Use Your Sense and Senses : Tips for Choosing a Good Nursing Home

Use your eyes, ears and nose if you are looking for a nursing home, says Jacqueline A. Lincer, California district administrator for licensing and certification of health facilities in Santa Ana.

But you don’t have to stop there, she added.

Anyone needing a nursing home for a relative or loved one also can scrutinize a facility’s record of inspections, said Lincer, whose staff inspects each of Orange County’s 65 nursing homes once a year.

Reports Posted

Homes are required to post their latest inspection reports conspicuously at their facility. And records for the past three years also are on file at Lincer’s offices at 28 Civic Center Plaza, Room 850, in Santa Ana. Anyone may come in and look at a file, she said. If you wish to see several files, a call to her office to let her staff know what you want is requested.

“We make no recommendations,” Lincer cautioned. Still, records compiled by her staff evaluate the kind of care a nursing home offers, especially meals, patient recreation and dispensing of medications.

They will show if there are any citations against a nursing home for such violations as untreated bedsores and any other instances of patient neglect or abuse. Detailed inspection reports on the physical condition of the facility also are included.

Though one citation probably shouldn’t disqualify a home, several could indicate a pattern of problems, Lincer said. Because some homes vary in quality of care from report to report, however, officials recommend examining the inspection history of any nursing home being considered, not just the latest report.

Information Lines

The district licensing office for Orange County can be reached by calling (714) 558-4001 or (800) 228-1019.

For Los Angeles County, call (800) 228-1019. For San Diego County, call (800) 824-0613. For Santa Barbara, San Luis Obispo, Kern, Ventura and Kern counties, call (800) 547-8267. For San Bernardino, Inyo, Mono and Riverside counties, call (714) 383-4777.

Information on nursing homes also is available through the state ombudsman’s office for nursing homes. In Orange County, that office is located at the Orange County Council on Aging, 1440 E. 1st St., Santa Ana. The telephone number is (714) 972-2676. Also, the toll-free number for the state ombudsman program is (800) 231-4024.

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 problems.

In addition, a consumer guide to choosing a nursing home is available, for a small fee, by writing the state Department of Health Services, 714 P St., Sacramento, Calif. 95814.

Visits Encouraged

Lincer also recommends that people visit all prospective nursing homes.

“If I were going to place a family member, I would make it my business to drop by at 5 o’clock at night to see what’s going on,” she said.

“If there are problems, they tend to be at 5--when they’re trying to feed people and give people medication” and the staff may be changing from the day to night shift.

Expect to be escorted through a home, but open your eyes as you walk through, Lincer said.

“Is it clean and in good repair? You might not agree with the decorating scheme,” but make sure there are no holes in the walls or bug droppings on the floor, she said.

And be sure to notice if there is any smell, Lincer said. A good home should have no smell--not even that of perfume. “If you go into a facility and it reeks of urine, that’s not where you want your loved one to be,” she said.

Check Staffing

Although geriatric patients cannot always control their bodily functions, a good facility should have enough staff to make sure that patients do not lie in soiled beds and are kept clean, Lincer said.

Among the things Lincer and Ralph Lopez, chief of the Los Angeles County Health Facilities Division, suggest noting when inspecting a nursing home:

- Is the staff courteous?

- 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?

- Are patients’ requests for assistance--either verbal 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 home’s administrator should be advised that the patient will be receiving frequent and unannounced visits by a relative to ensure proper care, Lopez said.

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 said.

Because most of Orange County’s 7,000 nursing home beds are occupied, Lincer said home administrators may be selective about which patients they accept. Though most Orange County homes are certified to accept Medi-Cal or Medicare patients, administrators may not wish to accept a Medi-Cal patient who requires a great deal of care.

Still, she and Lopez stressed, family members of Medi-Cal or Medicare patients have the right to demand good care from every nursing home.

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