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 Nursing homes do offer viable alternatives for many trying to address the question of, what’s next.  However, capabilities do differ among nursing homes so you will really need to do your homework.  What we found was that the ventilator proved to be an important selection criteria.  Some nursing homes did not accept patients on ventilators while others accepted only a limited number.  There are also differences in the level of therapy that is offered between nursing homes that need to be evaluated.

 Other criteria may be location, insurance coverage, and open beds available.  If you have a larger pool to choose from in your area you may consider seeking nursing homes that have other patients similar to your own.   

Below are some suggestions in making your choice. 

 This has got to be our number one suggestion.  Talk to everyone you can, get as many opinions as you can, but you have got to actually visit the facility and make sure you are comfortable there. 

 One of the most important criteria should be is there enough staff.  Ask what the patient to staff ratios are for all of the disciplines your patient requires, e.g. nursing, respiratory therapists, nurses aides, doctors, therapists.  Benchmark the answers you get to the ratios from the other facilities you are considering.  Compare the ratios to the hospital but keep in mind that they will probably be higher as these facilities are less acute than the hospital. 

 Remember, if your patient is on a ventilator, the number of respiratory therapists is critical.  You want to make sure the vent alarms are answered promptly and the maintenance care is done timely.  Finally, you also may consider visiting the facility off-hours to get a feel for the staffing levels during all hours of the day.

 Check out the rooms where your loved one will be.  Are the rooms clean?  Are they large enough?  Do you want private or semi-private?  Do you feel comfortable that there are adequate safety measures and equipment in place?

 Also check out the facilities they have for therapy.  Can they provide the level of therapy you desire in all three disciplines, Speech, OT, PT?

 Are the visiting hours lenient enough for you?  If it is our family, can someone stay in the room 24 hours a day, every day.  Do they have an arrangement with a local hotel for lodging?  What about a cafeteria or restaurants nearby?

 Finally, we suggest you do not transfer in to a new facility on the weekend.  Typically, the support staff and even the floor staff are reduced on the weekend and it is not the way to start your stay at the new facility.  We have heard more than once that this has caused problems.  The pushback you will get will come from the hospital you are currently in who are trying to clear space on the floor.  Try to partner with your doctor to help convince the hospital and the insurance company that you need to stay until Monday.   

 A lot will depend on your particular situation.  Is the nursing home nearby?  Are you able to visit daily, weekly?  Whatever your situation you need to make sure you satisfy yourself that your loved one is getting the care they need.  Work with the staff so you get the information you need.

It is normal to feel a sense of loss in all of this.  First, you have lost the interaction and companionship of your loved one, at least how it used to be.  Now, that loved one is having to stay away from home in a nursing home, furthering your loss.  So, expect the feelings but understand that you need to continue to be strong and help your loved one fight to get better.

 You are going to be more dependent on the staff in this environment so it is important that you establish good relationships.  There are many good people who work in nursing homes and share your concern for your loved one.  You need to speak with these folks and let them know you appreciate their care.  It is a tough balancing act interacting with all of the personalities and getting what you need without irritating the staff or them irritating you.

 Work with the doctor to put together a plan of care for your loved one.  Make sure it meets your needs as far as therapy and rehabilitation are concerned.  Make sure you receive status reports as to the progress that is being made to the goals.  Getting a written plan will help both sides to come to agreement on the expectations for care for your loved one.  

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