Friday, August 22, 2008

18 Questions to Ask a Nursing Home or Assisted Living to Save You Money

18 Questions to Ask an Assisted Living or Nursing Home to Save You Thousands of Dollars
Victor Martinez, 2006

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The cost incurred in a nursing home or dues, fees and rent pay assisted living facility.

The fees that remain the same for each person in an assisted living home are ones that may include:
Laundry, community fees, dining room, housekeeping.

The fee that is the most expensive is the fee incurred while giving care to a resident in a facility or home. This determines if the resident needs minimal assistance vs. maximum assistance the home is willing to tolerate.

This will vary from home to home.

A facility may be willing to take a resident who needs 3 people assistance while dressing while another home may not tolerate this type of care.

A home may choose to not accept a 3-person assist resident, because a home that serves 60-70 residents will only hire 5-8 caregivers during an 8-hour shift. Though a person who requires 3-person assist when dressing (will most likely be charged the max amount in assisted living care), a home may reject that applicant because it is not cost efficient for the home.

The higher the level of care needed for an assisted living resident, the higher the bill. If a person is oriented to person, place and time, they will receive a better score than a person who needs constant reminders to person, place and time

A potential applicant for assisted living may be incontinent person who struggles 3-4 times a week vs. a resident who is incontinent 3-4 times a day. There is more potential that this will hit the pocket two times because a person who needs assistance with their incontinence will require more caregiver hours during the day and will require more 1 on 1 assistance 3-4 times a day.

The second hit to the billfold occurs when the resident is charged for supplies used for dealing with incontinence. Higher cost incur due to the frequency of incontinence.

Why are these questions important for nursing homes and assisted living facilities?

1. Do I have the right to know?

The ombudsman program is a federally funded organization whose only job is to advocate for seniors and their families. They also protect seniors from their own families from time to time.

This program protects seniors from financial exploitation, physical and mental abuse. When it comes to your senior loved one, they have the right to let you, or not let you see their personal documents.

As your loved one turns over their documents, remember, that a good facility will do the same. If you cannot resolve an issue regarding disclosure of any type of document, just remember to communicate, remain calm and remember that all parties involved, most likely want to provide the greatest care for that facility and resident that they say they can provide.

Most people in healthcare fields care for their job and have chosen or been blessed to be hired the healthcare field because most administrators have a caring heart. You have the right to provide any questions in writing to your facility. Give them time if you can.

One season I was brought on to a facility that was in a chain. This home was the last place, revenue generating home in the State and the Executive Director instructed me that we would become #1 in one year.

How? A resident who takes longer and longer to dress, bathe, feed, toilet or walk, takes more time to assist. As the level or ability to accomplish Activities of Daily Living-such as dressing, bathing, eating, walking/transporting/ambulating, orientation to person, place and time-starts to decrease, staff notices the change in the resident.

As time of care increases, word is brought to the manager whose job is to make sure that the resident only receives the care they pay for. To go above and beyond in healthcare constitutes time and money. The time it takes for 2 staff members to bathe a 300 lb. woman is long when compared to a thin, healthy, frail-male who only needs to be reminded to shower daily.

2. What is your census now?

A census is a term used to describe how full a facility or chain of facilities can be. When the executive director meets other executive directors a common question is "How's your census?"

A census is one indicator in determining a nursing home's or assisted living facility's ability to take its mark in the community. Some questions that add value to determining factors when searching for a facility may include…

1. Do you have a waiting list? How long?

2. Do you use SPIN selling?

SPIN selling is a selling tool used to build long-term contacts in the community such as inviting community to 4th of July barbeque, learning your pets names or having a polling place in the facility and these types of techniques can be used to reach potential clients.

A husband and wife moved into a facility where I was a caregiver. They had lived there one month; their family intelligently moved them across the country into a place that could provide a safe environment for this couple.

One morning, I was in the dining room setting for breakfast for about 30 residents, when a fellow staff member told me the husband collapsed in their bathroom and could I get up there now.

I ran upstairs; I was just in their room 15 minutes ago to check on their dog. The husband had just come back from a short hospital stay and I got used to walking their dog outside to pee so the carpet didn't smell, and I liked the dog.

I opened the door and saw the man on the floor, mouth open. I ran and found another co-worker. I called 911, the nurse at home, called my boss and called the responsible family member.

All came rapidly, as it was a Sunday. As I did mouth-to-mouth, his wife and dog watched.

I bonded with those two that day. I was blessed to be there, I never thought that until just this moment.

3. When do you re-assess a resident?

A home or facility may choose to reassess the level of care that is provided for a resident. The facility may reassess if a resident goes to the hospital due to an event such as a slip, heart attack, stroke or hip/bone fracture. The facility wants to make sure the level of care provided for that resident will be sufficient upon their return.

If the level of care goes up you may want to know ahead of time if the cost will go up also.

One time, I was a coordinator of an Assisted living and two sisters who were in their 50's came in my office. Their mom lived in the facility I worked in. I was 25 and they were very nice but very tough customers. It felt like, every time the daughters came to the facility to say hi to their mother, they would find an incontinent product (depends or disposable underwear) tucked in the couch or hidden in her closet.

One of the daughters cried when she told me this, out of frustration and also the fact staff wasn't in her room often enough to remind her to use the bathrooms. Her mother had lived there less than 6 months and "professionals" say it takes 6 months to 2 years to adjust to a facility, family included. I believe them.

I asked the daughter if she had any trashcans that were her mothers. The daughter thought and said yes, they had her kitchen trash can at home. We brought it in, put it right in the bathroom and it worked.

4. How many LPNs per residents?

An LPN is an assistant to the nurse and is responsible for passing medications amd is a valuable employee.

5. How much is a room at basic service for a client at minimal care?

A facility will assess a potential client on that person's ability to function daily. This is a standard procedure and can be a useful benchmark in determining what kind of care will assist the senior in living life to its fullest to the best of their abilities.

Caring for a resident who is 300 lbs, doesn't walk and doesn't dress himself or herself, can cost more than someone who can dress and bathe themselves. Yet, if someone can dress himself or herself and they're at risk for wandering, the cost may increase.

Make sure you can determine what the regular standard of care is and how much it is and what kind of care your situation demands. I mean, if you want to upgrade your flight or hotel room, wouldn't you want to know the cost?

I once had a client with M.S. I was 23ish and he was in his late 30's and very thin. His body was balled up 95% of the day. When he needed to move from a wheelchair to a bed, I would lift him from his wheelchair and he would grab my shoulders and I would transfer him to a bed, where he would relax his body 8-10%, and if you touched him he would ball up or tighten his muscles again.

Damn M.S.

6. How much additional is incontinence care at the minimal level?

Incontinence products, such as wipes, gloves, disposable underwear and such items, are considered additional expenses when running a facility. If a senior loved one needs these items, it may be possible to bring them yourself. Just ask the staff to please label the items or label them yourself. Ask a caregiver or C.N.A. to replace any items they use because emergencies may occur on a hall or floor and sometimes it is easier to grab what supplies are the closest when assisting a resident.

Knowing the minimal cost for incontinence care and supplies is important because a resident who uses 3 pairs of disposable underwear takes more time in caring for in most instances.

A resident who uses one pair of disposable underwear for all day, may spend less on supplies than someone else. The nice thing about letting the facility stock the supplies is the convenience and most often, employees respect the residents' supplies.

7. How many nurses per resident per home?

Some facilities will have a nurse per hall or wing. Some facilities will have one nurse or no nurse even. Some facilities have a nurse or service on standby with a hospital nearby.

What is important is the response time or how available the nurse is when issues arise over time. These issues include incontinence, medication, eyeglasses, hearing aids, walkers and wheelchairs. Hopefully, the nurse(s) you communicate with love their job and aren't swamped with paperwork.

Nurse duties in a facility may include the following: Resident Assessments upon move in, oversees medication and ordering, if you pay for it; therapy ordering and consults, LPN management and Hospice set up and communication.

They also must ensure DNR (do not resuscitate) orders are available if needed, keep track of the resident's personal medical history including medications. In some capacity, this information about each individual resident if kept in their office.

8. How many clients have decubs?

Decubitus is a skin breakdown. If you have ever been sick with the flu for more than 4 days, you may notice a rash or pimple somewhere on your body. Seniors who lose their ability to ambulate (walk), or move while sitting, will begin to irritate their skin.

Areas that receive the greatest and most pressure, such as backside, or backside of legs, knees and arms. F.Y.I, if your loved one loses the ability in the short-term, to ambulate or move, do it for them. Literally lift their arms and exercise them and move their legs if possible. This helps get blood to the extremities of the arms and legs.

Residents with Decubes are documented- or should be according to law. Staff, who may assist your mother with morning dressing or bathing a father at night, will notice any new skin lesions. This is reported to a care manager or coordinator, who tells the nurse and/or documents the problem area.

A nurse administers some type of wound care or even hires out a wound care company whose job is only to get a stage 2 or 3 wound to heal. This may involve the use of physical therapy if necessary.

One time I had a senior resident and I was the coordinator for Assisted Living and she developed Type2 Diabetes, which led to symptoms that effected blood flow to her leg. 2-3 times a week, wound care people would come and try to help her with getting blood to flow through her veins.

They would come and get on their knees and did their best to physically help her. She lost her leg. But she came back months later and adjusted.

And once again, people from wound care came back took care of her stub and taught her how to protect her stub. They also ordered physical therapy for her so she could learn to ambulate in a wheelchair.

9.How many are on wound care now?

Generally speaking, a facility that cares for many residents who are on wound care at one time either….

1. take in the residents that are most difficult to physically move and do their best to pay attention to residents with wounds so they may heal and get of wound care because it is not free.

2. or staff is not doing all they can or not being provided with the resources they need to physically move residents or assist in physical therapy instructions to do more on their own.

3. sometimes residents may be dying or on hospice care. These residents still require and deserve wound care everyday if needed.

Make sure facilities are documenting wound care incidents when they occur, it's the healing process and length of time to heal that is an important determining factor.

I worked in a facility and I was in charge of a team of caregivers and every morning we would serve in the beautifully pink and rose dining room already set from the night staff. Bacon was cooking in the kitchen and I would pour cereals as the other caregivers assisted other residents with their A.M morning routine described in the resident's care plan.

Each staff member brought their perspective residents and had the same hall every time they worked, unless we were short on staff, which was not often.

Our kitchen dishwashers were not finding a reason to stay there so the turnover rate was high and still-the caregivers pulled in and washed the dishes because it had to be done.

10. What is your turnover rate for caregivers?

In any business it takes thousands of dollars to train a new employee and takes many months for the employee to adjust to a new position. The employee should be given time to train and make mistakes in their first year. The importance of maintaining a stable environment is very important when it comes to strangers going into a resident's room.

Providing a safe environment cannot be bought. It comes with training and time. Constant training and or learning should be done with any staff to make sure they grow in their positions and are given opportunities to prove themselves as management.

If a facility does have a high turnover rate and you move into the facility anyway, you will know if the turnover rate is high because you will see new different faces very often.

This can be damaging for many residents. They need stability.

A caregiver is responsible for documenting incidents in a facility. Do they know how to read and write in English?

Caregivers physically and mentally provide constant care. Stability is greatly needed in the care of seniors. Facilities with high turnover rates will no be able to provide this stability to your loved ones, for the most part.

11. How many decubes last year?

Residents move in to a facility to get their skin-breakdown issues dealt with. They shouldn't move in and then get skin-breakdowns. Are residents getting better when after they move in?

12. How many incidents of theft have been reported?

An incident of theft is always tough to deal with. Making sure a facility follows through with their procedures is very important. What is the policy on theft or missing items? If a shirt gets lost in the laundry, who pays for it?

When an incident of theft occurs in a facility, will the facility document the incident? They should document the incident and though it is tough to ask, it is important to know.

If you went to a hotel, would you want to know if that particular hotel had incidents of theft lately? You can replace real diamonds with fake ones for your own security.

A resident may feel their only way of reaching out is a pull-chord. Late at night and all alone, fragile, yet a life fully lived and able to carry more than we believe.

Still, a call for help may seem desperate, too loud or too pushy. The pull-chord should be a call to give residents better tools in dealing with stress, pain and/ or loneliness.

A home who checks on residents and cleans up if they are able, give residents a feeling of protection, knowing caring staff are awake at the facility 24/7. Everyone appreciates stability. Stability equates to smart employee investment by the organization. Employee investment equals better employee retainment.

13. How long does it take to answer a pull-chord?

There are two answers to this question. Answer number one is the one you want to hear. Answer number two is the truth.

If you are allowed, ask a current resident of the facility how long they wait when they pull the pull-chord. I've had family members of residents pull the chord to see how long the response time is, but they've already moved in the facility.

A pull chord is used in strategic locations in any assisted living or nursing home and senior living.

Independent living may or may not have them. In an emergency, a resident or staff can pull the pull-chord to call a team or single person to a room depending on the facilities procedures and policies. They must align with the state regulations protected by an ombudsman program

I worked as a caregiver for a man who every night before I left, I called the staff to come in to come tie him down, because he was a risk.

He had a catheter and dementia and if he got out of the rickety, 1960's bed they had, he would have hurt himself real bad. They didn't have the staff to check on him every ½ hour. Honestly, that would be tough to promise.

Though he was in a safe environment, I remember his eyes and the way they followed me when I left.

14. Do you ever tie down your clients ever and why?

It happens. Just ask first. If a place says yes, do not be quick to judge them. Ask them their procedures and if the state ombudsman knows they tie down residents. They may or may not know.

If someone is tied down for whatever reason deemed necessary, such as harm to others or themselves, they should be check on every fifteen minutes and the straps should be re-adjusted often. This should all be documented if it occurs.

15. Do your employees receive health benefits?

Do employees or employers pay? A caregiver or C.N.A makes less than $13 an hour, maybe more in a hospital setting. Offering insurance and providing insurance is two different issues.

16. How many lawsuits against your last year?

Is the facility in the midst of any legal turmoil? Any suicides within the last year? A lawsuit does not imply guilt or fault.

Do lawsuits affect the culture of the organization? You don't need to be nosy but disclosure of some kind is nice if were talking about caring for the lives of people.

17. What types of insurance do you take?

Insurance is a very complicated issue and out of my scope of responsibilities. I do know that a few services provided in a facility that may take insurance of some kind or Medicare: Medication and Administration, Physical Therapy, Equipment, Vision, Dental, Wound Care and Hospice.

If may help to know if your insurance or Medicare benefits are accepted.

18. Do new residents choose their seating in the dining room?

This question is very important. Imagine living somewhere new, going to a place you really don't want to be, you sit down for dinner and someone tells you to move because Mr. Smith sits there.

It happens often. When you visit a home as a potential client, you sit in the private area or get special seating. After move-in it may be different.

Do residents sit where they like or is their assigned seating? Do they get to choose a time to eat or do you have a 1st and 2nd seating? Do we get monthly food credits or do we pay per meal? Are wheelchairs allowed or must residents transfer to a chair? What if residents cannot feed themselves? Do you track weight changes in residents?

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