A Bittersweet Experience: Choosing the "Right" Nursing Home

If you are going to a nursing home or choosing one for a family member, there's no such thing as the "right" nursing home, because going there will always signify a frightful change. But just maybe there is a right nursing home where life will be pleasant, and the care will be given with kindness.

Since I handle nursing home cases, as do many other attorneys who are experienced in personal injury and malpractice law, I am often asked for advice about how to choose a nursing home. Decisions like this can affect every one of us, so I take the questions seriously and give the best advice I can.

That's because I've had a look at the dark side of nursing home care - pressure ulcers that penetrate to the bone, blood infections caused by dislodged feeding tubes, broken bones over and over again from unattended falls, restraints that entangle and cause terror or, even worse, strangulation - all compounded by malnourishment, dehydration, untreated depression, and chronic inattention from inadequate staffing.

Recently, the Centers for Medicare and Medicaid Services gave one in five certified nursing homes only one star of five based on quality of care, staffing, and health inspections. These are common problems for the 1.5 million Americans in nursing homes, but they don't have to happen. For-profit homes, contrary to our expectations, have the worst performance according to the Government Accountability Office. Even those statistics don't offer a reliable picture of the problem.

The Medicare/Medicaid star system, for example, is partly based on unaudited self-reports about staffing and quality of care criteria. My research in cases I've been asked to investigate show that reported deficiencies are only the tip of the iceberg and that substantial histories, documented in the medical records, show untreated pressure ulcers, malnutrition, falls and other problems that regularly happen in advance of these investigative findings.

So how do you come to the point of selecting the best nursing home for yourself or a family member? Whether it's someone else or me who typically represents nursing home residents against the homes they hire to provide quality care, we have to say at the outset that we are not social workers, physicians, or nursing home case managers.

With that caveat, we can say that we offer someone looking for a nursing home one thing, that is, an attorney's perspective on common financial, administrative, medical, and quality of life concerns that arise in nursing home care. And we as a group can offer some tools for evaluating how well a specific nursing home evaluates them. Considerations about which nursing home to select are so important for end of life decisions that any attorney practicing in this area of law, who is worth his or her salt, should give this advice without charge. Next week, I will suggest some things for you to consider.

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