Acknowledgments

15

Introduction

17

1

Nursing Home Operation

21

Three Types of Nursing Home Living

22

You should Know Whether the Facility is Licensed to Provide Skilled Care

24

You should Know Whether the Facility Accepts Alzheimer’s or Dementia Residents

25

Nurse-to-Resident Ratio

27

You should Know that the Nurse-to-Resident Ratio can be Deceiving

28

You should Know if the Facility has a No-Overtime Policy

32

Day-to-Day Nursing Home Operation

33

You should Know if the Facility Allows Sixteen-Hour Shifts

34

You should Know What Time Your Parent is Getting Up in the Morning

35

The 7-3 Shift

36

You should Know that Care Plan Meetings can Accomplish Goals if Family Attends

39

You should Know that Nursing Notes Should Document Everything

42

The 3-11 Shift

45

You should Know Your Parent’s Bath Schedule

46

The 11-7 Shift

47

2

Nursing Home Staff

49

Management Staff

50

You should Know that a Doctor can Write an Order for Anything Your Parent might Need

53

You should Know that the Unit Manager is a Resident’s Regular Contact Person

55

You should Know that Your Parent may Fare Better if Admitted at the Beginning of the Week

56

You should Know About the Possibility of Cross Contamination

59

Frontline Nursing Home Staff

60

You should Know that a Wound Specialist may be Available

61

You should Know that Agency Staffing can Affect Continuity of Care

64

You should Know that the Nursing Assistant-to-Resident Ratio is Important

68

Consult Staff

72

You should Know How to Get Podiatry, Dental and Ophthalmology Services

75

Ancillary Nursing Home Staff

76

You should Know the Activity Calendar

76

You should Know Recent Menus

77

You should Know that All Belongings should have a Label

78

You should Know that You can Volunteer at Your Prospective Nursing Home

80

3

Residents’ Rights

81

Residents’ Rights

83

You should Know Chat Many Residents do not Pursue their Basic Entitlements

84

You should Know that Residents’ Rights are not Usually Explained to the Residents

84

You should Know if Your Parent is Satisfied with His or Her Physician

85

You should Know if Your Parent is Comfortable with the Current Level of Privacy

87

You should Know the Telephone Availability for Your Parent

91

Quality of Life

93

Right to Access Medical Records

93

You should Know to Keep Copies of Medical Records

94

Legal Representatives

95

You should Know that Advance Directives are not Always Available

97

Right to Privacy

98

You should Know that Room Changes Occur Frequently

98

You should Know to Get Copies of the Resident Council Minutes

100

You should Know that Family Members can Make a Difference

100

Right to be Free from Restraints and Abuse

101

You should Know that Restraints are Still Used at Many Facilities

101

You should Know that Verbal Abuse is Common in Nursing Homes

103

4

Legal Requirements of the Nursing Home

107

The Facility Must Inform the Resident/Family

107

You should Know What to do if Your Parent is Injured

109

You should Know to Keep Track of Current Medications

111

The Facility Must Post Information

113

The Facility Must Assess the Needs of the Resident

116

You should Know to Become Familiar with the Care Plan

119

The Facility Must Provide Adequate Care

120

You should Know that You can Request a Psychiatric Consult

125

You should Know that Medication Errors Occur Often

126

Nutrition

132

You should Know Weight Loss is Usually not Normal

132

You should Know that You may Bring Your Parent Healthful Snacks

137

The Facility Must have Policies Against Mistreatment

137

You should Know Whether Your Facility Conducts Criminal Background Checks

138

You should Know Whether Your Facility is Affiliated with a Prison

139

The Facility Must Provide a Safe and Homelike Environment

143

You should Know that You may Bring in Your Own Washcloths

144

You should Know that You may Bring in an Air Conditioner

145

You should Know that Sprinklers are not Standard Equipment

146

5

Nursing Home Inspections

147

Types of Inspections

147

You should Know that the State Ombudsman’s Office may Offer Additional Information

148

How the Facility Prepares for the Annual Inspection

149

The Nursing Home Inspection Process

151

You should Know not to Judge a Nursing Home during an Inspection

152

Interpretation of the Annual Inspection Results

153

6

Improving Nursing Home Life

165

Ask for Special Treatment

165

You should Know the Facility may Replace a Lost Hearing Aid

166

You should Know that Residents’ Eyedrops, Inhalers and Sprays are Stored Together

167

You should Know that You can Request an Electrical Bed

168

Improving the Quality of Life

168

You should Know that Many Facilities have Pets

169

You should Know to Visit on the Weekends and Evenings

169

You should Know to Find a Partner and Work as a Team

170

You should Know the Compatibility of Your Parent’s Roommate

171

You should Know How Many Residents Share a Bathroom

171

You should Know Whether Your Parent is Supervised While Smoking

172

Getting Better Nursing Care

172

You should Know that an Activated Bracelet may Prevent a Tragedy

172

You should Know the Policy Regarding Incontinent Pads

173

You should Know if Your Parent is Having Problems Receiving Eyedrops

175

You should Know the Facility Policy for Complete Skin Examinations

176

You should Know if the Staff is Checking Your Parent’s Ears for Wax

176

You should Know that You can Request a Same-Sex Nursing Assistant for Bathing

177

You should Know to Post Notes in the Room to Remind Staff

177

You should Know Whether the Call Bell Reaches All Points in the Room

177

You should Know the Consequences of a Room Near the Nurse’s Station

177

You should Know to Keep a Journal of Events

178

Things to Bring Your Parent

178

You should Know that Many Facilities do not Provide a Remote Control or Headset

178

You should Know that You can Bring Your Parent His or Her Own Wheelchair

179

You should Know to Bring Your Parent Clothes that Open Easily

179

You should Know to Bring Your Parent Nonslip Slippers

180

You should Know that You can Arrange for Your Parent to Get Take-Out Food

180

Legal

180

You should Know Whether there is an Arbitration Clause in Your Admission Contract

180

You should Know Whether there are Any Registered Sex Offenders in the Facility

181

Web Sites and Services

181

You should Know that there are Many Helpful Web Sites for Nursing Home Residents

181

You should Know that Massage Therapists Visit Nursing Homes

182

7

Nursing Home Tragedies

183

Abuse and Neglect

183

Amputations

193

Bedsores

194

Document Falsification

195

Falls

196

Fires/Fire Safety Violations

196

Forced Feedings

198

Heat-Related Deaths

199

Inadequate Staffing

200

Sexual Assault

201

Theft

203

Wandering Incidents

204

8

Important Information

207

Nursing Home Checklist

207

Medical Personnel

211

Nonmedical Personnel

212

Staff Names and Numbers

212

State Licensing/Monitoring Agencies

213

Wound Care Checklist

213

Injury Checklist

214

Medication Chart

214

Family Council Members

215

Conclusion

217

Notes

219