Selecting a Nursing Home in New York State
Visiting the Facility
Section II When You Visit a Nursing Home
You can find a great deal of information about a nursing home from the various resources and websites that have been provided in this consumer guide. However, visiting any nursing home that you might consider as a future home is one of the best ways to determine if the facility is suitable to you. Call the nursing homes you are interested in and make an appointment to meet with the admissions staff (usually a social worker).
Each nursing home has its own policies and procedures, but all must follow certain state and federal regulations and respect residents' rights. A copy of the home's policies should be available upon request. Following is a list of some policies to check:
- the use of personal belongings and furniture;
- the availability of ethnic foods or special diet preferences;
- room assignments and changes;
- reserving a bed if transferred to a hospital;
- visiting hours (should cover a 10-hour period and two meal times);
- emergency procedures;
- phone calls;
- leaving the facility for short visits with family or friends;
- procedures for handling theft;
- complaint procedures;
- access to personal funds.
When you visit a nursing home, look for its license. It will be prominently displayed, usually in the lobby. It is also very important to see firsthand what the environment of the home is like. This will also give you an opportunity to ask questions on the care and services that the nursing home provides and to clarify any issues with regard to placing an individual in the nursing home. During the visit be observant of the interaction between caregivers and residents and pay close attention to the following:
- Physical Appearance
- Room Assignments
- Medical/Nursing Care
- Special Therapies
- Dementia Units/Alzheimer Units
- Mental Health/Mental Retardation Services
- Pediatric Units
- Activities Program
- Financial Arrangements
- Quality of Service Delivery
Take a good look around at everything.
- [ ] Do residents have personal belongings decorating their rooms?
- [ ] Does each resident have at least one comfortable chair?
- [ ] Does each resident have his/her own dresser and closet space with a locked drawer or other secured compartment?
- [ ] Is there an out-of-doors area where residents can walk or sit and is it used?
- [ ] Does the equipment—wheelchairs, therapy devices—appear in good condition?
- [ ] Is there a lounge or other area where residents can entertain visitors privately?
State standards require that a home provide a safe environment for residents whether they are mobile or in wheelchairs, whether they are confused or have poor eyesight.
- [ ] handrails in hallways and other critical places;
- [ ] wide, clear walking areas;
- [ ] the absence of hazards that might cause accidents;
- [ ] good lighting;
- [ ] telephones and large print notices placed so that wheelchair-bound residents can make use of them;
- [ ] appropriate inside temperature and whether or not residents are dressed appropriately;
- [ ] clearly marked exits and well-lighted elevators.
Find out if the local fire department participates in fire drills and how often drills are held in the nursing home.
A good home should be clean. Look in the corners of residents' rooms, bathrooms, kitchens, nurses' stations, etc., as well as in the main visiting lounges. Look for cleanliness EVERYWHERE.
Unpleasant odors reflect problems. If there is an odor in a particular section of the home go back to see if it has been eliminated within a reasonable amount of time. This will give you an idea of how long it takes the home to deal with the cause of the unpleasant odor.
- [ ] Do residents socialize with each other?
- [ ] Is there activity in the corridors?
- [ ] Are residents engaged in doing things or just sitting in a lounge or in the hallways?
- [ ] Are residents neatly dressed and do they appear to be wearing their own clothing?
- [ ] Are residents out of bed?
- [ ] Do staff interact with residents in a warm and friendly manner?
- [ ] Do staff address the residents by name?
- [ ] Do staff respond to someone calling for help?
- [ ] Are people assisted in walking for the purpose of exercising or retraining?
Ask several residents how they keep occupied, and what they particularly like doing at the facility.
- [ ] Do residents share rooms? How many people to a room?
- [ ] Does the facility select compatible roommates?
- [ ] Are rooms assigned based on severity of illness?
- [ ] How does the facility deal with problems between roommates?
Mealtime is an important part of the residents' day. Try to visit during mealtime and observe the way food is served and how the staff and residents interact.
- [ ] Is food appetizing and of good quality?
- [ ] Do residents have an alternative to the main menu?
- [ ] Are residents encouraged and assisted with eating (if necessary) while the food is served?
- [ ] Is this a time when socializing is encouraged?
- [ ] Is the dining room clean, attractive and colorful?
Many facilities try to be less "institutional" and use tablecloths, china and silver, enhancing mealtime.
It is hard to observe medical/nursing practices, but you can ask questions:
- [ ] Does the same nurse or aide care for the resident during each shift?
- [ ] Will your family doctor be able to care for you in the facility?
- [ ] If you do not have a private doctor, who will the physician be and what relationship will you or a family member have with this doctor?
- [ ] How often will visits be made, and how will medical emergencies be handled?
- [ ] Ask when and how often the facility performs assessments for attaining Information regarding the resident, including information for the Minimum Data Set (MDS) and Patient Review Instrument (PRI)?
- [ ] Ask the procedures for Preadmission Screening and Resident Review (PASRR) for patients with Alzheimer or other psychosocial impairments?
If you need more than routine medical care, ask if a specialist can be called in and how this is done. Find out with which hospital(s) the nursing home may be affiliated.
If you might need speech, physical or special therapy, look at the therapy rooms. If possible, speak to the staff person in charge.
- [ ] How frequently will therapy be offered?
- [ ] Can therapies be provided on an optional basis or a for-private-pay basis?
- [ ] Is the physician involved in assessing the therapy and your response to it?
- [ ] What additional services does your Dementia Unit offer?
- [ ] What additional training does the staff of your Dementia Unit receive?
- [ ] Does your facility float staff from other units to work on your Dementia Unit at times when staffing may be short?
- [ ] What special activities does your facility offer the residents on the Dementia Unit?
- [ ] Is there a time or situation my loved one would be required to leave the Dementia Unit?
- [ ] Does your Dementia Unit have specific precautions or safety features to protect my loved one from wandering out of the facility?
- [ ] Are there other types of safety features your facility offers on your Dementia Unit that you would like to show me?
- [ ] Does your facility offer assistance or education on Dementia for the family members?
- [ ] What are your policies on toileting/incontinence care?
Things to look for:
- Bright colors
- Safety features
Anyone who applies to a nursing home must be evaluated to determine if the nursing home can provide the services the individual needs. One of the tools that is used to conduct this evaluation is the Pre-Admission Screening and Resident Review (PASRR).
The PASRR must be conducted before admission to a nursing home. The PASRR determines whether a nursing home applicant qualifies for nursing home level of care and whether the person is suspected of having mental illness or mental retardation.
The first step in the PASRR process is for the referring entity – a hospital or home health care agency, for example -- to complete what is known as a Level I Patient Review Instrument and Screen. The Level I Screen determines the need for nursing facility services, and also identifies the presence or possible presence of mental illness or mental retardation. If there is no evidence of mental illness or mental retardation, and the applicant is determined to need nursing facility level of care, the person may be admitted to a nursing home.
A Level II PASRR evaluation is completed when the Level I evaluation determines a possible presence of mental illness or mental retardation. A Level II evaluation may also be completed for residents already residing in nursing facilities who are suspected of having a significant change in their physical or mental condition.
If a Level II evaluation detects the presence of mental illness or mental retardation, a determination must be made whether the mental illness/mental retardation is severe enough to require Specialized Services, or is less severe and requires less intense mental health services (Services of a Lesser Intensity). If a nursing facility applicant or resident is determined to require Specialized Services for mental illness, he/she MAY NOT be admitted to or allowed to continue to reside in a nursing home. Specialized Services must be provided on an inpatient basis by a mental health facility, such as a psychiatric hospital, psychiatric center, or, in case of a minor, a residential treatment facility.
If a nursing facility applicant or resident requires Mental Retardation Specialized Services or Services of a Lesser Intensity, he/she may be admitted to a nursing facility provided the admitting facility is equipped to provide the services required or makes arrangements for the services. Nursing home applicants or their legal representative may appeal the final Level II Determination as defined in the Letter of Determination that was mailed to them.
Questions to Ask Regarding the Provision of Mental Health/Mental Retardation Services When Reviewing Nursing Homes:
- [ ] What specific types of mental health/mental retardation services does the facility provide?
- [ ] Does the facility provide these services in-house, or are residents required to travel elsewhere to receive the services?
- [ ] Does the facility have psychiatrists or other mental health/mental retardation professionals on-site?
- [ ] What types of therapeutic activities does the facility offer to meet mental health or mental retardation needs? Ask for available calendars of activities.
- [ ] What kind of follow-up does the facility have in place to ensure required services are being received?
Currently there are nine nursing homes in New York State that deliver skilled nursing care for infants and children up to 21 years of age. Pediatric nursing homes are required to meet all of the same federal and State regulations that all other nursing homes in the State meet, with the addition of meeting each child's educational, developmental, emotional, and spiritual needs.
- [ ] What services does your facility offer for children, what are the age specific activities your facility offers?
- [ ] What are the ages of the children you serve?
- [ ] What additional training has your staff received to serve children?
- [ ] What safety checks have you done to ensure my child is safe and being cared for by your staff?
- [ ] Does your facility serve all pediatrics residents?
- [ ] Do you congregate residents based on their ages, clinical needs or by other definitions?
- [ ] Do you care for kids that require mechanical ventilation?
- [ ] Do you care for children that require respiratory assistance at night, similar to a Bi-Pap machine?
- [ ] Can I bring my child's medical equipment in for use in your facility?
- [ ] Do you have a pediatric respiratory therapist on staff at your facility? If so, how many hours a day is the therapist on-site?
- [ ] How does your facility assure my child will meet his/her educational requirements?
- [ ] Do I have to pay for my child's education while he/she is in the nursing home?
- [ ] My child has a learning disability and many medical problems that are contributing to his/her lack of coping, does your facility offer assistance or programming to respond to my child's needs?
- [ ] What are your visiting hours and rules for siblings and friends?
- [ ] Can I bring my child's clothes and will they be laundered for me?
- [ ] If there is a problem with my child how quickly will I be notified? May I stay with my child overnight if I chose? May I decide on which acute care hospital my child will be transported to in an emergency event?
- [ ] How many staff will be caring for my child? How do you protect my children from other children, visitors and staff that may have behavioral problems or criminal backgrounds?
- [ ] My pediatrician is planning on maintaining his professional relationship with my child during his/her stay in your facility, do you allow this?
- [ ] Will you assist in my child's admission to the Nursing Home? If my child has any psychosocial needs, will my child have a preadmission assessment?
- [ ] Will you assist in my child's discharge to home? If I need assistance, education or support after my child is discharged home will your facility be the contact for me?
Other items to look for in Pediatric Units:
- Age specific decorations
- Bright colors
- Clutter of units
- Space of room/unit and areas of space
All homes are required to offer activities for residents. As you visit homes, you may find a great difference in the way activities are offered. Ideally, a program should be designed to fit the interests and skills of each person and be available on a daily basis at various times of the day including weekends.
- [ ] Ask if residents are taken out for events in the community. How often? Where do they go?
- [ ] Do people in wheelchairs get to participate?
- [ ] How often are outside events brought in for the entertainment of residents?
- [ ] What activities are provided for bed-bound residents?
- [ ] How many staff work on the unit my loved one will live in, on each shift?
- [ ] How do you ensure that staff really know the resident they are assigned to?
- [ ] Is each resident cared for by the same staff?
- [ ] What religious denominations are served at the facility?
- [ ] What services are offered at the facility? How frequently are these offered?
- [ ] What system is in place for inventory of resident personal property?
- [ ] How does the facility investigate missing items?
- [ ] How is personal property safeguarded?
- [ ] Upon discharge, how is personal property handled, and returned to the family?
If you will be paying privately for care, ask about the fee schedule and be sure you find out what services and supplies ARE NOT INCLUDED and what these items will cost.
To determine how often fees increase, ask how often fees increased in the past and what the increases were.
State law prohibits residents from being asked to pay more than three months in advance upon admission. (People admitted under Medicare do not have to pay anything in advance.)
Standards governing the operation of a nursing home are set by state regulation (Part 415 of 10 NYCRR) and federal regulation (Part 483 of 42 CFR). These standards intend to assure the highest possible quality of care and most meaningful quality of life for all residents in nursing homes. Standards cover a range of requirements including but not limited to residents' rights, clinical services (including nursing, dietary, medical and rehabilitation services, for example), and administrative services (including quality assurance and the physical environment, for example). There are specific regulations that also address care for residents with head injuries, people with AIDS, ventilator-dependent residents, and residents requiring adult day health care services.
Look for the latest state survey (inspection) report of how the home met the state and federal standards. Nursing homes are required to make accessible in a public place the most recent Department of Health survey, so that you can review findings of the latest inspection.
In New York State, the Department of Health, acting as the agent for the Federal Government's Centers for Medicare and Medicaid Services (CMS), has the responsibility to monitor quality of care in nursing homes. State surveyors conduct unannounced inspections of each New York State nursing home every nine to fifteen months. Surveyors interview residents, review residents' records, inspect the premises and assess compliance with state and federal standards (see Appendix A). Surveyors may issue a statement of deficiencies any time they visit a nursing home if they determine that the home is in violation of federal and/or state regulations. If the need arises, state or federal survey staff may visit nursing homes more often to respond to complaints by residents or families or to monitor the progress as nursing homes correct deficiencies.
Based on the results of the inspection and the seriousness of problems noted, the Department of Health decides whether to take enforcement action. Repeat problems can result in fines, and in extreme cases, closure.
Remember, deficiencies are not necessarily the only indication of the quality of care and administration of the home. Ask to look at the results of a few surveys so you can see if there is a pattern of deficiencies in certain areas.
Consumers may obtain nursing home survey and complaint information on specific nursing homes from the New York State Department of Health website at www.nyhealth.gov or from the Centers for Medicare and Medicaid Services at www.medicare.gov.
The New York State web page at www.nyhealth.gov lists Nursing Home information by county, including facility name, address, telephone number, type of ownership, number of beds, and occupancy rates. Also noted is whether or not the nursing home is certified by the New York State Department of Health to provide services for residents with special needs (for example, AIDS patients, individuals who are ventilator dependent, traumatic brain injured). Unless otherwise noted, all nursing homes listed accept Medicaid and Medicare residents.
Complete results of the most recent survey must be available in the facility in a place readily accessible to residents and visitors without staff assistance. Ask questions about deficiencies, if any, and how they were corrected. If you have additional questions after leaving the nursing home, call back with follow-up questions. You can also contact the local office of the New York State Department of Health.
The nursing home program's Central office establishes program policy, monitors trends and activity in nursing homes across the state, and ensures appropriate oversight of nursing home care throughout New York. Contact the office at the following number:New York State Department of Health
Division of Quality and Surveillance for Nursing Homes and ICFs/MR
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