Take a Good Look--and Study the Record : Pointers Offered in Nursing Home Hunt

Use your eyes, ears and nose if you’re looking for a nursing home, says Ralph Lopez, chief of the Los Angeles County Health Facilities Division.

But don’t stop there, he warned.

Anyone in need of a nursing home for a relative or loved one should scrutinize each potential facility’s record of inspections, said Lopez, whose office is under contract to the state to inspect nursing homes in Los Angeles County--which contains one-third of such facilities in California.

Finding a good nursing home and ensuring that a patient’s needs are met requires study and diligence, he says.

Where does one start?

State health inspection district offices maintain inspection scores of homes within their areas. The lower the score, the better the home did on its last inspection. Homes are also required to post their latest inspection reports. But some “roller coaster” homes go up and down in quality of care from report to report. Therefore, officials recommend examination of the entire inspection history of any nursing home being considered, not just the latest report.

The district licensing office for Los Angeles County can be reached by calling (800) 228-1019. The district office for Orange, San Diego, Ventura, Riverside, San Bernardino, Santa Barbara, San Luis Obispo, Imperial, Kern, Inyo and Mono counties can be reached at (800) 228-5234. The Northern California district number is (800) 554-0354 and the Central California number is (800) 554-0352.

Inspection records should include all the citations a home has received for such violations as untreated bedsores and any other instances of patient neglect or abuse discovered by officials. Detailed inspection reports on the physical condition of the facility are also contained in the records.

Lopez recommends that the state Office of the Longterm Care Ombudsman be contacted for information about a potential nursing home.

The ombudsman program provides advocates for the elderly throughout the state to investigate complaints against nursing homes and to help older people cope with various other problems.

The toll-free number for the program is (800) 231-4024.

Lopez also recommends that three prospective homes be selected for personal visits. Los Angeles County health officials provide a nursing home guidebook with a checklist of what to look for. The guidebook is available at 313 N. Figueroa St., Room 317 or by calling (213) 974-7961.

A state guidebook is also available by calling the toll-free numbers for regional licensing offices. When visiting a home, Lopez said, try to get a sense of whether someone is in charge. For example, are nursing stations visible and occupied?

Take a tour of the facility, Lopez advises. Among the things to watch for or ask about:

- Is the place reasonably clean?

- Are patients well-groomed, properly dressed and is their privacy respected? Or are they sitting around in gowns, half exposed, or wet, without slippers, unshaven, with dirty jagged fingernails and uncombed hair?

- Is there a heavy urine odor?

- Are patients’ requests for assistance--either oral or by call-button--answered promptly by nurses or aides?

- Are patients fed proper diets and in a timely fashion?

- What are the care plans for serious health problems?

- Is there an active residents council and what do the minutes of its meetings reflect?

- Is there an active social and recreational program?

- Is there an active volunteer program?

The nursing home administrator should be made aware, Lopez said, that the patient will be receiving frequent and unnannounced visits by a relative to see that proper care is being administered for such problems as bedsores.

Lopez says that, in general, nonprofit homes have better records of patient care than for-profit facilities, but often have long waiting lists.

Overall, he stresses that families must be persistent in their quest for quality care.

Relatives of Medi-Cal patients--who make up 65% of the nursing home clientele in California--often are unnecessarily intimidated by nursing home administrators and the system in general, he says.

“People should know across the board,” Lopez said, “that they all have a right to be assertive and demanding. . . . Most of these places can’t survive without Medi-Cal. They’re not doing you a favor.”