By William J. Beerman, Sr.
If you’re told to find a nursing home for a loved one, will you be adequately prepared?
In my case, I received a phone call as the Fourth of July weekend approached back in 2011. The call was from a cousin who lived near my mother in a city 1,700 miles away from where I was living. My cousin told me that my mother, who had been living independently at age 85, had tripped over a footstool in her apartment and had broken a hip.
Prior to this, I had made some cursory efforts to prepare for my mother’s decline. I had purchased and browsed a book on eldercare, and I had called A Place for Mom to inquire about assisted living facilities. But after that phone call about my mother’s broken hip, I quickly realized that I was unprepared and utterly incompetent to deal with the nursing home crisis that was unfolding.
After the surgeon repaired my mother’s hip in such a way that it could bear weight, the hospital told me my mother was being released and I had to choose a rehabilitation nursing home that day or the next day. I thought my mother was being released abruptly and prematurely because she still was under the lingering influence of anesthesia. I was told there was a process to appeal the discharge. But I didn’t appeal and I let myself be rushed because I trusted the system; I didn’t want to make trouble; and I was afraid we would have to pay the hospital bills while we appealed if we refused to check out.
I did not realize then the high risk and consequences of choosing the wrong nursing home.
In response to my request, nurses gave me a computer printout with names of 28 nursing homes in the city’s east and south suburbs. They told me they were not allowed to recommend specific nursing homes. Any reasonable person would have tried to prioritize the list and visit the best nursing homes. But the list had no ratings – only names, addresses, and phone numbers, along with notations of whether the nursing homes accepted Medicare and Medicaid.
Driving miles through traffic, I visited two nursing homes, and my cousin visited two. The first nursing home I visited had the infamous smell of urine even at the front entrance. The second had the ambiance of a luxury hotel, and the residents were well dressed as they walked or rolled along the quiet carpeted hallways in wheelchairs. I didn’t think my mother wanted to dress up all the time in what she would call a “swanky” nursing home. (As I learned later, carpets and chandeliers do not equal good care anyway.)
As I did my search under deadline pressure, I didn’t know how the process worked. Would the nursing home I selected even accept my mother? How would the payments work? Would I have to arrange an ambulance to transport my mother?
My cousin and I settled on a nice-looking nursing home in a green suburban garden apartment district near my cousin’s house. My cousin planned to visit my mother often. The hospital arranged for the transfer and had a wheel chair van transport my mother. No one asked for any money.
Without going into detail, my selection of a nursing home was disastrous. Within a month after breaking her hip, my mother was transformed from a mentally sharp and pleasant person into a dying one who was drugged, barely conscious, and plagued with a half dozen illnesses. After 21 days at the nursing home, she was sent to the emergency room of the closest hospital, where she died 10 days later.
I found out too late that the government ranks nursing homes, and that the one I put my mother in was rated “below average” with only two out of a possible five stars. Three minutes down the road was a different nursing home that we could have chosen. It was rated above-average with four stars. Because my mother acquired a contagious illness called clostridium difficile while in the nursing home, she required isolation and I could not get her transferred from the bad nursing home to a better one.
Since Medicare and my mother’s AARP supplemental policy covered the first 100 days of rehab, the cost to us for the two-star nursing home was the same as the four-star, or even a five-star, would have been. That is, virtually no out-of-pocket cost.
Since my mother had her ordeal more than six years ago, one might assume a lot has changed. But many people today still are ill prepared to deal with a nursing home chapter in their life. I recently saw friends face problems similar to those encountered by my mother and I, as their friend or spouse entered a nursing home. They didn’t know ratings existed, or that there was a hospital discharge appeal process. In fact, they knew virtually none of the basic information that could have helped them avoid serious difficulties and possibly create a better outcome.
Anecdotes such as mine and those of my friends are informative, but what about facts?
The Commonwealth Fund reported on August 8, 2017 that most hospital patients who require care from a nursing facility following their discharge receive no information about the quality of available facilities, according to interviews with patients and medical staff.
The title of the Commonwealth Fund report is: “Patients Are Not Given Quality-of-Care Data About Skilled Nursing Facilities When Discharged from Hospitals.”
I was amazed to find out that this problem, which my mother and I encountered in 2011 with severe consequences, continues today.
In the Commonwealth Fund study, a research team interviewed 138 staff members at 16 hospitals and 25 nursing facilities across eight U.S. markets. The team also interviewed 98 patients admitted to 14 of the nursing facilities in five of those markets.
Researchers found that hospitals are not providing patients who need care in skilled nursing facilities (SNF) with data that would allow them to select a high-quality provider. Hospitals should provide these data to help patients make a more informed choice, researchers said.
When researchers asked patients what information they had been given by hospital staff members to help them select a SNF, only four patients said that they had received any information about SNF quality, or instructions about where to find such data. Instead, patients made comments such as this: “I got a two-page list of different facilities that I could go to. It basically was the name, the address, and a phone number.”
You can find nursing home ratings at www.Medicare.gov on the internet. On that site, click on “Find nursing homes.” Look at the ratings and pick a couple of likely candidates nearby, and then visit them. Talk to residents and staff members. Periodically check for changes in their ratings.
But there is so much more to know. For example, there is even a database that tells “How many care givers does your nursing home really have?” I recommend spending a couple of days reading my book, “Mary Regina’s nursing home,” or someone else’s book about the nursing home experience. If I had known the information that’s in my book at the time my mother broke her hip, our experience and the outcome would have been much different. As my fellow nursing home book author Phyllis Ayman (Nursing Homes to Rehabilitation Centers) commented, “Forewarned is forearmed.”