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Yes, Good Nursing Homes Do Exist!

Good nursing homes do exist.  In fact, there are many dedicated facilities throughout the country dedicated to the compassionate care of the elderly.

In an era where we are bombarded with horrific descriptions of nursing home abuse and neglect, it was a pleasure to come across Jane Brody’s personal accounting of the Miami Jewish Health System– one of largest nursing homes in Florida. Ms. Brody’s article, ‘Nursing Homes That Belie the Bad Image’ appeared in the New York Times and may be viewed here.

The Miami Jewish Health system is a huge, 20-acre complex in Southern Florida that cares for a variety of young and elderly patients with a diverse range of medical needs.  In fact, the facility is designed to provide such a broad range of medical treatments, that the patients truly never need to leave the facility confines.

Unlike, many ‘generalized’ nursing homes, Miami Jewish Health Care Systems offers:

  • An acute care hospital
  • Short and long-term skilled nursing care
  • Rehabilitation services
  • A dementia clinic
  • Psychiatric clinic
  • Pain care center
  • Recreational activities
  • Respite care
  • Religious services
  • Assisted living services
  • Hospice care
  • Care for children with cerebral palsy

Although the lack of specializations may appear to be a bad idea, a recent article in the Journal of the American Medical Association concluded that continuity of care- where the same physician oversaw medical care both in and out of a hospital setting; speeded recovery, cut costs and reduced re-admissions to hospitals in the elderly population.

Amazingly, 85% of the patients at the 492-bed-facility, are recipients of the Florida Medicaid program which reimburses the facility $205 per day.  To cover the difference between what Medicaid reimburses and the ‘actual cost’ of care, the facility raises money through contributions and grants.

Learn more about the laws applicable to Florida nursing homes here.
Click on the links for information on nursing homes in Miami, Orlando and Tampa

Finding A Good Nursing Home In Your Area

Weather you are looking for a nursing home in Florida or across the country, Ms. Brody’s article cites some useful advice proposed by Jeanne M. Hannah in her book ‘Taking Charge: Good Medical Care for the Elderly and How to Get It”.  As the daughter of a victim of nursing home neglect, Ms. Hannah’s suggestions are particularly well taken.

  • Investigate Nursing Home Deficiencies: Check to see if the nursing home has violated federal nursing home standards at the Nursing Home Compare Website. (I also suggest checking on the facility via your state’s department of health’s website as well)
  • Choose Quality Over Location: Avoid the temptation to place a loved one in a facility simply due for convenience sake.
  • Monitor the Care: Be vigilant in checking on your loved one as frequently as possible.  Vary your schedule to make sure they are being cared for even on weekends and holidays.
  • Assist At Meals: One of the best ways to assure your loved one stays healthy is to make sure they eat and drink.  It they need assistance hire an assistant to help them eat.  All Many nursing home patients are susceptible to dehydration and malnutrition.
  • Hire a Geriatric Care Manager: Sure it may seem like a luxury, but if you can not personally look after your loved one, a care manager can act as a patient advocate and liaison between the nursing home and family.  The National Association of Professional Geriatric Care Managers has a searchable directory by location.

Learn more about the laws applicable to Florida nursing homes here.
Click on the links for information on nursing homes in Miami, Orlando and Tampa

Related:

High Staff Turnover Rates Plague Most Nursing Homes

Eden Or A Warehouse? You Choose.

Nurses Admit To Problems At Nursing Homes

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  • Naomi Pemberton

    You find one facility and say there are some good nursing homes out there? I tell you what when you have done better reesearch by going to these homes yourself under cover and finding out which ones you would consider good, please do us all a favor and provide a list of places you stayed for a week so we will be a little more enlightened when you there are some good ones out there.
    Sincerely,
    Naomi Pemberton

  • Naomi-
    First of all, thanks for your comments. Although I tend to share your frustration with the lack of quality facilities, I think its unfair to generalize and say all nursing homes are evil.
    I do echo your thoughts about an intensive search / investigation before placing a loved one at a facility. Along these lines, even ‘highly rated’ facilities do have their share of problems, all families should visit the facilities at least two times before placing a loved one in the facility and should try to visit at various times throughout the day during an admission to ensure quality care.
    Lets hope that these random visits provide a fairly accurate depiction of the type of care at these facilities in an effort to weed out poor care.

  • Kim Stewart

    Dear Mr. Rosenfeld, I have to side with Naomi. My mother in the past 6 months has been through 2 nursing homes and when released from Hospice this week will go to her 3rd nursing home. I have been there with her and she has still been neglected and abused right in front of me. I need to repeat a TOTAL OF 3 HOMES IN 6 MONTHS. I want the laws changed these people need to go to jail. Do you know in Florida that if you abuse or neglect an ANIMAL you go to jail and/or get fined. Does anyone understand that CHILD MOLESTERS, RAPIST AND MURDERERS get better healthcare, nutrition and treatment and have more rights in prison than an elderly person in a nursing home. I have a family and lucky enough to still have a job and need to keep that job to support my family. I need to trust a facility and our laws and government to care for my mom in a humane environment.

  • RN

    I am pleased to find this post on this blog, as a Registered Nurse, I am also an advocate for quality and safety in long term care facilities. I assure the readers that yes, good, compassionate nursing homes do exist, and good compassionate nurses and nursing assistants also exist.
    The tips described above are a good start to identifying the good from the not so good, to assist the readers, I would like to contribute some additional tips to ensure that your loved one receives the best care that they can get.
    When making that difficult decision to place a family member in a long-term care facility, take a moment to reflect upon your own personal thoughts, prejudices and perceptions of nursing homes.
    Do you see them all as horrible, depressing places, are you just waiting for your opportunity to make accusations?
    If so please attempt to separate yourself from these prejudices before making any decisions, for you are already starting off on the wrong foot.
    How do you feel about the reality that you are at a point in your families life that you must accept that you can no longer care for your loved one by yourself and must consider nursing home placement?
    Do you feel guilty, angry, burdened, burned out from years of caring for someone dependent?
    If you have answered yes to any of these, it is recommended that you seek the support of trained professionals such as; a Licensed Clinical Social Worker, Geriatric Advanced Nurse Practitioner, Psychologist or Clergy, before making any decisions .
    Are you alone with this difficult life transition, do you have other family members to assist you in this decision , what are the dynamics of your family, is there tension, conflict, resentment, financial issues between adult siblings, parents?
    If there are issues such as these, make every attempt to resolve them as a family unit and make this decision together, you will most definitely need the help of family.
    I be I’ve that I am employed in a “good” nursing home and I would like to share with as a trained medical professional what makes a nursing “good” vs. “bad”
    1. Your initial visit, before you even consider placing your family member in a facility, make an initial inspection, preferably with someone else. If you are fortunate enough to know a nurse or other health care worker bring them with you to provide objective feedback. It is not necessary to identify this persons title or profession when you make your visit.
    2. There are several ways to plan your initial visit, the best way is to just show up unannounced , a good nursing home should not hesitate to provide you with a tour of their facility and answer your questions. If you do show up unannounced , be courteous and civil to the staff that you encounter, you may first interact with a receptionist. Simply explain that you considering nursing home placement for a family member and request a tour. Depending on the activities of the day, the facility may be able to accommodate you immediately, or offer you an alternate appointment. Remember nursing homes are healthcare facilities and most always very busy.
    3. If possible, request your tour from a supervisory staff member such as; Director of Nursing (DON), Nurse Manager, Head Nurse or Charge Nurse.
    4. As you begin your tour the initial observation should begin with the first person that you encountered, the person at the front desk, were they friendly, accommodating, did they seem happy with their job. (remember we can all have a bad day at work) this is only one aspect of your observation.
    5. The next and important observation to make regarding the quality of care is odor, is there any odor? A good nursing home should not have a persistent urine odor, or any other unpleasant odors. The keyword here is persistent , there may occasionally be transient odors but there should be no consistent unpleasant odor throughout the facility. Also be alert for cover up odors such as air fresheners or chemical odors, although the facility may not have an unpleasant odor, air fresheners and scents do not necessarily indicate good hygiene.
    6. Next observe the nursing staff themselves, do they appear happy with what they are doing, are they dressed professionally, in scrubs and in some facilities neat, clean street clothes are permitted to make the facility feel less institutional.
    7. Do you observe the nursing staff interacting positively with the residents? Do they say hello to residents as they pass by them in corridors, do you get a sense that for the most part there is a positive, therapeutic social culture between the staff and the residents? if you have the opportunity, simply say hello to a staff member and you may be able to get a feel for the overall staff culture. Keeping in mind that we are currently in a global nursing shortage crisis, this means that many facilities struggle to find quality, dedicated nursing staff, a shortages of qualified profession al nurses and nursing assistants are common and widespread.
    8. Next observe the residents themselves, most nursing homes are considered “free roaming” meaning that residents who are mobile residents are encouraged to roam about the facility or in designated safe areas, encourages to socialize and interact with other residents and staff.
    9. Residents should appear well groomed and clean, dressed in street clothes or sometimes residents will elect to wear pajamas or comfortable jogging suits. Residents hair should appear clean, not greasy or matted, should be combed, brushed. Female residents may have long hair pinned up, permed. If the opportunity arises make an attempt to view the residents fingernails, they should be clean and trimmed, not long claws or dark material underneath.
    9. Often seniors may become incontinent, this means they may not be able to control their bowel or bladder function, several interventions may be applied to remedy this. The best and preferable is an incontinence program or sometimes referred to as a bowel and bladder program. This is a question you may ask about, a good program offers incontinent residents toileting assistance at regularly scheduled intervals. Incontinent resident may wear adult briefs (diapers) but they should be checked and changed at a minimum of every 2 hours and as needed. There should never be an odor of ammonia coming from an incontinent resident, this is an indicator that the urine has been there for a while.
    10. Incontinent residents may also have indwelling foley catheters when medically indicated, this is a flexible tube inserted via the urethra into the bladder to continuously drain urine. An indwelling catheter should never be used if the resident is capable of urinating without it. another method of managing incontinence for men is called a condom catheter, external urinary device or Texas catheter, this is simply a disposable condom-like device which drains into a catheter bag, sometimes attached to the residents leg.
    11. A good nursing home respects the dignity of residents by ensuring privacy and confidentiality. Some positive indications of a culture of dignity include, catheter bags are covered at all timed, you may see a cloth bag underneath a wheelchair, at no time should you see urine, the actual plastic urine bag should be concealed inside some type of cover.
    12. A nursing home with a culture of dignity respects the privacy of residents by allowing them to close the doors to their rooms if they choose, requiring staff and visitors to knock on doors before entering, pulling privacy curtains closed when providing hygiene and personal care, and also closing any window blinds or shades when providing care.
    13. Additional indication of an emphasis on dignity include encouraging residents to maintain their own self care abilities as long as possible, this may include simple things such assisting them by placing a brush in their hands so that they can brush their own hair, providing electric razors so men can shave themselves, or assisting residents to wash their own faces after meals.
    14. Be sure to ask for the following; a copy of the facilities resident handbook or brochure, if they do not have one or something similar, it could a quality flag. There should not be a sense of anything about the day to day operations of the facility that seem “secret” or “hidden” the only exceptions being medical information regarding other residents, which is protected under HIPPA laws
    15. Also ask about the facilities Recreational Therapy program, a good facility will have a clearly defined program to include a daily schedule of activities, special events to include activities outside the facility such shopping trips, restaurant visit. Ask if the facility has their own bus for recreational outings and also ask if you are invited to join an outing with your family member, this should be allowed.
    16. Negative indicators include a vague or non-existent recreational therapy program, lack of an activity schedule, observing multiple residents sitting in one area for extended periods unattended, many residents in bed as opposed to more out of bed in social areas such as lounges or day rooms, even residents who are considered “bed-ridden” can be out of bed in specially designed wheelchairs for periods of time. Much research has been conducted that demonstrates that social isolation is a major factor in depression. Interaction with others is a good way of preventing depression in the elderly.
    17. Ask about the facilities fall prevention program, contracture prevention program and pressure ulcer program, a good facility will have a structured evidence based approach and established methods of ensuring safety. You may ask about fall rates, acquired pressures ulcer rates, however facilities may not be obligated to share this data with the general public (this is when your nurse friend may be helpful )
    8. Listen to the tone in which the staff address the resident, volume is not always an accurate indicator as many seniors are very hard of hearing and speaking loudly close to their ear may be appropriate to communicate with them

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