• Finding the right nursing home can be daunting
• There are few guarantees: The worst homes can have good staff; poor care can happen at the most highly rated homes
• Key to ensuring the best care is visiting 

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Too often, there is little choice in nursing home care; it happens after an unexpected hospitalization. Decisions must be made in hours. 

And even with time, there are few guarantees.

“Things can go wrong in even the best nursing homes,” said Alison Hirschel, program director and managing attorney of the Michigan Elder Justice Initiative and a decades-long advocate for nursing home residents. “And even in problem nursing homes — those with chronic understaffing and quality issues — there are compassionate, good staff.”

A few tips can help boost the odds of finding the best choice for quality care — and advocating for better care when necessary, she and others told Bridge Michigan.

Step 1: Do some online sleuthing

The US Centers for Medicare & Medicaid Services offers Nursing Home Compare, an online tool, to help consumers find and compare nursing homes in their area. It offers consumers a look at health and safety inspection reports, quality measures and staffing. It also allows you to see if a facility has been cited for abuse and whether it has paid penalties when it fails to meet standards.

Related:

• Michigan, aging faster than most, faces big challenges as it ages. Read our series here
• Michigan sits on $35M fund to improve nursing homes. It’s largely unused
• Michigan nursing homes have few staff, little training. Misery can follow
• Abuse, neglect common in Michigan nursing homes — and no one is coming to help
• Install cameras, beef up training — and 5 other ways to fix Michigan nursing homes
• Michigan cities balk at costly 911 calls to understaffed nursing homes

(CMS has produced this guide to explain how the ratings are calculated and how to use them.)

But it’s a far from perfect system. Some of the data is self-reported. Moreover, citations are often based on inspections that happen just once a year or after a complaint. And inspection reports are visible to the public for three years only. 

It also can be outdated information, but it can give you a picture 

For past reports, see the Nursing Home Inspect page from the news outlet ProPublica.

The national nonprofit Long Term Care Community Coalition offers state-by-state data, notably about staffing, at NursingHome411.org.

Step 2: Drop by

Once you’ve narrowed your search, it’s important to visit. Consumer advocates recommend going unannounced.

“Nothing beats going into a facility, especially after hours,” said Cindy Evertsen, a long term care ombudsman for Muskegon, Oceana and Ottawa counties. 

“And if they say you can’t visit after hours, that would be an automatic red flag for me. ‘Why don’t you want me there after hours? What are you doing when management isn’t around? Are you short-staffed?’” Evertsen said.

Sara Gusler, ombudsman for Ingham, Eaton and Clinton counties, takes a different approach: “I tell people to go during meal time.

“Notice the dining room. Is everyone eating together, and are staff helping them?” she said. “If there’s 100 people in the facility, and only 10 are in the dining room, that’s indicative of a problem with staffing; there’s not enough of them. We are social, and we tend to want to eat together.”

Residents, staff and guests mingled over a charcuterie board and fresh fruit at The Willows at East Lansing. The smell of fresh popcorn filled the air, as did live music. 

The key to good care is supporting staff so they develop relationships with residents, executive director Ellie Davis said.

It was something that Laura Taylor, sitting with her mother-in-law, a resident, said she notices each time she’s here. She glanced around. One staff member was serving up apple cider from a drink cart, joking with residents at one table. One was helping a resident sway to music; another was flipping through a magazine with another resident.

“They seem to enjoy their jobs,” Taylor said. “That makes all the difference, right?”

Additionally: 

• Notice how you are greeted when you walk in. Are you welcomed, or ignored?
• Ask about the facility’s resident council and if you can speak with one of its representatives.
• Talk with staff, residents and other visitors.
• Notice residents’ grooming and the cleanliness of the facility.
• Check out the activities list (and check later to see those activities occur, Evertsen said).
• Pay attention to the response time for call lights.
• When possible, choose a facility close to home and to friends and family who will visit and, if necessary, advocate on your behalf.
• Notice the staff. Are they interacting with residents or scrolling social media?

Some suggest bringing the occasional treat for staff or stocking a resident’s candy dish. It’s a treat that thanks staff for their work, but serves as a gentle reminder, too, of your watchful eye.

Step 3: Speak up

Above all, it’s important to advocate — whether you’re a loved one or the resident.

Nursing homes are paid billions of dollars every year to provide quality care to residents, their consumers, said Eric Carlson, an attorney who leads advocacy efforts for long-term care at the Washington-based advocacy organization Justice in Aging.

Carlson wrote a how-to consumers guide for residents and their loved ones. In it, he dispels common myths about nursing homes and care.

For example: No, nursing homes can’t force everyone out of bed at 6 a.m. just because it’s easier for staff. And no, for the most part, they can’t evict a resident.

“People are generally really hesitant,” Carlson said. “How many hundreds or thousands of times have I heard something along the lines of ‘I don’t want to create any trouble,’ or ‘I don’t want them to think poorly of me or my parents.’” 

Be the squeaky wheel, said Carlson, whose book can be downloaded for free here.

Step 4: Where to turn for help

Ombudsman: The Michigan Long Term Care Ombudsman Program is part of a federal network of consumer advocates. Help is free and confidential and available at 866-485-9393.  A listing of local ombudsmen, searchable by county, can be found at this link here.

Resident councils: Residents also may turn to each facility’s resident councils. By law, councils have the right to meet alone and run the meetings by themselves, but they also may be attended by a staff liaison or a local ombudsman. Others, including family members, may attend by invitation only. 

Some councils are stronger advocates than others. Some work more closely with facilities; others are more independent.

Formal complaints: Residents, family members, friends and nursing home employees all can file complaints about nursing home care with the Michigan Bureau of Survey and Certification.

Complaints can be made anonymously at 800-882-6006 or at this link.

A serious complaint may be classified as “immediate jeopardy,” and the state is required to investigate within two business days. Less serious complaints may take weeks or months to be addressed.

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