With at an all-time high, how do you know if your loved one is getting the quality care they’ve been promised? Unfortunately, you can’t really know, not without being reasonably involved in your parent, relative or friend’s care.
While the long-term care industry clearly attracts hard working, caring people, whether due to strained budgets or lax hiring practices, investigations and media reports have highlighted troubling gaps between care that senior facilities advertise and the actual services delivered. There seems to be a steady stream of news reports around the country of scam and stories in long-term care facilities.
Some of that may be due to the numbers involved. You have a lot of people in , and so it may be inevitable that there will be some problems. , over 4 million people receive care in a every year. There are approximately 15,000 nursing homes across the United States.
Still, even if some neglect seems inevitable, nobody should resign their loved one to a fate of receiving subpar care. If you have somebody you care about in a senior living facility, it’s important to visit regularly, to look for signs of neglect and to have strategies in place so you can make sure the staff stays accountable.
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How to Assess the Quality of Care in Nursing Homes and Assisted Living
You want to make sure your loved one is getting the right care, but it’s also important to have your expectations in check, says , a licensed in Tacoma, Washington.
“The truth is there is no care facility with the capability to provide the level of care most families would actually hope for. They are not really designed for that,” Horton says. “The goal is usually that the resident’s basic needs are met and their overall quality of life remains stable.”
She says that the basics are “meals, bathing, medications, physical activity and some level of connection.” She also points out, “there will always be multiple patients needing something at the same time, which means someone is going to have to wait.”
But with those expectations in check, you still obviously want to do everything you can to ensure that you’ve selected a good, safe place for your loved one to live. And that’s where your strategy comes in.
That goes for care in or scenarios too. You want your loved one to have good care, wherever they are, and as much as possible, you want to be involved.
Basic care concerns
— Assistance with like bathing, dressing or eating, are often unmet
— Safety concerns, such as instances of , excessive bedsores, unsupervised or
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10 Key Components of an Effective Nursing Home Care Plan
Use this seven point checklist to help you monitor care in nursing homes, skilled nursing facilities, assisted living, or home health scenarios.
1. Monitor the care plan
Nursing homes have a care plan for all of their patients — federal law requires them to have one. They’re also required to review the care plan with the resident or the resident’s representative every three months.
So chances are, especially if it’s a good nursing home, they’re reviewing your loved one’s plan, and you’ll know what type of care they’re supposed to be receiving. Still, pay attention to what the care plan is — and whether you think your loved one is getting the attention they should be receiving.
Nursing home care plans may outline:
— Health assessment results
— Needed personal or health care services, such as medication management, therapies and monitoring of chronic conditions
— Needed daily living assistance
— Frequency of services
— Essential support staff that’ll be part of your loved one’s care team
— Any supportive supplies or devices needed
—
— measures
A care plan is also a place for input from the resident, family or caregivers regarding care preferences. With a short-term , if your loved one plans to return to their community, it’s really important to work with staff on establishing goals as part of the care plan.
2. Visit often and during off hours
That may sound like a strategy your aging relative has come up with, if they’re not too thrilled with being moved into a nursing home or skilled nursing facility. But if you want to know that they’re getting quality care, you really should drop by regularly, and you should pop over at different times of the day, suggests Chris Weldon, founder of , a home health care service servicing parts of Connecticut and New York.
“Go to the facility off-hours, early in the morning, late in the evening or on a weekend to see what the B-team looks like,” Weldon says. “Note how many caregivers are on the floor and what they are doing. If it is hard to find someone at 7 p.m., it is likely impossible at midnight when your senior needs help safely getting to the restroom.”
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3. Look for signs of neglect
It may not always be obvious that your parent or relative is being neglected. Some clues to look for include sudden weight loss, if they seem , appear disheveled or if there are unexplained bruises on their body.
Bruises doesn’t mean that your relative is being abused, but Weldon says that it could mean that due to a shortage of staff, there weren’t enough people on hand to lift the patient, and they dropped them.
It’s important, Horton says, to “be present and observant.”
Horton’s father — who passed away last year at the age of 82 — was temporarily in a facility. She says she visited him every day and could see that he wasn’t getting the care he needed. There were times she would return to him hours later, only for him to be still sitting in the same place, or his untouched meal tray wouldn’t have been moved.
Sometimes staff wouldn’t respond for over 30 minutes after he rang for help. Horton eventually had him move in with her. “It was a fight to get him into a facility, and it was a fight to get him out,” she says.
4. Monitor your loved one’s valuables and personal funds
If your loved one has valuables with them, or they’re still able to access to their checking account (meaning that a staff member could get their personal information), and you’re not doing so, keep an eye on everything and make sure nothing is amiss. All it takes is one shifty caregiver to cause you and your relative financial headaches.
Never allow facility staff to have direct access to your loved one’s personal bank accounts. You may have given the top people access, and they may be paying bills on your loved one’s behalf, but under federal law, you still have the right to have access to your loved one’s checking accounts (provided you’re your loved one’s and had that access before you gave it to the nursing home or other senior facility.
5. Talk with and audit your staff interaction
In other words, are the staff pleasant and seem like they’re on the ball? Or is there a lot of staff turnover? What’s the vibe? If something feels off, that may be the case.
And if there isn’t much staff, that, too, may spell trouble.
“The nursing home and more broadly the facility-based healthcare model works on the same principle as a school — a student-teacher ratio or in this case, caregiver to client ratios,” Weldon says.
Some facilities, he says, will staff as few people as they get away with, to remain profitable. And that, Weldon says, can lead to subpar care.
Holly Harmon, senior vice president of quality, regulatory and clinical services at AHCA/NCAL, adds, “Family members are encouraged to make regular visits to their loved one’s nursing home to engage with them and develop relationships with their care team. Their insights can help staff better understand the resident’s healthcare needs and preferences, enhancing staff’s ability to provide person-centered care.”
Family involvement may also improve your loved one’s health outcomes, such as boosted life satisfaction, Harmon says.
If or family members have concerns with their loved one’s care, step one should be to speak with the staff directly.
“Open communication and dialogue between family members and nursing home staff is key to foster a successful experience for both the resident and their loved ones,” Harmon says. “If staff receive any complaints or identify any problems, they seek to quickly address the issue and remedy the situation. Not only is it the right thing to do, but nursing homes have strict regulations in place that require them to take the necessary steps if an issue arises.”
Once you speak with staff, it’s reasonable to ask when you can expect change, and check back in regularly to ensure changes are happening.
Request itemized billing: That is, compare invoices against the daily care log. Mistakes could be made. You might be paying for services your loved one didn’t actually get.
6. Document your concerns
Keep a written log of any concerns or issues — big or small — including dates, times and any relevant details, to have a clear record for discussions with facility management or regulatory bodies. This helps avoid misunderstandings or discrepancies when discussing issues, making it easier to reference specific incidents and ensure nothing important is overlooked.
Although it takes extra thoughtfulness and planning, this proactive step helps empower you to advocate effectively for your loved one, ensuring accountability and effective communication for any future challenges that arise.
7. Check inspection reports
Nursing homes that receive Medicare and Medicaid funding are inspected by the state every year for deficiencies. You’ll want to stay on top of those.
If a nursing home fails to meet a care requirement, they get a deficiency mark. Essentially, nursing homes’ deficiencies are graded, like in school, but instead of A through D and then an F, the letters go from A to L. If a nursing home has an A, whatever was wrong wasn’t significant. If a nursing home has an L, it is significant. Generally, J, K and L could be signs of some serious problems at the nursing home.
Review the ratings from U.S. News to see the . U.S. News analyzed data about staffing, quality of care and health and safety inspections at almost 15,000 nursing homes to help you find the best care near you.
ProPublica has a “ that is worth checking out, if you’re concerned or hope to feel better about the place your loved one is at.
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8. Watch for illegal contracts
This directive, to watch for illegal contracts, sounds overwhelming, for those of us who are not lawyers. But in this case, it really comes down to the fact that nursing homes can’t legally require a family member to pay for a loved one’s care using their own personal money, known as personal guarantee or a “responsible party” clause. In fact, the law forbids nursing home contracts to have language that makes it sound as if anyone beside the nursing home resident is required to pay for their care.
So if you’re being pressured to sign a contract stating that if your parents one day can no longer pay for the nursing home, that you’ll step up and do so, out of your own checking account, that’s illegal. If you are looking at a contract that refers to you as a it’s probably best to not sign it. In fact, you may want to get a lawyer to look over the contract, and possibly find a different and honest facility or report the nursing home to an ombudsman program.
9. Use ombudsman services
“While facilities are likely to defend their practices, you have more power than you might imagine. Every state has a long-term care ombudsman program that you can report the facility to,” Weldon says. “If they hear there are problems, they have a duty to inspect the facility.”
You can find these programs by going to your search engine and typing in your state and long-term care ombudsman program, and it’ll pop up.
. If your state has a Department of Aging, the ombudsman program is likely located there. These programs exist to take your complaints and work as your advocate.
10. File a legal complaint
As a last resort or for very serious concerns, filing a legal complaint may be necessary. Anything that involves should be reported.
Generally, you’d file a complaint directly with your state’s health department or licensing agency. State-based agencies, who are responsible for inspecting facilities, will review and investigate the complaint and will take action if the facility is found in violation.
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Strategies for Monitoring Home Health Care and Ensuring Accountability
It may seem easier to monitor a home health care service since they’re probably at your home or your loved one’s, but frequently they are there when you aren’t. So you’ll want to consider the following.
Verify hours with electronic visit verification (EVV)
If your loved one is on Medicaid, there is a federal law that home health aids must use electronic visit verification technology. (There is no such law or requirement for .) That means, your home care agency should use electronic tracking to confirm aides are present for the hours paid. You may want to ask to make sure, but it should be a given that it does. You can certainly ask the agency for the verification that the aide is showing up for work, if you suspect otherwise.
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Financial accountability and fraud prevention
You’ll want to keep an eye out, that valuables in the home don’t go missing. Ideally, you want a health aide who has a heart of gold, and not filling their pockets with gold.
Several strategies that may help:
— Either do a background check on anyone you hire, or hire somebody from a , since any reputable service will have vetted their employees.
— You’ll need to make sure you follow your state’s laws about recording people in your home, but visible security cameras — such as outdoor and indoor — may help remind any ethically-challenged home health aides that they’re being watched.
— Remind your parents to not leave money out in plain open view. It might sound like a reminder so obvious you shouldn’t bring it up, but it’s their home, and they’re naturally going to assume that they’ve got a trusted aide watching them. They probably are working with somebody who is honest, but just in case, no need to tempt anyone with a billfold strewn about on a dresser or kitchen table.
Listen to your gut
You’ll probably have a sense, fairly soon, whether your loved one is getting good home health care or not. If the caregiver seems dismissive and acts as if their job is drudgery and not a calling, that’s probably a bad sign. If the care plan seems to never be followed, the caregiver isn’t reliable and is always late, those are more bad signs, and you will want to talk to management — or find a new service.
On the other hand, if your parent seems happier and healthier than before they received their care, as far as home health services go, you probably have a winner.
Check Medicaid or Medicare records
You’ll want to periodically check Medicare or Medicaid claims to see that providers are not billing for services they did not provide.
For instance, with Medicaid, you can check the account portal online that your state should provide (all states handle this differently); there should be a Medicaid explanation of benefits (EOB) outlining everything that Medicaid has paid. Medicare has something similar, a (you’ll get it at least twice a year), and you can see what Medicare paid or didn’t pay.
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Red Flags: How to Spot Neglect in Senior Living Facilities
Some signs to look for include:
— Frequent staff turnover. Nurses and aides never seem to stick around long.
— Rapid weight loss or dehydration. For no apparent reason. It could be illness but also neglect.
— Poor customer service. If management or staff isn’t responding to your concerns, it could be a bad day or week, or a bad facility.
— Super fast and sloppy care. If the staff is always rushing through visits to your loved one or missing scheduled tasks, that’s a problem.
— Avoidance. So is the facility not answering direct questions about care quality? That’s a red flag.
Many of the signs that you’re in a facility that isn’t well run are fairly obvious, according to Weldon. Some nursing homes literally don’t pass the smell test.
“A well run facility smells like a home. If you walk into a facility that smells like urine or feces, it’s likely due to short staffing or not following hygiene standard operating procedures,” Weldon says.
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Key Resources to Help You Get the Help You Need
If you feel your loved one isn’t getting the care they need, and you feel stuck, there are resources out there. A few to consider include:
Medicare’s . This is the official website to compare nursing homes, home health and hospice care.
Long-Term Care Provider Search. Many, if not all, states have long-term care provider search engines that may help with finding better care, if you aren’t satisfied with what your relative currently has. Texas, for instance, has its . Ohio has a . Maine has a .
Medicaid Fraud Control Units. All states have them, as do U.S. territories. These are state-level agencies that investigate and prosecute fraud committed by Medicaid providers. If you suspect your loved one’s facility is defrauding you, contact them.
Whatever you do, do not stay silent, Horton urges. “You speak up. You document concerns. You ask direct questions,” she says. “You involve supervisors and care coordinators. You reach out to the state eldercare ombudsman if needed, and sometimes you have to seriously consider moving your loved one somewhere else. Families have to trust what they are seeing, because subtle changes are often the first warning sign that something is wrong.”
The Bottom Line
, building a relationship with facility staff and staying engaged with your loved one’s care plan are the best ways to ensure your loved one is getting the care they should. If concerns arise, start with the staff. If your issue is ongoing and isn’t resolved, there are resources available to help you address concerns effectively.
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