Choosing a nursing home can seem like an overwhelming 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.

This section contains some invaluable information and checklists on making an educated decision in locating a suitable nursing facility for your loved one.  

Insufficient and untrained staff are key problems. 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.

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 a "spot check" (which is with notice) at least once a year.

They 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.

They should visit the home unanounced 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.

Relatives 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 aging rather than to bad nursing, excess sedation, insufficient exercise 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. The following article compares private vs public government run homes. It does not compare not for profit vs for profit homes.

We need to know whether the government run 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. Valid comparisons can be performed here.

What is missing from reports are the incidence 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.

One can only urge relatives to learn about aging, 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, 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.

You should not expect the complaints agency to tell you what they have found and it may cost you years of angst and expense to even see a censored copy.

Dr. J M Wynne MB. ChB, FRCS, FRACS, Grad Cert Ed (UQ)