Choosing a Nursing Home Part 2

I did my last noc shift night before last, which means I have more time now again! In fact, my new job is split day/eve shift, but never both in one day, and I'll always have 2 days off in a row; isn't that called a weekend? I can't remember. It sounds heavenly though.

So now I have time to share my hard-learned lessons on choosing a nursing home to live or work in. I think they can be the same post, because if a nursing home is bad to work in, it's probably bad to live in. The reason residents are there is to get care, and if the employees are miserable, the care is going to be substandard. If the employees are happy, the residents are happy, and it creates a happy cycle.

I made some big mistakes on my last job hunt; I let schedule and pay dictate which facility I chose, and overlooked some red flags. I'm actually pretty embarrassed about that, but at least I can come clean here so any readers (hopefully) won't do the same things. I was just so focused on finding a job that would allow me to keep my homecare job that I chose the wrong facility. If I'd been willing to give up my security-blanket job at the homecare agency earlier, I think I'd have chosen differently. Oh well, here I am about to start at the GreatRep, so it all is for the best now!

Mistakes I made:
1. On my tour of the facility, I didn't insist on seeing into any of the resident rooms.
Realistically, this may not have saved me, because usually you don't get to see one that's currently occupied. The "model" room or apartment is usually empty and therefore looks perfect. But at the Crapdorable place, I had no idea that around 20% of the residents sleep on mattresses on the floor. It's for safety, to keep them from falling out of bed, which makes sense and all, but is incredibly hard on the caregiver's body that has to try to change their briefs and reposition them while kneeling on the ground next to them. This is why I was limping after each 4 day rotation there. The other reason to ask to see the rooms is to see what type of beds they have (if the facility provides them) and whether they're adjustable or appropriate for employee and resident safety.

2. I didn't ask the hard, slightly rude questions.
I did ask about aide to resident ratios, length of shifts, etc. But I didn't ask about how long management had been in place, whether there were any recent or upcoming changes there (new Executive Directors, new Administrators, etc). I didn't ask about their employee retention rate (20% at the Crapdorable place - huge red flag that I wish I'd known before I began there). I didn't ask about their call-out policy; if the answer is "you can't leave until the next shift arrives" this probably isn't a good place. Of course you can't leave, that's common sense that you cannot abandon patients. However, a good answer is "If there's a no-call no-show, your manager will find someone to come in, and will make sure the floor is covered in the interim". An excellent answer is "We provide an incentive for anyone who comes in on their day off so it's usually pretty easy to find coverage". A typical, reasonable (in my mind) policy is that if you call out, you must find your own replacement. The idea here is to discourage people from calling out hungover, or for other fishy reasons. Each employee gets a phone list, and usually if you're calling out for a real reason and have tried to find coverage and can't, a good manager will help you from there.

Another big question that's good for families AND employees to ask is "how full is your facility?" (aka what is your census like). If it's very nearly empty, proceed with caution. Sure, there's a recession, and more people are trying to make do with home care. But the good places will still be fairly full. Because locals have heard good things about them and prefer to put family there, rather than the sketchy ones. And if the answer is "lower than normal because of stop-admittance orders" RUN AWAY. Remember, that means they did something so bad they cannot allow new residents to move in for a set period of time. BAD.

3. Take a good look at the residents and employees you see during your tour. Do the residents look clean and kempt? Is their hair greasy, or is it combed pretty neatly. Do they themselves smell bad at all? Are their clothes weather appropriate and fairly clean? If it's a dementia facility, lower your standards a bit, because the residents often resist care, but still should get as much as possible. If they look visibly dirty, or unwashed, or their clothes obviously haven't been changed for days, this is a bad place. Now how about the employees? Are their uniforms clean? Is their hair reasonably done? Are they wearing inappropriate makeup? Do they look professional, or do they look like they should be smoking out back of a gas station? I know I'm judgemental here, but if the employees look trashy, it's a warning sign. If the employees look like they could be posted on www.peopleofwalmart.com it's not a great sign.

4. Lastly, smells. Any bad smells should be temporary. Or have a specific reason for them. If the entire place smells like old pee, it's because it's covered in old pee. The hallways absolutely shouldn't stink. Individual rooms sometimes might, especially if the resident living there has a habit of peeing on the floor (many do) or has frequent UTI's. Nonetheless, staff should be working on it to keep it to a minimum. A stinky place is probably not a clean place.

Leaving my Blankie

I just realized that even though I told you all about leaving the Crapdorable place, I didn't say what I'm going to do instead! Duh.

My interview at the GreatRep place went very well, and they called back to offer me a job the same day. Even better, the position they offered me is one that I didn't know was available: full time, part dayshift, part evening shift (probably 2 days per week of each, one variable, 2 days off per week). That means NO MORE OVERNIGHTS!

And this time, let me tell you, I interviewed. I asked that administrator so many questions that I wish I'd asked at the Crapdorable place. Everything from "What's your employee retention rate?" to "What's the average census of your residents?" to "How long has the administrative staff been here? Any upcoming changes?". I'll explain all those in my next post about how to choose a nursing home, so if anyone reading that went "Huh?", don't worry.

I feel confident about the care the residents get at the GreatRep place, which means I'm very likely to be able to stay in my job there. Add to that the fact that I'm only working 5 days a week, and no more than 8 hours at a stretch, and I'm very likely to actually enjoy this job! It did, however, mean that I'm finally having to cut the apron strings and leave the Home Care Agency.

That place has been my only constant in the past year. I'm embarrassed to tell you how many other supplemental jobs I've had and left throughout my year at the Home Care Agency. Okay, fine: Four. About to start my Fifth. So leaving the Home Care Agency is me leaving my blankie, basically. But it was becoming a crutch, and preventing me from taking potentially great jobs that would have conflicted with my schedule there.

The GreatRep place has a scholarship program for nursing school. And if they ask you to come in on your day off, you get $2/hour more, which should translate into almost never working understaffed. They do a lot of things which mean members of the community come through all day every day, which makes it much less likely that anyone is being neglected; they're doing a fitness study with one of the State Universities. And they have a very, very cool program that I wish I could write about but it would give away which facility I'm talking about.

To make it more bittersweet, I just had my 1-year review at the Home Care Agency with Big Boss Betty (remember her from my first post here?), and it was awesome. They gave me a bonus equal to 25 hours of work, because that's what I've averaged for them over the past year. And they said I'm welcome back any time that I want. Awwwwww.

So I just have to get through my very last crapdorable rotation, then one week of only Home Care (should be easy as pie) and then I'll begin my new full time job at the GreatRep.

Whew!

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.