Having worked in a long-term care facility for several years, I must toss out my impression of lawyers who specialize in nursing home 'problems'. Please read on.

Each facility has a medical director as mandated by law. There are some who are in the building regularly and know most of the residents; and then there are those who come in regularly and know only their residents. The second way is the usual way. If a doctor has a decent practice, then that MD doesn't have the time to spend in the facility poking around at charts and stuff. Where I worked, there were three nurse practitioners in the facility 5 days a week and those health care providers did all the quality day-to-day things, including the tapering of psych drugs (also mandated by the federal government and it is tracked by the nursing office and the consulting pharmacist in every Medicare certified facility).

In the nursing home where I worked, there were about 200 long-term and short-term (rehab only) people. There was 9 physicians who were following those patients. Most of those 9 came in, but 2 would not come to the facility because of their busy office practice; their patients had to get to the doctor's office. Each doctor (or NP or PA - in states where they are allowed to write prescriptions) are responsible for only their patients and cannot address day-to-day issues for other people.

For folks who are in a long-term-care facility and they are Medicare, then the government mandates that they be seen by a physician every 60 days. That's the law. Folks who are recent admissions or are there after a hospital stay will generally be seen more often. That is also the case with government mandated Care Plan Meetings. Those take place every quarter.

Any nursing home has nurses who are there all the time, just like the nursing assistants (who do most of the grunt work) are there all the time. If they were not there, then they would have never been certified by the Public Health Department of the state.

Those attorneys who claim that they are specializing in Nursing Home problems (med errors, falls, inappropriate diets, pressure ulcers, etc.) and what they represent are the equivalent of ambulance chasers. They are seeking clients who are upset with the perceived care that their loved one gets.

If you really want to find out about what happens, then talk to the family members of someone who lives in the nursing home. Talk to some of the employees of the nursing home. If they have legitimate complaints, you will hear them.

And remember that a nursing home is not the same as assisted living. If you aren't aware, then find out. There are not 'retirement homes' for elders. They are there because they multiple chronic medical conditions whose needs cannot be met any other place. One is in a nursing home because that is the most appropriate place for the person to be.

Jim

Thank you for posting this, Chisue--very helpful. I have not seen the medicare.gov comparison chart before and have bookmarked it for future reference. As to your last paragraph, how would you go about finding that information?

And thank you too, Jim for posting your thoughts and good information too. It's great if you can talk to the relatives of current relatives and staff members, but as an outsider, perhaps on a tour, it may be difficult to get that chance. I'm sure there are ways though....

Jim -- I'm aware that lawyers are interested in bringing suits, but there is useful information on this site. Sometimes lawsuits are the only way to correct wrongs -- but that's not why I posted.

There are both very good and perfectly atrocious *licensed* nursing homes. Few departments of public health have anything near adequate staffing to do inspections, and many patients are incapable of complaining to authorities.

I pulled up 111 homes within 25 miles of my home far north of Chicago when I queried the medicare.gov site. They're all licensed. Some have great ratings. Some sound terrible. People are living in all of them.

You are so right that people need to visit homes, but they need to know what to look for beyond the nice wallpaper and thick carpet in reception or in the areas for the least disabled residents.

When our DS worked as a paramedic for a private ambulance company, he saw a range of conditions in homes. He and his partner once arrived to transport a patient to an afternoon appointment a hospital. They found the patient tied in his chair, dead, with his *breakfast* tray, untouched, in front of him. The man may have been dead when the breakfast was put in front of him. (Just one example; they also saw good care in some homes.)

Every state has Ombudsmen who advocate for the individuals who are in nursing homes. They are good at what they do and most nursing home administrators welcome their presence.

Check out this link:

Here is a link that might be useful: List of ombudsmen in US

I must apologize for sounding off like that. But it bothers me when lawyers get on a radio program and talk about vulnerable elders in a nursing home.

I would rather have those people on the radio talk about the children in our public schools who are getting poor treatment through the fault of many more people than those who operate (and are sanctioned by the state departments of public health) nursing homes.

In the facility where I worked, the median age is 87 and the average length of stay is about 3.5 years. More than half have a diagnosis somewhere in their chart of dementia of one sort or another. These folks cannot have their health care needs met in the community.

And yet, we have young people who are graduating from our public high schools who cannot read, have very little in the way of skills to make their way properly in the community and sometimes show a lack of insight about what is right or wrong. Rarely are school boards sued because they are not doing the jobs expected of them. However, nursing homes are taken to task on a regular basis.

Are people of the age group who are in nursing homes more valuable than those who are younger than 18?

I realize that my responses might be more appropriate on another forum, but this got my hackles up. Thanks for understanding my defensive comments.

Jim

Jim -- No worries. We need to do more for our children AND our elders!

Within the last two months The New Yorker had a good article about changes being championed for the care given patients with dementia. It was about fewer meds and restraints, and 'going along with' patients' benign delusions. Staffers were re-training to better understand how frightened and out of control some patients felt and to discover what was driving some of the most wild behaviors. Patients were encouraged to walk more and could eat more meals 'on request'. Patients (and staff) were happier.

Where I worked, all new employees (no matter where in the building they worked) were given a 5 hour dementia training by our in-house certified dementia trainer. Then, every two years you were required to re-do the training.

Those who had direct contact with the folks on our dementia neighborhoods were required to take 18 hours of dementia training every year. That included housekeepers, dietary, laundry, maintenance, etc. It was thorough and Gail does a great job. She also hosts a monthly dementia support group for anyone involved with a person who has dementia.

I got to know and appreciate all the residents. They were (and still are my family). I volunteer at the nursing home doing the landscape chores. I get inside once in a while to chat with my friends. It is fun.

Jim

We had been using a facility for our son, for several years, until he passed this spring. Not all facilities are the same, but it isn't impossible to weed out the good from the bad. Jim is right, they are strictly regulated. If they don't pass inspections they don't get paid. My advice is to look at the Medicare site and eliminate the ones you can see are not suitable for you needs. Drop in, unannounced if possible and look around. Observe the dinningroom, are the residents eating what they are offered, are they well monitored by staff? Talk to residents if you get a chance and ask what their food is like. Meals are the only thing many of them have to look forward too, and it takes no more to serve good meals than it does bad. See if there are activities going on, keeping them occupied. If it smells bad, that is a red flag. Some patients are incontinent, so some smells are unavoidable, but the smell can be minimized by routine attention.
When you narrow your choices, repeat your inspections on off shifts. The staff numbers will go down, but direct care shouldn't suffer. Each facility should have a book of current inspections readily available you can read.
The main thing is that YOU have to advocate for you family. Drop in to check on them at different times and day's of the week. Make a point of seeing the supervisor or nurse, and ask questions of them. They need to know you are involved.
In most cases you will never find more caring dedicated people you will ever find on a job. It may be the toughest job of all. This has gotten so long, but please email me if I can be of any help.

Cathy's post reminded me of another issue addressed in the article: Toileting. One of the improvements was having staff take the patients to the toilet a bit after meals. It really cut down on the diapering -- to the relief of patients and staff. That this should be a 'breakthrough' seems amazing, given that it is the same way we toilet train kids -- and these poor minds are quite childlike.

Jim -- You are a treasure! I'm glad that the facility where you worked, and now volunteer, is one of the 'good ones'.

Chisue, just a comment about this last post. You will find many people with very active minds in nursing homes. They can be there because their physical bodies no longer allow for independence. With many returning veterans, they may not need lifetime care, only rehabilitation. In these cases, placing them in a facility with a younger population can be very important.