Choosing a nursing home

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.

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.