This list, of what to look for and some questions to ask when looking for a Long Term Care Facility for your loved one, was compiled by my friend Jennifer Sierra, a long time care giver herself, who graciously gave me permission to post it to AZ Spouse.
Before starting, it should be noted that it may not be necessary to ask all the following questions, perhaps just the ones pertinent to your situation would be enough.
“I have learned from experience (unfortunately) that it does not matter if the LTCF is 5 minutes away or 2 hours away. It’s nice if it’s only 5 minutes but in reality, family isn’t there 24/7. We must be able to trust the staff. I believe it is in the best interest of my mother to have placed her in the LTCF an hour away because that is where she receives the very best care. (Her old LTCF was only a 5-minute drive and that was the last place she should have been.) The right LTCF will care 24/7 when we can't.
*First Impressions*
Is the facility or home clean, tidy and well maintained? Is there a pleasant atmosphere? (i.e. pictures on walls, plants, open areas, gardens) Are there pianos and/or organs? Is there a communal T.V., VCR, CD player and array of discs, and tapes to entertain? Are residents clean and well groomed? Are they appropriately dressed? Are there any offensive odours? Do residents appear comfortable and at home with their surroundings? Do the residents appear happy and interact or do they look ‘zombie like’ and sullen? Are most at a good weight or do they all look thin? Is there convenient access to public transportation, stores, banks, restaurants, library, family and friends? Will family and friends be welcome at any time? Is there a private area where you can meet with your family and friends? If there is a reception desk, is it staffed during the evening and on weekends? Is your language spoken? If not, how will the staff communicate with you?
*Licensing, Accreditation, and Quality Improvement*
Who is the Administrator, director and owner? How is the facility licensed? Is this a government facility or a privately (profit) run facility? Does it appear money is being spent on residents’ quality of life? What or whose regulations (or ‘Acts’) does the facility work under? Can you see a copy of the latest licensing inspection report? Is the facility accredited? Can you see a copy of the latest accreditation report? Is there a quality improvement plan? Does the facility conduct a residents’ satisfaction survey? Can you see a copy of the results? How will residents and their families be involved in accreditation and quality improvement activities? Is there a resident/family council and what is their role? Do the facility administrators and family council jointly discuss concerns? Is there a resident support groups? Is there a family support group?
*Staffing*
Do staff appear to be happy, responsive and caring? Do staff address the residents and families as they pass by? Do they ‘touch’ the residents in a compassionate fashion? Do staff order, demand or pull residents along? Do any residents have any injuries, bruises on arms etc. and what happened? Do staff ‘ask’ residents to encourage cooperation, or 'tell' them? Do staff listen to the residents and family? Do they have a sense of humour? Do the residents like the staff and interact with them? How many staff is on duty during the day, evening, holidays and at night? What is the lowest and highest ratio of staff to residents? What are their qualifications? Does staff go for retraining or recertification at any time? Does staff treat residents respectfully? (i.e. address by name? Knock before entering the residents’ room?) If you are on a tour, does the person directing the tour take time to say hello to residents and staff? Does staff have name badges (first name) so they can addressed by name? Are their uniforms and shoes clean and neat? Are there policies in place to handle emergencies such as inadequate staffing coverage? What array of procedures is in place to handle aggressive residents? Are there quiet rooms with music to place them, enough staff to calm or separate residents? Is staff trained in ‘conflict resolution’ strategies to diffuse resident’s outbursts (physical aggression and/or screaming) without relying on drugs, restraints or staff physically manhandling? When you ask the staff questions ‘how’ do they answer and do they avoid an answer? When you ask the staff questions do they have time to answer you (If they don’t, they don’t have time for the residents either.) Does staff use food/dessert/beverages as a ‘present’ to get residents to cooperate?
Will you have a private room? If there are double rooms, can you choose your roommate? If you have to start with a double room, and there are single rooms in the facility, is there a waiting list to get into one of these single rooms when one becomes available? How is this waiting list managed? If you also needs care are there shared rooms for spouses available? Do the rooms make you feel at home? Are they comfortable, bright and cheery? How much storage and closet space will you have? Is there a cupboard or drawer that locks for your personal items? Can you bring some of your own possessions (i.e. pictures, furniture, and television)? Is there room for a wheelchair or walker in the bedroom and bathroom area? Is there a phone you can use that is private and accessible? Can you have a phone in your room? Who pays for basic phone service? Can you have cablevision in your room? Can you have food in your bedroom?
*Dining Arrangements*
Is there a central dining room? Is the dining room within easy walking distance from residents’ rooms? What times are meals served? Are meal times flexible? How much time is allotted for residents to eat (some eat slow)? Is the menu displayed? What dose the food look, smell and taste like? Is there a choice of menu items? Do you have input into menu items? Are meals provided that are compatible with your special diet (vegetarian?), cultural or religious background? Can you order diced or minced food? Who helps the resident if they have trouble eating? Are clean shirt protectors (bibs) supplied with every meal? What is the staff/resident ratio at meal times? Will healthy snacks be provided? What times are snacks served? Can you eat in your room if it is necessary or if you choose to? Can you invite guests to a meal? Are residents’ hands and faces washed after eating? Are dietary supplements provided if your doctor/health care provider orders them? Who pays for dietary supplements? How much will this cost and who arranges this? Is there an area where you or your family can make a cup of coffee, or a snack? Will you be given a packaged lunch if you are away during a meal?
Can your own doctor/health care provider/clinician continue to care for you in the facility? Is there a facility doctor who visits all the residents? How often does he/she visit? How do medication bills get paid if the facility doctor orders medications? Will you be able to stay at the facility or home if your care needs increase? Are rehabilitation services such as physiotherapy available? Do they do extra things for the residents such as offering footbaths (this is calming)? Is there a dietician on staff? Is there a music therapist? Will facility/staff help you with daily care of your teeth or dentures (flossing, cleaning etc.) if needed? Does a dental hygienist, denturist or dentist visit the facility? If so, who arranges and pays for these services? Is a hairdresser and barber services available? Does a podiatrist (foot doctor) visit? Are massage therapist services available? Will you and/or your family be involved in planning and regular reviews of your care? If you need extra health care services, how can you access them?
*Special Care Program*
Is there a separate are area for persons with dementia/Alzheimer’s disease? Is there a different eating area specifically for persons with dementia or are all residents included in the mealtime together? Are the special or recreational activities constructed so they are easy and fun so all residents can participate regardless of their level of dementia? Are safe indoor and outdoor walking areas provided?
Can you have a bath or shower when you wish? How many baths or showers are you entitled to in a week? Do care aides help in the bathing or showers? How will your privacy be assured during bathing or showering? Is there any special equipment available, such as lift equipment or wheelchair showers? Who will help toilet you if you need help? How often do they get put on the toilet? How often do their disposables get changed? Can you use your own soap and shampoo? When is shaving done and who does this? Where do razors get stored? Who cuts the residents toe and fingernails? How many residents share each washroom?
*Lounges, Activity and Outdoor Areas*
Is there a lounge or living room where you can socialize or entertain visitors? Does it look comfortable and inviting? Is there a space for you to have private conversations with family and friends? Is there an area of special room for crafts and other activities? Is there a garden or patio? Can you go outside when you wish? Is there outdoor shelter to protect you from the wind and rain?
Is there an activity director? What kinds of activities, musical programs, entertainment, outings and crafts are available? How often are these and are they varied? How is the schedule of activities, programs, and outings communicated to residents? Is there a schedule of monthly events posted? Are there a variety of craft activities? Are there equal male/female activities to choose from? Are there extra fees for materials for any activities or crafts? Do residents and/or families have a role in planning activities? Will you be able to pursue your own hobbies (gardening/bridge, etc.)? Are activities scheduled during the evenings and on weekends (& Stats)? Is there a pet at the facility? Does the facility have a pet visitation program? Can you bring your pet to live at the facility (a bird?)? What religious or cultural holidays are celebrated? What religious service or pastoral care is available? Are birthdays celebrated? How are residents transported to appointments, activities, religious services etc.? Is there a facility or rented wheelchair-accessible van or bus? Is there a fee? Are the residents encouraged to use public transportation in lieu of facility van?
*Laundry*
What laundry facilities are available? Are you allowed to wash anything yourself? Are laundry supplies provided? What items of personal clothing may be sent to the laundry? Will the facility do all the laundry or the family (excluding sheets)? Who is responsible for mending personal clothing? Who is responsible for labelling of all clothing? Who is responsible for labelling shoes, brushes and other personal belongings?
What types of incontinence supplies are available? Are incontinence supplies provided without charge? What is the policy if you prefer to use a type of incontinence supply that differs from the type provided?
*Pharmacy Services*
Who is responsible for administering medication? What is the procedure or administrating meds when going on an outing? How are prescription drugs stored? What is the policy regarding the use and storage of non-prescription meds? Are non-prescription medical-related supplies provided without charge?
Are visitors welcome at all times? Are there restricted visiting hours? Can you have overnight visitors? Can you go away for weekends and/or holidays? Who will you or your family approach for information and/or problem solving? Is there a facility social worker, or counsellor? What is the procedure if you or a family member has a complaint? Is there a resident bill of rights? Can you have a copy? Do residents and family have access to the policy and procedures manual for the facility? Do you need to sign out or get permission if you leave the facility with family? Is there a curfew? If so what time? What are the policies regarding advanced directives (types of medical intervention you may agree to if you become incapacitated) and “Do-Not-Resuscitate orders” (NDR)? What are the policies on restraints? Does the facility use straps, belts, and harnesses to restrain residents? How does the staff manage without the use of restraints? What are the policies regarding alcohol? What are the policies on smoking? Is there a designated smoking area? What is the eviction/discharge policy?
*Financial*
If the facility is private pay, what is the daily rate? If the facility receives funding from the Government what accommodation rate/user fee is the resident required to contribute? Are the rates being charged affordable? What extra charges can be expected in addition to the daily accommodation rate/user fee, (i.e. Private phone, cable hood-up, newspaper, special supplies, special activities? Is there a ‘comfort fund’ procedure for family to pay in advance to cover extras? What arrangements can you make for payment of extra charges if you do not have enough money? What are the policies regarding storage of money and valuables? What are the policies regarding the administration of your funds? Do you continue to pay if on vacation or in a hospital?
How will your private information be protected? Has the facility had any elopes how is this avoided? Are residents’ rooms locked at night? Will outside doors be locked overnight? What is the policy for dealing with uninvited visitors?
*Emergency Management*
What policies and plans are in place to handle emergencies such as earthquakes, fires, snowstorms etc.? Is there a sprinkler system for fire safety? When was the most recent fire drill? Are emergency exits well marked? What is the policy on contacting families in the event of an emergency or illness? What is the policy on ’quarantines’ due to contagious (flu?) outbreaks?
Make sure the Primary care giver (family) gives the facility phone numbers where the family can be reached 24/7 should questions arise. Families are part of the care system and must make themselves available for consultation. If families don’t keep actively involved and continue to care, how can we expect facility staff to care?
When you tour a facility ask the residents questions if you can, they know more…they live there. And remember that we are paying not just for a home to feed, clothe and wash our loved one. We are paying to ensure they are safe and receive the best health care, nutrition, personal care, stimulation, enjoyment, attention, compassion, dignity and hope. Their ‘quality of life’ is everything, and they deserve to feel valued and loved, just like us. “
Thank you (and your friend) for posting this. I'm not at the point where I need a facility for my husband, but I am going to print it out and keep for the future should the need arise. A very comprehensive guide to what you should check out.