General Observations Is the facility clean? Is the facility free of odor? Are the building and grounds well cared for and attractive? Do the residents have access to an outdoor area? Is the room temperature comfortable? Is air conditioning available in the resident’s room? Are all residents dressed appropriately for the time and season? Are residents without family or regular visitors treated differently? Does the facility have a good reputation in the community? Do the elder law attorneys in the area speak to groups at the facility? Does the facility currently have any lawsuits pending against it for violations of residents’ rights? Location Is the location convenient for family and friends to visit? Is there public transportation nearby? Is there ample parking available? Is the location near the resident’s physician or a cooperating hospital? Safety Is there a security checkpoint at the entrance? Is there an up-to-date safety inspection notice posted? Have elevators passed updated inspections? Is there an emergency evacuation plan posited? If so, are staff members trained on the plan, since a resident’s dementia leaves no time for staff to figure out the plan? Are exits clearly marked and left unlocked from the inside? Are there smoke detectors in resident rooms and in the common areas? Are there fire extinguishers, alarms and a sprinkler system on each floor? Are warning signs displayed and other steps taken when floors are being cleaned to prevent falls? Are there handrails in the hallways? Is the lighting adequate in hallways and common areas? Are there perimeter alarms on all exits to prevent confused residents from wandering? Are residents given a supervised area in which to smoke? Staff Are staff welcoming and courteous to you? How many staff members are on duty for each shift (morning, evening, nighttime – especially nighttime, when it is unlikely that any visitors would be present to monitor the care)? Is there a registered nurse and/or a nursing supervisor available on all 3 shifts? Is there a physician on call for residents? What type of certification do staff members have (e.g., licensed practical nurse, social worker, occupational therapist)? Do staff members have training in CPR? Working with dementia? Sexuality and aging? Do staff members appear to know residents by name? Do staff members appear to have a good rapport with residents? Do staff members respect the rights of residents not to be diapered? Does the facility have a full time staff development coordinator? How does the nursing home ensure that all staff receives continuing education and keep their knowledge and skills up-to-date? Resident Bedrooms Are rooms private or shared? How many beds per room? Do residents have any say regarding their roommates? Can a married couple share a room? Is there a privacy curtain around each bed? Is the bedroom convenient to a toilet? Can the resident bring personal items and decorations? Is each resident given a reading lamp, chair, nightstand and accessible dresser/closet with adequate storage? Does each bedroom have a window? Is there a call button next to each bed? Bathrooms Is the bathroom clean? Is the bathroom equipped for wheelchair access? Are there grab bars near the toilet and tub/shower? Is the staff rained to respect privacy and dignity during the bathing routine? How often does the resident receive showers or a whirlpool? If a shower is needed or requested more frequently, can this be arranged? Medical Services Was there a Resident Assessment Protocol? Did you feel rushed through the care plan meeting? Is the care plan posted and followed? Is there an individual assessment of need? Is there 24-hour on-call physician access? Does the facility offer rehabilitative services (physical therapy, occupational therapy, speech therapy)? How often are these services available? Is there a pharmacy on site? Or is a pharmacist reachable for telephone? How quickly? Are registered dieticians available to plan meals and oversee nutritional needs? Does the facility help arranging medical appointments or hospitalization? Dental? Is there non-emergency transportation for medical care? Does the facility offer assistance and supervision for people with dementia or a special care unit? Are there specialized services (e.g., ventilator care, respiratory care, coma care, dialysis)? Is there a room to isolate residents with a contagious illness? Does the facility have an emergency box of medications available for critical stat meds/ if not, is a stat med available within 2 hours? Does the facility do IV hydration and antibiotics? When a physician cannot be reached within a reasonable length of time, can you call the house physician for MD orders? Is a podiatrist available, how often, at what cost? Who provides psychiatric care? How often do they visit? What facility do they use for hospitalization? Is the facility restraint free? How are confused residents kept safe from falling/ambulating without assistance? Optional Services Is Laundry service available? Is there an extra cost? Is clothing returned to the proper resident? Does any resident have complaints about lost clothing? Does the facility offer a beauty shop or barber services? At what extra cost? Is there cable TV connection, VCR or Internet access? At what extra cost? Can residents have their own newspaper or magazine subscriptions? At what extra cost? Can a resident have his or her own phone? Who is responsible for hook-up? If not can the resident have privacy in using a facility phone? Are you able bring in your own TV? Is cable available? Who is responsible for hook-up? To whom do I report missing clothing? Can adaptive clothing be ordered i.e., garments with Velcro closures? Meals Are there menus available for review? Does the food seem appealing? Do the menus offer variety and choices? Are foods served at the right temperature? Is enough time allowed at mealtime? Is the resident asked if he/she is done before the unfinished portion of the meal is removed? Is adequate staff assistance available to those who need it at mealtime? Are snacks available? What type? How often are they served? Are special diets and food preferences accommodated? Can meals be delivered to a resident’s room? Are guest meals available? At what extra cost? If a resident does not like his/her meal will another meal be offered and substituted in a timely fashion? How often is the resident weighed? Is the dietitian notified of all wt losses or weight gains? How frequently? Can you bring in special foods that your family member enjoys. Is it stored on the unit for easy access? Can you join your family member for an occasional meal and how much notice is needed/ at what cost? Activities Is there a schedule of activities posted? Are activities appropriate and interesting? Do they include events outside the facility? Does the facility have special programs for: Visiting pets? Children or youth? Volunteers? Gardening? Is there reading assistance for residents with visual impairments? Is therapeutic recreation provided (e.g., exercise or yoga)? Do residents participate in planning the activities? Do residents have access to worship services of their choice? Are one to one visits available for the residents who are unable to attend or participate in activities/how often? Are family members encouraged to attend some activities with their resident? Visiting Can visitors come at any time? If not, what are the designated visiting hours? Is there a sitting room where residents can visit privately with guests? Can family pets come as visitors? If so, what are the restrictions? Payment Issues Do you understand what the basic rate covers and does not cover? What is the daily bed rate? How much does the rate increase with all additional optional services? Is there an initial deposit or application fee? If yes/is this refunded when the resident moves out (or is unable to move in)? Is there a cap on the amount the monthly rate can increase? How much notification would you receive? Is the facility certified for Medicare? Is the facility certified for Medicaid? Does the facility offer to help with the MassHealth (Medicaid) application? Is the facility informing you that the resident must be moved from a Medicare bed to a Medicaid bed? Has the facility told you that a particular bed is a Medicare bed without telling you that the bed is also certified as a MassHealth (Medicaid) bed? Does the facility attempt to explain all options the resident’s family may have in preserving assets even where MassHealth (Medicaid) eligibility would be accelerated and the facility would end up being paid less than if you were making private payment? Do you understand what would happen if you could no longer pay the bill? Does anything in the admissions agreement seem unclear? Do you feel rushed to sign the admissions forms? Do any rules make you feel uncomfortable? If so, would the facility be willing to amend the contractual agreement to accommodate your concerns? Is the facility asking anyone to volunteer to be a guarantor of payment? Resident's Rights Is there an active resident’s council? Is there an active family council? Is there a grievance procedure to handle complaints in a timely manner? Do residents have free access to contact the local ombudsman’s office? Do you feel that there could be reprisals if you complain about anything? Do residents have the right to come and go as they please? Is there a policy to restrict the use of physical and chemical restraints? Are resident’s valuables and cash safeguarded? How? What happens if personal items are lost or stolen? Is mail delivered promptly and unopened? Does the facility not just post and distribute but also follow a resident’s bill of rights? Is it clear under what conditions the facility can discharge or transfer a resident?
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