh air? Perhaps lunch being cooked or a nice roast beef for dinner meets your olfactory sensor as you come in.
Many facilities use baby powder liberally along with baby lotion for direct skin care on incontinent clients. If you arrive just after shower time this may be what you smell.
Unfortunately, many times the first smell you will notice is urine – sometimes worse.
If the first odor is less than pleasant, note it and ask about it. Either the Administrator or the Director of Nurses you talk to will give you some kind of explanation. One common explanation is “It’s morning and all the bed linens are being changed. We have a lot of incontinent clients”.
If this is similar to what you are told approach the rest of the meeting with caution for these reasons:
- Any client who wets the bed should be cleaned and the entire bed changed then; not the next morning. Nursing assistants should be making rounds (checking on clients) every two hours throughout the night.
- Many clients can be taken to the bathroom on a routine schedule and incontinence will not happen.
- An overwhelming smell of urine in a facility is a warning sign that employees are not doing their job.
- An overwhelming smell of urine in a facility is a warning sign that employees are not doing their job.
Some buildings are very old and have urine in the floors. One location had so much old urine in the floors that for years every time it rained during hot weather the dampness seemed to bring the odor up throughout the facility. That building has recently been torn down and replaced.
2- Ask for State Surveys
Surveyors hired by the State Health Department must inspect each Long Term Care facility each year, and each time a complaint is reported concerning the nursing home an investigation is launched.
This results in reports that the facility has in its possession. Some keep the annual surveys posted on a bulletin board. Most do not.
Your query should ask specifically to see the last annual state survey. On it you will find statements of any existing problems, and the objectives to be met by the facility to fix those problems. There will be separate sections dealing with general nursing care, dietary, and housekeeping.
Some surveys will site things like not having bottles of shampoo and soap labeled clearly enough. But you may find incidences of bedsores and weight loss among the clients. More than one or two of these per hundred clients and you should move on to the next LTC facility on your list.
You won’t find client names on this report. Names are coded to protect the client’s privacy.
3- Observe, observe, observe!
- Watch and listen when staff interacts with the clients. Are they friendly and involved or hurried and short?
- Does each room have pictures, personal décor, large faced clocks, and personal memorabilia, or are they stark and institutional?
- Are the linens fresh and neat or stained and threadbare?
- Is there an Activity Director to involve clients in organized activities other than TV?
- Do the clients look clean and fresh?
- Are the clients involved in activities or are the majority just sitting or lying in their rooms?
- Do the clients smile and greet you?
- Ask any clients that strike up a conversation how they like it there.
4- Nursing Staff
Ask the person or persons you are interviewing about the nurse to client ratio. This will give you an idea how many nurses and assistants there are to care for the client census. If there are 100 clients to 10 nurses then the ratio is 1:10, or one caregiver per ten clients.
The backbone of any Nursing home are the Nurses Aids, Nursing Assistants or in some areas Nurse Techs. These are the people who will have the most contact with the client, your loved one. The Nursing Assistant will walk, read to, bathe, and dress clients, change and make the bed, tidy up the room and answer the call light. They will also feed them, help with oral hygiene, transport to activities, and act as a liaison between the client and the Licensed Nurses.
Ask if all the assistants are certified, or if they hire uncertified personnel. Certification assures that the assistant has been trained to lift, transfer, transport, feed, and perform other duties while preventing harm to the client. They are required to report falls, skin tears, abrasions, and areas that could indicate skin breakdown to the licensed nursing staff. Their first response duties make proper training essential.
Arm yourself with knowledge to make the transition through this stressful time as smooth as possible for both you and your loved one.
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