Choosing a nursing home can seem like a daunting task. If the need for care has become too much for you to safely provide and you find yourself trying to make difficult decisions in an emotional whirlwind, this section will provide you with some invaluable tips if followed.
As with any decision-making, finding the right nursing home is a step-by-step process. But those emotionally charged decisions can make it awfully hard to understand and navigate through the process.
There are many nursing homes that do provide excellent services and others that try very hard in the face of real funding restrictions and an inability to secure staff. Sadly, they are caught up in the distrust and suspicion which attention to the welfare of our loved ones indicates we should bring to this new competitive aged care system when we enter it. That is what a market system has done.
Even the best of homes and the most motivated of nurses make mistakes, things go wrong in spite of every effort and elderly residents continue to age and die. In these situations it is gracious and appropriate to recognise this, be forgiving and also constructive in assisting the home to prevent recurrences.
A good home will explain what happened openly and honestly. They will tell you what they are doing to prevent it happening again and often involve you in the planning. We all like to feel that our misfortune has at least benefited others and we should give our support.
The difficulty for the resident and the family is knowing when this is an isolated event and when it is a manifestation of a systemic problem. You will have to look around you to see whether there are other problems and speak to others to see if they have had similar experiences.
Management may be totally unaware that they have a problem and you will be most successful if you approach them in a friendly and non-confrontational manner. They may be in denial but should be prepared to listen carefully to your concerns and consider your suggestions for improvement. They should be able to explain what happened openly to your satisfaction and if it is needed initiate changes.
If you feel that you are being fobbed off then you should become more concerned. Consult someone with more experience than you have. Seek managements agreement to have the situation reviewed by someone you know who is knowledgeable and independent. They can hardly object. If you can resolve the issue without acrimony, your relationship and influence within the home will improve and you can contribute further to ensure the residents get better care.
The problem for relatives is that they are in an unfamiliar situation, are anxious, angry and sometimes grieving. In this situation it can be difficult to remain objective and restrain ourselves. Judgement can be clouded. We need to reflect before acting and have a friend who is able to stand outside our involvement and advise.
Insufficient and untrained staff are key problems
Insufficient and untrained staff are key problems. Prospective residents and their families should obtain staffing information and have the knowledge to assess staffing ratios. They should insist on the disclosure of past as well as present oversight (accreditation) reports.
Recurrent offenders are of most concern and the accreditation agency should be forced to supply these on request. Families should see what the company was capable of when no one was watching (i.e. insist on surprise inspection results) - not when they had been given time to prepare and not after they had responded to an adverse finding in order to stay in business.
Most nursing homes are accredited once every *3 years, and are subject to an "unannounced visit" at least once a year.
*Recent announcements plan to extend the accreditation period for much longer under recent reforms/announcements in 2015.
Consumers should examine the track record of the owner in its other homes. It is the owner that allocates funding and dictates policy. The profit focus (not for profit, private for profit or publicly listed for profit status) should be considered and the public statements examined within this context.
Visit the home unannounced and be given access preferably during a meal time to see the quality of food and whether there are staff helping residents to eat. A pervasive smell of urine or faeces is a warning. Facilities for physical exercise and mental stimulation are important.
Family members are often unaware of the key relationship between bad nursing and the deteriorating condition of the elderly resident. Weight loss, dehydration, pressure sores, contractures, being bedridden, and mental deterioration may be accepted as due to ageing, rather than to bad nursing, excess sedation, insufficient exercise, food and hydration and a lack of mental stimulation.
Wouldn’t it be useful if homes were required to disclose publicly what they spent on food, nurses and cleaning, as well as their staff/patient/skills ratios? Prospective residents should make a point of asking and comparing.
Note that the not for profit private homes have also been compared poorly with publicly run homes. We need to know whether the government homes are giving better care as one might expect from the additional expense, or are they inefficiently wasting the extra money as the marketplace claims. No one seems interested in looking at data to see. Experience from the USA suggests that it might be very challenging to market believers but there are insufficient public facilities in that country to make a valid comparison. It can be done here.
What is missing from accreditation reports are the incidences of pressure sores, contractures, weight loss and dehydration. This is the sort of information you require when you select a nursing home and decide whether to go public, not for profit or for profit.
Prospective residents and their families should obtain staffing information and have the knowledge to assess staffing ratios (amongst other things). They should insist on the disclosure of past as well as present oversight reports.
Families should examine the track record of the owner in its other homes. It is the owner that allocates funding and dictates policy. The profit focus (not for profit, private for profit or publicly listed for profit status) should be considered and the public statements examined within this context.
We urge relatives to learn about ageing, about good care, about failures in care and about the staffing ratios and training in the home their relative is in. If they really care for the resident then they should visit very frequently and at unexpected times to see what is happening. If all is not well, be persistent. If need be become such a nuisance that something is done.
If things are not right take photographs, record (with consent of those present), or take notes of all interviews and visits. Complain through the complaints mechanism, but don’t expect the faults to be there when they visit. If you have hard evidence and photos then you can still force the issue by going public.
Plight of residents and relatives
The resident has little leverage to ensure that staffing is adequate and that good care is provided. Because staff are often motivated, overworked and driven by cost conscious management residents are sympathetic to their plight and reluctant to complain. The overworked staff will be penalised if they do. At other times families are worried that if they antagonise staff by complaining the resident will suffer.
Management is often oblivious to the problems under their noses and can blame the relatives or resident for being difficult or having a problem. Some claim they have been bullied or threatened. If the resident is removed from one home a vacancy in another may not be found.
When families have complained and investigation of their complaints has revealed serious problems some homes have elected to go out of business. Others have been forcibly closed by the government (not many). In both cases the residents suffer more because of the closure than if they had remained silent. This is not what they had wanted.
People in their 80s or 90s whose home this has been for years can be forcibly relocated to geographically distant accommodation losing their entire nurse support system. The trauma of Riverside is a constant deterrent to anyone wanting to complain, yet unless families do so there will be little change.