The decision to enter a nursing home is one of the most difficult decisions an individual and the individual’s family will make. The question of whether nursing home placement is a good option comes at a time when the individual’s already fragile health situation may have taken a turn for the worse.
Before choosing a nursing home, consider other care options. For example, in-home care may give someone more independence. In-home services may allow the individual to remain in his or her home for a long time. Here's a list of in-home services:
- Meal programs
- Home health aides
- Visiting nurse programs
- Therapy services
- Transportation services
- Adult day care
- Chore services
Assisted and supportive living facilities are other alternatives to a nursing home. These options are for people who may be at risk of harm when living alone, but who do not require skilled nursing care. In these facilities, residents live in their own apartments, but are provided services. These services may include housekeeping, meals, laundry, and some assistance with activities of daily living.
Congregate living arrangements, where several adults pool their strengths and resources together, are another option to a nursing home. Ask your local Area Agency on Aging for more suggestions and options in financing these alternative arrangements.
Involve the individual’s physician in the discussion of whether nursing home level of care is required and if it may be a temporary or a permanent arrangement.
Choosing a nursing home
If you decide that a nursing home is the best placement, there are several guides that provide information to consider when making your choice. There are some factors to consider when selecting a nursing home.
One guide can be found on the Illinois Department of Public Health's website. It contains a checklist to be filled in for each nursing home visit to provide a clear comparison. A copy of the guide can also be requested from the Department of Public Health by calling (217) 782-4977.
Another guide is available from Illinois Pioneer Coalition entitled “Your Way!” It provides many tips and suggestions including:
- Definitions and descriptions of the available levels of care
- Agencies and organizations involved with nursing homes
- A nursing home comparison sheet
Another resource is the publication “Your Guide to Choosing a Nursing Home” available on the Medicare website. You can also call 800-MEDICARE (1-800-633-4227 toll free) or 1 (877) 486-2048 TTY/TDD to have a copy mailed to you
Before you begin looking at nursing homes
Before beginning to look at nursing homes, determine the medical and physical needs and financial resources of the person in need of a nursing home. Ask friends and the resident’s doctors to assist in identifying the resident’s needs, finding available resources, and sharing their experiences with local nursing homes. Consider homes that are located near the people who will be visiting most frequently. Visits are important in maintaining a resident’s morale, well-being, and quality of life.
The Illinois Department of Public Health also provides a directory of facilities. You can find all facilities in the state by name, city or county. The directory includes the name, address, phone number, administrator’s name, and the number and type of licensed beds for each facility.
Visit nursing homes you are interested in several times. Arrange a time to meet with the administrator of the facility and ask for a guided tour. Return unannounced for a second visit and take a closer look. Compare 3 or 4 nursing homes, or as many as it takes to find one you are confident will provide good care and a comfortable home.
Things to consider in choosing a nursing home
Have a list of questions and considerations when visiting a nursing home. Take notes so that you can compare the nursing homes and discuss the choices with family members and friends. Below are some considerations and questions.
Is the nursing home close to family and friends so that they can easily visit? Is it close to the resident’s physician and the resident’s preferred hospital? Does the resident’s physician visit patients in the nursing home?
What level of care is provided? Does it meet the needs of the patient?
Can the resident’s doctor of choice visit the nursing home and will they be called when the nursing home has a question? Is there a staff doctor or medical director for emergency calls? Do eye doctors, dentists or psychologists visit the facility if needed, or do the residents need to be transported for those appointments?
Rehabilitation and physical therapy
What types of therapy are available and what are the staff qualifications of those that provide therapy services? Does the therapy at the facility meet the prescribed needs of the resident? If the resident requires special services, how will those needs be met by the facility?
Are meals planned by a registered dietitian? Are there choices of food at each meal and are special diets available? If a resident does not want to eat at meal time, may they eat at a different time? Are snacks available between meals? Ask to see a copy of the planned menus, and sample a meal. Does the food look and smell appetizing?
Are there handrails in the hallways and grab bars next to bathtubs, showers and toilets? Is there an emergency call system which is easy for the residents to reach? Are hallways free of clutter and wide enough for 2 wheelchairs to pass? Is there a fire safety system that includes smoke and heat detectors and sprinklers? How often does the staff train in fire safety? Ask to see the home’s last fire inspection report.
Are rooms shared? How does the facility choose roommates? Husbands and wives should be roomed together unless there is a medical reason not to. What is the nursing home policy about changing rooms if there is a problem with a roommate?
Rooms and bathrooms
Do the rooms look pleasant and comfortable? Can the residents decorate their rooms? Are the bathrooms and bathing areas easily accessible and free of clutter?
How will prescribed and over the counter medications be purchased and stored?
What kind of activities are there? Is there a regular schedule? What religious services are available? Are there community outings?
Is the home clean and neat? Does it have a foul odor? Are the residents smiling and do they look well-cared for? Does the staff smile and talk to residents as they walk by? Are call lights, pages and resident requests for assistance being answered in a timely manner?
Is there a space available for families to visit besides the resident’s room? Is there a comfortable lounge area where the resident can socialize? Does the home have an outdoor space that residents can access?
Costs and charges
What services are included in the "basic daily charge" of the nursing home? What services are provided for an extra charge? Do these extra charges include all of the supply costs that are necessary for the service?
What, if anything, is required in advance? How will the deposit be returned? If a deposit is received from a potential Medicaid resident, the deposit must be returned within 30 days of proving Medicaid eligibility.
Third party payment
Does the facility take Medicare and Medicaid patients? Will the facility allow you to shift to Medicaid payment if the resident enters as a private pay or Medicare patient? If so, does the facility have a limit on the number of Medicaid beds? Does the nursing home have a set procedure when Medicare or private pay resources run out?
The nursing home is required to be licensed. Ask to see the license and the most recent inspection report. Find out if the faults mentioned in the report have been fixed.
The Illinois Department of Public Health also prepares a quarterly list of all nursing homes that it has cited for serious violations. The report can be obtained on the Department’s website or by calling 217-782-4977.
The Illinois Department on Aging operates a long-term care ombudsman program. Ombudsmen regularly visit nursing homes and address questions and concerns of residents. Find the ombudsman covering your county by calling the Illinois Department of Aging at (800) 252-8966 or look in the directory.
Learn more about Nursing home financing.
Understanding a nursing home resident’s rights
Understanding the rights of a nursing home resident is important. A person does not give up any rights as a citizen of the United States because they have become a resident in a nursing home. Unless a court has deemed a resident incompetent and appointed a guardian to act on their behalf, they have the same rights to make decisions about their care and finances as any other adult.
Nursing home residents have additional rights which the nursing home must provide to the resident in writing within 48 hours of admission. See Nursing home rights and complaints for more information. [linkto: Nursing home rights and complaints]
Signing the nursing home contract
Once you have chosen a nursing home, the home is required to provide a written contract. Make sure that you obtain a copy and read it thoroughly before you or your loved one is admitted and before you sign it. Request to take it home and read it at your leisure, if possible. If blanks are not filled in or items are not described as was discussed with the nursing home representative, call it to their attention and have them make the necessary changes. Strike out terms that are contrary to your verbal agreement.
The contract should include:
- The term or period of time of the contract
- The services to be provided under the contract and the charges for those services
- Additional services that may be provided at an extra cost and the cost of those services
- The persons or sources liable for payment under the contract
- Whether a deposit is required and the amount of the deposit paid
- Whether the nursing home is certified to accept Medicaid and Medicare and what steps it will take to ensure that a Medicaid bed is available for the resident if it is needed at a later date
- The bed hold policy for hospital stays
- The involuntary discharge procedure
The contract should not include:
- Any restriction on choice of physicians
- Any restriction on choice of medical treatment
- Permission for use of physical restraints or psychotropic medicine without the requisite physician orders
- An impediment to communication with or access to the resident
- An agreement to be involuntarily discharged or transferred for reasons other than those set forth in the statutes or without being provided a hearing
- A limitation on resident’s right to handle his/her financial affairs
- A waiver of the nursing home’s liability for loss of property, for negligence, or for personal injury
Adults are presumed to be able to sign a contract for admission into a nursing home unless they have a guardian. Have the resident sign, if it is possible. If someone other than the resident signs the contract, be careful to sign only on behalf of or as the agent for the resident. Nursing homes may not require that a person other than the resident be financially liable for their services. The signer should make sure that they are not agreeing to be responsible for payment of the nursing home charges, if that is not their intention.