How to play the nursing home lottery

Shortly after a stroke destroyed her father’s ability to communicate last spring, Elizabeth Lange* realized that even with home care, her 80-year-old mother wouldn’t be able to cope with his needs. Lange would have to find a nursing home that she and her mother hoped would care for his physical being and, as importantly, treat him with respect and compassion.

She visited at least six nursing homes, bypassing several more which did not appeal. When her father’s rehabilitation period was over, Lange discovered how waiting lists really work. “The list is sort of thrown out the window if there’s somebody in greater need. If they’re in the hospital and the hospital has determined that there’s no reason for them to be there any longer, they go to the top of the list.”

Although her dad did move to a highly recommended north Toronto residence, Lange still had misgivings – until one day shortly after her dad moved in when a visiting piano player helped allay her fears. “Staff were getting people up and dancing, or they were singing songs and holding their hands. There was a lot of hugging, and it was really a lovely thing to see. It reassured my mother and meecause we saw these people were compassionate and really cared about the people they were looking after.”

The reality is there’s not much choice when it comes to moving into a long-term care home in Canada. There’s usually a single entry point through provincial agencies such as Ontario’s Community Care Access Centres (CCACs), and options are limited to one, two or perhaps three selections.

If the home you prefer doesn’t have an opening, it may be possible to transfer there later. But Eileen Kraatz, author of A Spy in the Nursing Home: Inside Tips and Tactics for Choosing the Right One in Five Days (Health Information Press), says once someone moves into a nursing home, they’ll probably stay there.

Given that you or your relative may not get your first pick, your second and third choices are vitally important.

After working or volunteering in nursing homes in both the United States  and Canada for more than 20 years, Kraatz developed a systematic approach to evaluating nursing homes that she outlines through a series of checklists in A Spy in the Nursing Home.

Peter Silin, a social worker and geriatric care manager in Vancouver, recommends watching how staff interact with one another and with residents. Once your relative is on a waiting list for a specific home, he suggests taking them there for a meal and joining in some of the activities.

His book, Nursing Homes: The Family’s Journey (Johns Hopkins University Press), has detailed suggestions for choosing a place, but it also helps family members understand how to deal with issues that arise while their loved one lives there. “A really good home will have resources such as psychiatric help, geriatricians and physiotherapy but will also have good caring – the way people talk to the residents, serve them meals, the interaction they have.”

Indeed, Elizabeth Lange says the best advice she got came from her father’s geriatrician. “She told me, ‘Don’t look at the place, look at the people.’ And it’s true. The most important thing is the care they’re getting from the people. So I tried to stay alert and not get won over by pretty pictures.”

Here are more tips and questions from Eileen Kraatz

• Start checking out nursing homes before you need to find one.
• Volunteering is a good way to get to know how a home operates.
• There should be no unpleasant odours, including that of strong disinfectant.
• Is there enough staff to look after everyone?
• How do residents react around staff members?
• Are people stuck in wheelchairs with nothing to do?
• Visit on a Saturday, when there is fewer staff. Are residents being looked after?
• Have a meal there. Is the food inviting? Are people being helped to eat? Is the kitchen clean?
• With a resident’s permission, push the call button. Does staff respond in a reasonable time?
• Ask people who live in the nursing home what they think of it.
• Are there too many thin residents, indicating they’re either not getting enough nutritious food or that they’re not being helped to eat?
• Are people confined to bed being fed in a timely way?
• Do too many residents have bruises?
• Are people left to slump uncomfortably in wheelchairs or in beds? Are many restrained in chairs or beds?
• Are residents well groomed and clean?
• Does the home have a full-time activity director?

* not her real name