Before choosing a Care Facility it is very important to ensure the care being provided is of a superior level. When you tour the facility and are initially greeted by an Administrator/Owner of a Care Home, be sure to ask what hours of the day the Administrator is there providing oversight, then re-tour the facility when the Administrator is absent. This is important to ensure the level of care is consistent at all times, even when the Administrator is not present.
Most importantly, get to know the primary Caregivers; it is the Caregivers who will have the most exposure, hands-on care and socialization with your loved one. We all want our elder loved ones to have a friend and someone to talk to, and this close bond will occur between Caregivers and Residents, so correct staff training on the development of bonds with Residents is extremely important.
Questions to Ask When Considering a Care Facility
What is the employee turnover ratio?
A high turnover of staff could be problematic. The bond and trust built between Residents and Caregivers is done over time, thus the importance of long-term employees.
What is the experience level of the employees?
Generally those with more experience are more able to ensure that the little things don't get missed, and with experience comes a greater understanding of the needs of elder care.
What kind of basic care documentation is used?
Ask to see a sample. Check for daily care notes documentation. Examples include: urine/bowel output, water intake, mobility, etc. Depending on the Resident's ability to self -care, you want to be sure that residents are assisted and reminded for toileting if incontinent, and also that staff assures that they wash their hands. This hygiene step is imperative for safety, to reduce any possible cross-contamination to other residents, staff and community visitors. There should never be a urine odor, this usually means that residents are not properly cleaned and cared for on a regular basis. It also could be a tell-tale sign that hydration reminders and assistance are not provided.
Is the facility clean and sanitary?
The first thing you will notice when walking into a facility is the overall odor. Take note of an odor of urine, feces, body odor, etc. Check the carpet, floors and furniture for cleanliness. Check the cleanliness of doorknobs, wall surfaces, remote controls, and things of this nature.
How are Residents monitored during the night?
This is usually the time when Residents get into trouble; without proper monitoring they may fall and hurt themselves. Proper night monitoring also helps to avoid accidents that may occur if a Resident does not get to the Restroom as needed.
What is the frequency of Resident bathing/showering?
Twice per week is optimal, and with assistance it is imperative for hard to reach and private areas to be cleaned properly to avoid infections and skin breakdown. Ask if sponge baths are given in between shower days. Check to see if the skin of Residents appears dry, and ask if they apply lotion, if so, how often. Check the overall cleanliness and odor of Residents, included but not limited to: hair, skin, fingernails, and clothing
What level of oral/mouth care is provided?
Dental hygiene is often missed in many facilities. It is imperative for staff to provide stand-by assist and reminders to brush teeth, at a minimum, twice daily. If your dentist tells you that your loved ones teeth are in bad shape and have a great amount of tartar build-up, this could lead to potential pain and agitation when a Resident has an infected tooth, as well as medical complications from the infection.
What is your activity schedule and what are the activities?
Activities are best provided per a regular schedule since the body and mind will more favorably respond to an activity that has been done on a routine basis. In addition, the simple act of performing group activities aids in socialization, and is a helpful motivator. Ask about the activities and the schedule of these activities. Activities aid in the following: social interaction, eye-hand coordination, engagement in something fun, creative and interesting awakens the mind, and inclusion in the community helps to avoid potential isolation, loneliness, depression, agitation, and a failure to thrive (watching television is not an activity).
What is the Ratio of Caregivers to Residents?
Caregivers cook meals, clean the facility, provide Resident care and monitoring, and participate in activities and exercise with the Residents. It is absolutely necessary to have a minimum of two staff per six Residents between the hours of 7:30am-8:00pm. Additionally, if a care facility claims to be “24/7” there should be at least one AWAKE staff member at night.
What fall prevention measures are in place? Do they have a call button system, or a personal body alarm?
A call-button system is a great option for Residents who do not suffer from memory impairment or loss. A Resident who has memory difficulties may not remember to hit the call button for assistance prior to ambulating. Look for a facility that has personal body alarms for those Residents at risk for a fall. In addition, how will the Staff know if a Resident is getting up at night? Some facilities have infrared cameras that will sound an alarm once their feet touch the floor, while others have floor mat alarms, which sounds an alarm when their feet touch the floor. The bed/mattress alarms, which sounds when a Resident gets up, is not the best option as the Resident is already standing before the alarm sounds, thus too late if there is a fall. The best options are personal body alarms and/or floor mat alarms.
What if a Care Facility is sub-standard in any manner?
You should address your concerns with the Care Facility Administrator. Sometimes Administrators are not aware of sub-standard activities in the home until brought to his/her attention by a third party. If you are afraid of retaliation by lodging a complaint directly with the Administrator, you may also file an anonymous complaint with Community Care & Licensing or with the Ombudsman. You should advise them that it is confidential and you would like to remain anonymous. The licensing agency will then conduct a thorough visit and assessment of the Care Facility.
The only way things will change in these communities is if they are held to higher standards and subjected to the Licensing / Regulatory authorities. Please keep in mind if you are noticing lack of care for your loved one, consider the other frail elderly residents whose family members unaware of lack of care issues.