Going Shopping for a Good Nursing Home

Rule No. 1 for picking a nursing home: If the halls reek of urine, or an overpowering dose of air freshener barely covers the smell of something worse, just turn around and walk out. This is no place to put your mother or anyone else you care about.

A recent Senate hearing focused on California nursing homes, and the sight was an ugly one.

“Too many California nursing homes neglect the residents in their care,” said Sen. Charles Grassley (R-Iowa), chairman of the Senate Special Committee on Aging. “People are going hungry. People are not getting water. People are not being turned over to prevent bedsores. Despite all kinds of laws and regulations, too many people are suffering.”

Consumer vigilance can help. Check out a nursing home the way you would comparison shop for a car, a pair of running shoes, a refrigerator or anything else. Don’t wait until the hospital calls, and the harried social worker says, “We are discharging your mother tomorrow, and here is a list of local nursing homes.” Do some planning if you have an aged and frail relative. A fall, a stroke or a sudden failure of memory will rob a person of the capacity for living independently.

Here are the things to look for, gleaned from conversations with experts.

* Find several places within easy driving distance. No matter how expensive the nursing home is, you’ve got to visit often so the staff knows someone outside is interested in the patient. Someone who will complain if the resident is huddled in bed, wearing a soiled diaper and begging for water.

* Make an unannounced visit. Just tell the administrator you have a family member who might be a potential customer and that you want to check out several facilities.

* Walk around and talk to a few residents. Are they out of their rooms, talking to each other and the staff? Do they seem happy and comfortable? Talk to staff members. Do they seem relaxed, or stressed and overworked? Remember, the hands-on care is delivered by nursing aides. If they are caring and compassionate--and if they don’t have too many patients to wash or feed on a shift--the nursing home will provide decent care.

* Look for a copy of the most recent state inspection report. It must be posted in a public place. If facility officials won’t show it to you or they tell you it is not immediately available, walk out.

* A good nursing home has an independent family council, run by relatives and friends of the patients. Get the name of the person who runs the council, and call him or her.

* Find out what activities are available to give the residents mental and physical exercise. Even 90-year-old nursing home residents can improve their muscle tone and agility with weightlifting programs.

* There should be a lawn or a garden where residents can go for outdoor relaxation.

* Hallways should be wide enough for two wheelchairs to pass.

* There should be special rooms for social activities, chatting, playing cards or reading.

* And most important, listen to your intuition, your gut, your heart. Is this a place where you would be willing to go yourself?

Good sources of information include:

* California Advocates for Nursing Home Reform. Call (800) 474-1116, or look it up on the Web at https://www.canhr.org.

The Web site has a list of every licensed nursing home in California, and the total number of deficiencies and citations listed in state inspections, as well as the number of complaints by the public against the facility. The listing is limited to the total number of citations and complaints.

If you want more information on a particular nursing home, call the group for a detailed report on the state citations against a particular home.

The group also provides counseling on Medi-Cal, the program that pays for nursing home costs for the poor.

“If someone thinks they are not eligible, they should really call and find out anyway,” said Louis Nuyens, the group’s consumer information coordinator. The organization also provides a referral service to lawyers for people who want to do financial planning. The address is California Advocates for Nursing Home Reform, 1610 Bush St., San Francisco, CA 94109; or call (415) 474-5171.

* The California Department of Health Services licenses and inspects nursing homes. Check the Web site: https://www.dhs.ca.gov.

The hotline for the Residents Rights project, (916) 445-2070, provides information on picking a nursing home, learning residents’ rights and finding out how to complain about problems.

California is divided into districts by the state’s licensing and certification office of the Department of Health Services. Call with a question or complaint about a particular nursing home. District offices by county are Los Angeles, (800) 228-1019 or (323) 837-1005; Orange, (800) 228-5234; Riverside, (800) 354-9203; San Bernardino, (800) 344-2896; Ventura, (800) 547-8267; and San Diego, (800) 824-0613.

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We have inquiries this month from readers about health insurance, for those with ample financial resources and for those with minimal amounts of money.

Question: My 34-year-old daughter works only part time since she takes care of her 2- and 4-year old children. Her husband just became a partner in a large law firm and no longer gets health benefits. He is 35 and healthy and can easily afford a $10,000 or $20,000 deductible health insurance plan. Since this family is young and healthy and wants the option of any doctor or any hospital, what catastrophic health insurance is available? I could help my children with meeting any medical emergency and would gladly pay up to $10,000 if necessary to be sure they get the best available medical care.

Answer: Catastrophic coverage is available for people who can afford to pay “for the day-to-day stuff and want to insure only for the big problem, the accident or the major illness,” says Jim Armitage of Arroyo Insurance Services in South Pasadena. The coverage will cost about $44 a month for a single person or $116 a month for the family. It covers all hospital costs and doctor bills for a stay in the hospital and for emergency care. Any routine visits to the doctor’s offices would be excluded, along with drugs, dental care and other items covered in regular health insurance programs. Because you are generously willing--and able--to pay up to $10,000 a year for regular medical costs, your daughter’s family can get a cheap and effective policy for use only if catastrophe strikes.

Q: I hope you can put me in the right direction to help my cleaning lady get some type of medical coverage. This lady is 60 years old, an American citizen, but has very limited education and does housecleaning work for rather small wages. I know there are medical programs for those who are not working as well as for people who are disabled, but is there anything for somebody who makes very low wages, has no spouse but works hard all the time?

A: She would not qualify for Medi-Cal because she is under 65 and is not caring for children under 21. However, each county has a medical services program for indigent people. In Orange County, where you live, the income limit is 200% of the federal poverty level, or $16,100 a year for one person. Assets are limited to $2,000. The home and one car are exempt from being counted as assets. She must be an Orange County resident and a U.S. citizen or a legal immigrant. Medical Services for Indigents covers hospital and doctor services, dental care and drugs. Eligibility is determined by the Orange County Social Services Agency. She can apply at various hospitals and community clinics, including Coastal Communities Hospital, Western Medical Center, HRAP (Health Reform Action Project) Community Clinic and the UCI Family Health Center, all in Santa Ana. The MSI hotline is (714) 575-5858.

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This column appears every second Monday in Health. Send your questions, worries, tips, successes or failures in living with the health insurance revolution to Benefits Bob Rosenblatt, Health, Los Angeles Times, Times Mirror Square, Los Angeles, CA 90053. Or e-mail: Bob.Rosenblatt@latimes.com.