When selecting a nursing home, families have a lot of information at their disposal, including the vast amount of data available online. However, some argue the best way to learn about a home is to make a visit.
"The website is a good place to look for some background information, but I would advise anyone to visit these locations. The ratings only tell a part of the story," said David Smeltzer, executive director for Heritage Ministries. "You need to walk, talk, see and smell in a facility. Those are the critical indicators."
"We provide people and families with information about local facilities. We encourage them to go look at them," explained Mary Bosek, director of case management at WCA. "This is a small community. People know people. Ask around. See what you think of the staff, the people, the smells and the food."
Lois Taylor, a resident at Lutheran Social Services, enjoys Halloween Night at LSS with Denise Ohman, a social worker at LSS, and her daughter Madelynn. Employees bring their children and grandchildren dressed in costumes to celebrate with residents.
Tracy Merritt, director of rehabilitation at Lutheran Social Services, assists Alice Buck with ambulation.
Kim Mancino, certified music therapist, leads LSS residents in choir practice. From left are Miriam Simmons, Salvatrice Cali and Linda Paterniti.
According to Janell Sluga, Lutheran Social Services geriatric care manager and author of the "Senior Life Matters" column in The Post-Journal, every nursing home has its own specific atmosphere that people can only experience by making a visit.
"Each nursing home has its own niche, its own personality," she said. "When I talk to families about touring, I ask them, does the staff look at you and smile and say 'hi?' That's probably the No. 1 indicator on whether or not you'll get good care. Just because you've heard bad things doesn't mean they're true."
When making a tour, Ms. Bosek said families should look for some specific elements in a nursing home. "Is everyone involved in activities? Is the staff interacting with residents? You can ask about resident-to-staff ratios and services. Ask about costs. See what's included."
WHEN IS IT TIME FOR NURSING HOME CARE?
Before looking at specific nursing homes, families should make sure their loved one actually needs nursing-home care.
"There are different qualities or triggers that lead people to needing care," Ms. Sluga explained. Those qualities and triggers include Activities of Daily Living, ADLs, such as the abilities to walk, get dressed, bathe, eat, move around and use the bathroom.
"Those are the ADLs that nursing homes use to determine if someone needs this care," Ms. Sluga said. "For a specialized nursing facility, a resident must need help more than half the time with their ADLs to qualify."
At times, residents also check into nursing homes after elective surgeries. "We have people going to Brooks Memorial Hospital going in for elective surgeries who are already contacting us because they need a place to recover," Smeltzer said. "Many times, with a senior, our care is just to get their strength back."
Normally, families don't have a lot of time to make a nursing-home decision. The need for nursing-home care often stems from an unforeseen circumstance. "Typically, the need for a nursing home stay results from an acute incident that results in a hospital stay," Smeltzer said, noting new people often check into nursing homes after suffering heart attacks, strokes, or urinary-tract or kidney infections. "The majority of our residents come from an acute-care hospital stay."
Due to the circumstances surrounding their needs for nursing-home care, hospitals often get involved in the selection process for area residents and their families, Smeltzer said. "Most of that is coordinated through the hospitals. They work with the families. We have admissions coordinators and counselors who go down and meet with these people in hospitals and talk about their care and payments."
According to Ms. Bosek, her staff at WCA will offer advice on strategies for care. However, they won't endorse any of the eight Chautauqua County nursing homes over any other.
"We would talk about specific types of care, but we won't necessarily recommend homes," she said. "You have to differentiate if this is a patient who had a surgery who needs some rehab or if this is a patient who needs long-term care. The case-management team has to figure out that assessment. It's really an assessment of their mental-health and physical condition."
WHAT ABOUT ASSISTED-LIVING FACILITIES?
Often times, elderly individuals may not be capable of living on their own anymore, but don't necessarily need specialized nursing care. According to Ms. Sluga, when seniors begin to lose the ability to prepare meals, shop for groceries, talk on the phone, properly take medications or pay their bills, considering an assisted-living facility may be a good option.
"Check to make sure they've been taking proper doses. Look for moldy food and old cans. Look for improper food storage," she said. "When things start to fall through the cracks, like checks getting sent back or not getting their car inspected, they might consider an assisted-living facility."
CHECKING IN ON NURSING HOME CARE
After checking a loved one into a nursing home, the best way to make sure he or she is receiving quality care is to make regular visits, according to some.
"You want to be in the facility as much as possible," said Tom Holt, president and CEO of Lutheran Social Services. "If you can't be there, you can make arrangements to Skype or talk on the phone. The facility is obligated to work with you on that."
A facility's location in relationship to a family's home can make all the difference, the experts say.
"I recommend families to choose a facility that is close to them. You're going to visit more because it's more convenient," Ms. Sluga added. "If you live in Frewsburg, it probably doesn't make sense to choose the Chautauqua County Home. Choose what gives you more of an opportunity to get there. Because if you're there building a relationship with the staff, your loved ones will be better off."
"If you live locally, visit your parent," Ms. Bosek added. "It's harder when you live out of town. It's important to keep in touch."
Visiting frequently at varying times of day could help families find problems, according to Ms. Sluga.
"Come a couple times a week. Come at different times. If you're uncomfortable with visiting, get an activities calendar, and come when those things are going on. Bring something along: a family book, a photo album. Bring something they enjoy. You don't have to stay for an hour. Think about things to talk about," she said. "If the people you visit can't talk, be comfortable with the silence. If they're dying, just be with them and think about what they meant to you."
WHAT TO LOOK FOR; REPORTING PROBLEMS
When visiting a nursing home to check on a loved one, area residents have a lot to consider.
"If you call the nursing home on a regular basis and no one answers, make sure you say something," Ms. Sluga said. "If you come in and whoever you're visiting seems to be in the same chair all the time, stares at the same wall, doesn't wear the clothes they like or doesn't get their hair done, that's when you should say something."
"Are they happy? Look to see if they're losing weight," Ms. Bosek added. "Do they look clean? See how they look; see how they feel."
When a resident or a family member feels the need to make a report, a nursing home ombudsman - a non-nursing home-employed third party - may be the best place to start, according to MaryAnn Spanos, director of Chautauqua County's Office for the Aging.
"They're specially trained volunteers. Each nursing home is required to have one for every 100 beds. If there's a problem, they're there," she explained. "The ombudsman is always a confidential person you can talk to about issues. Then, the ombudsman will investigate them."
An ombudsman can be the perfect tool for a family who lives far away from a nursing home, according to Ms. Spanos. "Talk to the ombudsman, especially after the person checks in. Out of town family will call the ombudsman often," she said. "You need someone to be that independent voice. You have to walk that fine line between letting the residents have their rights and not infringing on the rights of others."
Those who wish to deal directly with a nursing home's staff should always act quickly, Ms. Sluga said.
"If there's something you're not quite sure about, ask. Don't think they won't take care of you," she said. "If you don't think you're getting help, try again; try someone else. You should have good relationships with the staff. You should come forward with concrete problems and solutions."
"Bring your concerns to the nurse in charge right away. If that doesn't work, go right to the administrator," Holt added. "It's surprising how often people don't address issues out of a false sense of fear."
A quick look at the five-star ratings provided by the Centers for Medicare and Medicaid Services may have some area residents questioning the quality of care provided by nursing homes in Chautauqua County.
However, those working in the medical field in the area believe Chautauqua County residents should feel fortunate for all of the options available.
"As far as the nursing home facilities in our county, they all provide very good care. They all lose underwear, and the dinner isn't always great, but that happens at home too," Ms. Sluga said. "You're going to have problems. No place is perfect."
"All of the local facilities are all Medicare-certified facilities. That's important. It shows they're quality facilities," added Ms. Bosek. "We're very fortunate in this area. We have really high-quality nursing homes here. In other areas, it's more questionable."
A DIFFICULT TIME
Some individuals who work in the medical field recognize that checking into a nursing home isn't exactly a dream come true for a resident.
"Often, when a patient comes into a hospital, the family might just say, 'Mom can't manage living at home anymore," Ms. Bosek said. "I think it's a difficult conversation to have. It's hard for people to say, 'Mom, you're just not managing well at home anymore.' I hear all the time, 'I promised them I'd never let them go to a nursing home.' It's a difficult time in a family's life. Some people like the socialization, but I think it's a tough transition for most."
"We don't, as a society, value the end of life. We don't like fall and winter: the final seasons," added Ms. Sluga. "When it gets to be winter, when it gets towards the end of life, people get uncomfortable. There are a lot of really neat experiences in nursing homes. Everybody has people coming in and out of their lives. My job is no more depressing than anyone else's. Other people die too because of accidents. We all die every day."