Choosing a Nursing Home: Part 1

Since I'll be leaving my current Assisted Living facility soon, I'm on the hunt for a new job. But not just any new job, one that I'll actually be able to stay at for more than a few months. It occurred to me that now that I've been "behind the curtain" at one facility, I'll have a much better idea of what to look for in the future, so hopefully I won't get burned again. And if anyone out there who's reading this wants to know how to find a decent facility for yourself (work) or to live in (for a family member) maybe reading my thought process on this will be helpful. Since I don't want to give out the real information about where I live, I'll do this as if I were looking for one for my faithful reader Annie's Mom, in Chicago IL.

I'll start by looking up nursing homes in Cook County, Illinois on the medicare.gov site.

This search gave me waaaaaaaay too many results, so I'm choosing to narrow it down by searching only for nursing homes with Resident and Family councils. I want this because it makes it easier for me to address issues if I have questions or dislikes about the way my parent is being cared for. Now we're down to just 59 nursing homes, which is tons more than we have in my whole county where I actually live. This is more results than I'm used to! What should I sort by now? STAFFING RATING. Using the pulldown tab, I can re-arrange the 59 homes in Cook County with Councils so that the most-staffed are on top. Staffing is so important because it doesn't matter how great the CNA's, nurses, and med techs are at any one place; if there aren't enough of them, the care will suck. And if a place is always understaffed, the staff there won't be great; the good ones will get out asap and all that'll be left are the people who won't or can't go find a better job.

You need plenty of staff in order to answer call bells in a timely manner, prevent falls from residents who get frustrated with wating and try to do things for themselves, prevent neglect that can lead to bedsores, and reduce medication errors that can happen when one person is overworked and trying to dose a huge number of patients. Staffing is key. Here are my 59 homes sorted now.


Next I'm going to look for some that are nearby, because I want to be able to come in regularly to see my family member. This is another great way to be sure someone is being cared for: be present. Don't bug staff if you can't find Mom's nonskid sock when she has more in the drawer, or to ask why she's not going to such-and-such activity if it clearly isn't within her skill set (hint: she should be able to move her hands and arms, hear, and see if you want her going to BINGO). But if she's not eating, offer to sit and help feed her for a meal; sometimes confused or stroke patients really need a lot of time and help to eat and staff just can't do it every time. Does she seem to be in pain? Ask about her meds: do they need to be increased? Do you need to call her doctor to get an order for this? That kind of stuff is invaluable.

From list I have now, I'm looking for ones that are in proximity to my home, are well-staffed, and have a decent overall star rating. Don't weight this star rating as heavily as you may be tempted to. In the county where I actually live, the highest rated home is only 3 stars, and the one that I personally (though observation) think is the best is only a 2. These are not crappy places and the people there aren't suffering. I don't know why they are rated so low, but I'd be happy to work or live in them.

The thing that I would check before making a final decision is to see what specifically, if anything, the facility is under "enforcement letters" for. This will tell you what deficiencies state inspections found and what they were, plus what the consequences for the facility were. In general, the more $ the facility had to pay the state, the more serious the problem. If they had to stop accepting new residents, it's because the wrong thing was considered serious. If they had to stop accepting residents for a long time and then that time got extended? I wouldn't want to live or work there. Management isn't able to resolve problems with any speed.

This is where it gets to be a pain in the ass. Not every county and state tells you exact details about this stuff online. Your best bet is to go via the county health department website, like this.


In my state, you can read the entire text of the enforcement letters. The facility I currently work at had some because staff wasn't then in the habit of searching residents' rooms for smoking paraphernelia or escorting them out to smoke every time, so it was deemed a fire hazard. This was corrected within the first "stop admittance" period, so I wouldn't say it's an unsafe place to live.

Another facility closer to my house that I was thinking about applying at has enforcement letters for failing to protect residents in the locked memory care unit from being abused by another resident. Yikes. This could be as simple as that Mr. Hennessey goes nuts with sundowning every evening and smacks whoever is in reach of him. But if that's the case, staff should be able to obtain an order for a sedative to be given to him every evening in order to keep other residents from being smacked. And since the type of abuse wasn't specified, I'm staying far, far away from that one.

Coming up in part 2: So now that we've narrowed it down to homes near your house, with good staffing, and no outstanding problems, we're ready to go visit in-person and see what we think.