How to Evaluate a Skilled Nursing Facility

Absolutely no place is perfect, there are just levels of imperfection. We are all human and all make mistakes, after all.

I don't care how nice a facility looks when they are giving you a tour, you should really find out how much their average CNA makes. If it looks nice, and they give you a good speech, but their employees aren't paid well, exactly what kind of care do you think they will be giving?

You should also really find out how many CNA's and nurses are normally on staff at each shift (not how many they'd like, how many there really are.) In other words, how many patients is the CNA taking care of your family member expected to take care of during an average shift. The higher the number, the less time they can give to each patient. Remember also that CNA's have duties they are responsible for outside of normal patient care that can take up their time.

You should know what the facility’s turnover rate is. Chances are, if they have serious problems keeping employees, there is a very good reason. I have quit more than one facility because of the way it was run and the obvious lack of care for the patients the facility engendered.

You should also find out what their policies are about sending patients out to the hospital for care, and how frequently this happens. You want a facility that will send a patient to the hospital for care when it is necessary. There are facilities that pressure staff to not send patients out, even when it is necessary.

Try to talk to the CNA's without their supervisor watching. Find out what they think of the facility.

Ask about the following:

• Are they being treated fairly?
• How is the patient care in general?
• Are there enough nurses?
• What does a normal shift look like?
• Do they often have to work short-handed?

An important question to ask is about the nurses. If the CNA feels they are able to go their nurse with concerns about a patient and see the issue addressed in a timely manner. You want to hear that your aides can talk to their nurses about potential problems or changes and be taken seriously. CNA's will see your family member far more than any other staff, and you want a nurse to listen to them if they think something is wrong with your family member.

You should find out if they try to assign the same CNA's to the same patients every day they are working. You want the same people to see your family member daily. This causes the patient to be more comfortable and receive better care. If they have the same aides every day, then the aides know what they like, dislike, have a schedule and routine with them, and will be able to easier identify problems or concerns. If the patient has a different aide every day, there will be less consistency in care and routine. Some facilities don't like the attachment between patient and CNA this causes, but as a family member that is a bond you want. Aides often become attached to their patients and want to take care of them the best they can.

No one wants to tell you this is true, but it is. Patients who have regular visits from family (daily, weekly, etc.) usually get better care and are a higher priority for their CNA's. Basically, if staff (even the bad stuff) knows someone is coming to check on their work and there will be serious repercussions for it not being done, they will make it a priority to have it done.

Even good facilities have bad employees. There are at least 3 shifts of people who will take care of your family member daily, sometimes even more when people leave and assignments change. Not everything that happens is one person's fault, and good people won't be there all the time.

Please remember that whether they are at home with you or in a facility, accidents will happen. If accidents are too frequent then you should be concerned, but please don't think that just because they are in a facility that no accident will ever happen. Facilities do lots of things to keep patients safe, but most person specific safety measures (alarms, mats, seat belts, etc.) won't be done until an accident has already happened once. Because unless they have a precedent for it happening the facility can't do anything to prevent it.

Shared by Sharon at caregiver.com:  this was written by my daughter w ho was the primary caregiver for my mom who was living with Alzheimer's