Nursing Home Red Flags You Should Watch Out For
The importance of visiting nursing homes
Overwhelmed with choosing the right nursing home for yourself or a loved one? With an abundance of options, as well as startling stories about senior living conditions, this can be a challenge. You want a facility where the residents aren’t merely surviving but are also socializing and thriving, even in their advanced age.
To avoid nursing home red flags, get started on comparing facilities:
— Rely on nursing home ratings from federal and state agencies. Using websites like Care Compare, you can search by region and view different metrics for nursing homes, long-term care hospitals, in-patient rehabilitation centers and other facilities. You can also try Medicare’s Nursing Home Lookup.
— Research state agencies for similar resources. For instance, the California Department of Public Health provides the California Health Facilities Information Database.
— Check out U.S. News ratings. U.S. News assessed more than 15,000 nursing homes this past year and rated most of them on short-term rehabilitation and long-term care. You can also search for nursing homes by city or state.
— Look up online reviews. If you notice multiple negative reviews, consider steering clear of that facility. Nursing homes cited for abuse will have an icon showing a white hand within a red circle next to their name on Medicare.gov.
Even after sufficient online research, consider visiting a few nursing homes in person. Dr. Tanya Gure, section chief of geriatrics and clinical professor of internal medicine at the Ohio State University Wexner Medical Center in Columbus, says that ratings can lag behind recent updates or improvements a facility has made. On the other hand, the facility could have since taken a turn for the worse.
But once you take a tour, what should you look for? Here are nine signs a nursing home isn’t right for you or your loved one:
1. A high number of infections and deaths
Infections have almost become an unfortunate guarantee with any type of senior care facility. As of 2018, the Centers for Disease Control and Prevention estimated that there were approximately 1.3 million nursing home residents, but between 1 million and 3 million infections every year between nursing homes, skilled nursing facilities and assisted living facilities.
Common infections that plague nursing homes include:
— COVID-19.
— Methicillin-resistant Staphylococcus aureus, or MRSA.
— Pneumonia.
— Urinary tract infections.
— Norovirus.
— Clostridium difficile, also known as C. diff.
— Scabies.
Depending on the infection, they can be transmitted through the air, fecal matter or from direct contact. For this reason, observe the staff in action while touring a facility.
“Do they wash their hands before and after handling a resident? If they don’t, this poses an infection risk, which is a big concern for older adults with weakened immune systems,” advises Dr. Gary Small, chair of psychiatry at Hackensack University Medical Center and behavioral health physician-in-chief at Hackensack Meridian Health in New Jersey.
2. High turnover among staff
Turnover among certified nursing aides at nursing homes is often near or more than 100% annually, according to researchers. This means that all employees in that facility will likely have quit within a 12-month period and been replaced.
In addition to turnover, look for:
— Nurse-to-patient ratios and staff-to-resident ratios.
— Nursing care availability overnight.
— Procedures that are available in case of emergency.
— Onsite medical staff, such as a doctor.
A high turnover rate among staff does not necessarily mean a nursing home is short-staffed, though it may affect the quality of care. Having the same nurse aide care for your loved one for a long period of time means they will be in tune with their mood, emotional and physical needs and any potential signs of decline. With high staff turnover, staff don’t get to know their residents and their routines as intimately, and information can get lost between shifts.
3. Limited socializing
When you’re visiting a nursing home, be sure to pay attention to the social enrichment activities available to the residents.
This may include:
— How many residents are up engaging in activities by 11 a.m.
— Availability of nursing home activities, including arts and crafts, clubs and low-impact exercise, like walking or aquatic activities.
— The amount of residents who eat in the dining halls during meals.
— Residents who feel comfortable asking questions to or socializing with staff at appropriate times.
— Outdoor space available. Small says that spending time outdoors can improve quality of life for nursing home residents.
— A location in a safe neighborhood. The outdoor area should be secure in case of wandering residents.
Social enrichment in these facilities is not just a nice amenity; it’s a necessity. If social activities aren’t a priority, that’s a nursing home red flag. That’s because social isolation is linked to mental and physical health conditions. According to the CDC, people who are more socially isolated have a 50% increased risk of developing dementia.
4. Complaints to state inspectors
The state agencies that license and certify nursing homes inspect these facilities at least once a year, according to the National Center for Biotechnology Information, or NCBI, a branch of the National Institutes of Health. Inspectors determine whether facilities are complying with federal and state standards.
One of the goals of these inspections is to assure that each resident receives appropriate quality care, according to the NCBI. Inspectors also investigate complaints from residents, family members, ombudsmen or other third parties.
Unfortunately, some residents in bad nursing homes have been subjected to elder abuse. Such neglect could include withholding food and/or medications or not providing access to health care.
Signs that a resident is being physically or emotionally abused include:
— Broken eyeglasses.
— Disruption in the resident’s medication routine.
— Unexplained bruising.
— Thumb-sucking, mumbling or rocking.
— Harsh treatment by a staff caregiver, which could include belittling or intimidating the resident.
One of the biggest red flags would be physical signs of poor transfer techniques or prolonged time in bed, says Cara Dobbertin, a physical therapist based out of Colorado and a team member at Practitionr.com, a content site to help medical practitioners navigate their careers or private practice.
She adds that it’s also a red flag when patients need routine hygiene assistance or other assistance with daily living activities right before their rehab sessions. This may indicate that the resident is neglected during other parts of the shift.
Request a copy of the annual state survey and, if relevant, copies of complaint investigations. Complaints that led to investigations could be a red flag. Gure adds that it can be helpful to learn about the facility’s background. You might have more peace of mind knowing they are associated with a reputable academic medical group.
5. Long response times and inadequate staffing
The call light is the link that provides residents access to anything from comfort to immediate life-saving measures. In fact, the CMS also has regulations on call lights. The most important requirement is that every resident must have their call light in reach, no matter what. If residents don’t have access to their call lights, they don’t have access to proper care.
When visiting a nursing home, take note of the following:
— Active call lights.
— How staff prioritizes answering call lights. Do they answer them in order? Are the lights color-coded? Do they have a nurse aide find out the needs and then order them accordingly?
— How long the call lights are on until they are addressed.
It’s normal for there to be more call lights on at certain times, like during meal times, shift changes or times that are common for medication administration. However, if you notice call lights are on all the time and the caregivers aren’t able to keep up with demand, it could be a sign they are understaffed.
In fact, staffing shortages in nursing homes have been a growing concern, particularly after the COVID-19 pandemic. For instance, KFF reported that 25% of nursing homes across the country reported a shortage of a minimum of one type of staff. To address this issue, the Biden administration has announced reforms to improve nursing home safety and care, including requirements for staffing levels.
Ensuring a nursing home has adequate staffing is critical for your loved one’s safety. One of those call lights, for example, could be a resident who fell and needs help or is having acute chest pain.
6. Unresponsive residents
When touring a nursing home, if you notice there are a lot of residents out and about who are unresponsive, this could be a red flag. This can be a sign that the facility is resorting to antipsychotic medications, like Haldol or Seroquel, as a way to curb behaviors that are challenging for staff to handle, especially in residents with dementia or Alzheimer’s.
Sometimes these medications may be necessary to prevent a resident from hurting themselves or to treat a genuine psychiatric condition. However, misusing these medications can limit resident communication and facilitate a decline in their physical and cognitive abilities.
When touring a nursing home, make sure to ask a member of the staff how they handle “difficult” residents and how psychiatric evaluations are used in their facility.
7. Unclean residential rooms
Small advises checking the cleanliness of resident rooms if you can. Issues with cleanliness and sanitation could also point towards a quality control issue or poor staffing. A nursing home doesn’t need to have exquisite interior design or break the bank, but it should be clean. Proper sanitation isn’t just about having tidy living quarters but also about stopping the spread of germs and harmful bacteria.
Older adults have a weaker immune system, so they are more susceptible to infections, Small adds. Research also shows that a clean living environment may promote healing.
Signs of unclean rooms include:
— Trash cans that haven’t been emptied.
— Food trays that are left in place without being cleared properly.
— Beds that haven’t been made or linens that are soiled.
— Clothes, shoes and other items that are strewn about on the floor.
Nursing homes should take pride in having clean and tidy facilities that don’t smell unpleasant. If you aren’t confident of a facility’s cleanliness on a tour, consider going elsewhere. Their cleanliness could decline if more staffing issues arise among the clinical staff or housekeeping department.
8. Poor and limited food quality
No one expects a nursing home cafeteria to offer a five-star menu, but it does need to provide healthy food that meets the nutritional needs of its older residents. Not only should the nursing home cater to residents’ likes and dislikes, it should also be able to provide meals to meet the needs of residents on special diets, such as:
— Low-sodium diets.
— Lactose intolerant diets.
— Gluten-free diets.
— Diets catered for residents to avoid individual food allergens, like tree nuts.
— Meals for those with acid reflux who avoid trigger foods, like onions or garlic.
Unappetizing food or meals that don’t follow their diet could lead to a loved one not getting the proper nutrition and losing weight.
9. Disrespectful and evasive staff
You should feel comfortable talking to staff and having your questions or concerns addressed.
Questions you may need to ask include:
— Have there been any recent changes to my loved one’s care plan?
— Have you seen any growing signs of pain or discomfort in my family member?
— What does my loved one do to stay occupied when I’m not able to visit?
— Lately, I’ve been noticing this particular behavior in my family member. Do you have any concerns about that?
The care team at the nursing home — including therapists, health care providers, nurses and aides — should all be invested in the well-being of their residents.
A nursing home that cares will validate your questions and allow you to be a collaborator in the care of your family member. If they don’t, that is one of many possible nursing home red flags.
“If you find they are unwilling to answer questions or they behave rudely, consider going elsewhere,” Small says.
Watch out for these red flags in nursing homes:
— A high number of infections and deaths.
— High turnover among staff.
— Limited socializing.
— Complaints to state inspectors.
— Long response times and inadequate staffing.
— Unresponsive residents.
— Unclean residential rooms.
— Poor and limited food quality.
— Disrespectful and evasive staff.
More from U.S. News
Nursing Home Statistics: What to Know in 2023
Nursing Home Secrets: 11 Things They Don’t Want You to Know
Options to Consider Besides Nursing Homes
Nursing Home Red Flags You Should Watch Out For originally appeared on usnews.com
