The phone call from your mom's doctor changes everything. After her recent fall and hospitalization, she can no longer live independently. Now, you face the daunting task of finding a nursing home that will provide excellent care while treating her with dignity and respect.
Selecting the right nursing facility represents one of the most important decisions families make during this transition. Our Chester County elder law attorneys can help you understand your options and legal protections, but knowing how to evaluate facilities yourself gives you confidence in making an informed choice.
Research Nursing Facilities Online Before Visiting
Start your nursing home search with a thorough digital investigation. Pennsylvania maintains detailed inspection records for every licensed nursing facility through the Department of Health. These reports reveal citation patterns and how facilities responded to problems.
For current staffing levels and related metrics, review the facility's Staffing section on Medicare's Care Compare. The federal site also assigns star ratings based on health inspections, staffing, and quality measures. Facilities with consistently low ratings often struggle with fundamental care standards. Pay particular attention to facilities with one or two stars, which typically indicate significant deficiencies.
Research facility ownership using Pennsylvania DOH's License and Ownership Information lookup for nursing facilities. Corporate chains sometimes prioritize profits over patient care, leading to understaffing and quality issues. Look for any history of legal settlements related to patient care, abuse, or neglect.
Conduct Multiple Facility Visits at Different Times
Online research provides important background, but nothing replaces seeing a facility in operation. As part of your nursing home selection process, plan several visits at varying times to get a complete picture of daily operations and quality of care.
Schedule your initial visit so staff can provide a proper tour and answer questions. However, unannounced visits often reveal more about actual conditions. Try stopping by during different shifts, including weekends and evenings when staffing may be reduced.
Watch how staff members interact with residents during your visits. Do they speak respectfully and make eye contact? Are residents dressed appropriately and appear clean and comfortable? Notice whether staff seem rushed or have time to provide individualized attention.
Evaluate Staffing Levels and Training
Adequate staffing represents the foundation of quality nursing home care. Federal regulations now require a registered nurse (RN) on-site 24 hours a day, 7 days a week (with limited exemptions), and licensed nursing coverage at all times under 42 C.F.R. § 483.35.
Ask about typical staff-to-resident ratios during different shifts, particularly overnight when staffing is usually reduced. High staff turnover disrupts continuity of care and often indicates workplace problems. Facilities with turnover rates above 100% annually struggle to maintain consistent care standards.
Quality facilities invest in ongoing education about topics like dementia care, fall prevention, and infection control. Staff should be able to discuss their training and demonstrate knowledge about residents' specific needs.
Assess Quality of Life Programs
Medical care addresses only part of nursing home residents' needs. Quality facilities provide meaningful activities, social interaction, and opportunities for residents to maintain their dignity and interests.
Review activity calendars and ask about participation rates. If most residents don't engage in programming, this may indicate activities aren't well-designed or staff don't encourage participation. Quality programs adapt to residents' changing needs.
Observe mealtime experiences during your visit. Food should be appetizing and served at appropriate temperatures. Notice whether residents receive assistance eating when needed and whether dietary restrictions are properly accommodated. Many residents should have the opportunity to dine socially rather than eating alone in their rooms.
Understand Pennsylvania Residents' Rights
Under Pennsylvania elder care law and the federal Nursing Home Reform Act, nursing home residents retain the right to respectful treatment, privacy, and participation in their care decisions. Facilities must provide written copies of residents' rights and cannot retaliate against residents or families who raise concerns.
Quality facilities have clear procedures for addressing complaints and work cooperatively with state ombudsman programs. The ombudsman serves as an independent advocate for residents and can investigate concerns about care or treatment.
Federal law allows discharge or transfer only for specific reasons:
- When the facility cannot meet the resident's welfare needs
- The resident no longer needs the facility's service
- The safety of others is endangered
- The health of others is endangered
- Nonpayment of nursing home fees
- Facility closure with required notice and appeal rights
Review Medicaid and Financial Arrangements
The financial aspects of nursing home care are equally crucial for families to make informed decisions. Most families eventually rely on Medicaid to cover costs, as private pay rates often range from $10,000 to $12,500 monthly in Pennsylvania, depending on location and room type.
Ask whether the facility accepts Medicaid patients and about waiting lists for Medicaid beds. Many facilities accept "Medicaid pending" applications, but acceptance is at the facility's discretion. Confirm whether the home accepts pending status and what happens if eligibility is delayed. Some require private pay until approval or limit admissions to private-pay first.
Nursing home base rates typically cover room, board, and basic care services. However, many facilities charge additional fees for services like beauty shop visits or enhanced activity programs. Ask for a complete fee schedule to understand total monthly costs, and be wary of facilities that charge for basic care services like assistance with eating or bathing.
Make an Informed Elder Care Decision
Choosing the right nursing home requires careful research, multiple facility visits, and an understanding of residents' legal rights under Pennsylvania law. Take time to thoroughly evaluate your options to protect your loved one's safety, dignity, and quality of life.
Remember that you can continue advocating for excellent care even after admission. When you meet with your Chester County elder law attorney, they can help review admission contracts and provide guidance about residents' rights and family responsibilities throughout the process.