Nursing Home Red Flags: 7 Things to Look For

From dirty facilities to outdateCOVID-19 policies, here are seven nursing home red flags you and your family should look out for when choosing a care facility.

Nursing Home Red Flags

Whether you need a short-term rehab for yourself due to illness or long-term stay for your aging loved onenursing homes provide a needed health care service. Unfortunately, not all care facilities are created equal, with some being better than others.

Below are seven nursing home red flags that you and your family should look out for when choosing a care facility.

  • 1

    Low-rated facility

    There are some 15,600 nursing homes in the U.S. in 2018, the most recent year for available data from the National Center for Health Statistics. Each one must meet state and federal standards to ensure the health and safety of residents.

    Compliance with those laws must be documented after each annual state inspection – or more frequent inspections, if called for – and posted in publicly available formats. Check those documents for complaints of abuse or neglect of residents. If that request to view the documents is not honored, it should give you pause before moving yourself or a loved one into the facility.

    For more on nursing home standards, check the Medicare website to find and compare providers near you. You can also check with your state’s department of health. In addition, the Better Business Bureau is a good resource to view complaints may have been lodged against a facility.

  • 2

    The facility is dirty

    During your tour of the nursing home, be sure to look closely at shared spaces such as the entertainment room, and, if possible, available resident rooms. If the rooms emit an odor or are noticeably unclean, beware. This could be a red flag that there’s not enough housekeeping staff to keep up with the work. Dirty facilities breed germs and can ultimately lead to higher rates of infections.

  • 3

    Untrained and/or unlicensed staff or lack of staff

    Staffing is a critical element in any nursing home. Unlicensed or untrained staff are a hazard to any facility. Just as dangerous is a shortage of nursing staff.

    You can ask the administrator for the number of licensed team members and compare that to your state’s minimum guidelines – based on federal recommendations – for nursing home staff. If those number don’t match, consider that a red flag.

    Solid training and current industry knowledge ensure better resident care. In addition to certifications and licenses, staff should be compassionate and patient and capable of communicating clearly. If you find expired employee licenses or ill-tempered employees, you may want to look elsewhere for a facility.

    Finally, the number of staff per shift is a number you need to know. Federal law requires Medicare and Medicaid-certified nursing homes to employ “sufficient” staff. That means registered nurses (RNs), licensed practical and vocational nurses (LPNs and LVNs), and certified nurse aides (CNAs). Each state determines minimum number of each practitioner per shift. Again, if you find that the number of staff employed per shift differs from state guidelines, you may want to choose another facility.

  • 4

    Unwilling to give tours

    If your nursing home of choice has administrative staff not willing to readily accommodate a tour or who are rude or inattentive, it’s time to reconsider your choice of facilityReluctance to give a tour could be a red flag that the staff is struggling to bring the facility up to required standards.

  • 5

    Unsafe environment

    When visiting a nursing home, be on the lookout for tripping or slipping hazards. Wet floors not marked by proper signage, exposed electrical wires or loose cords could become a potential accident for you or your loved one. Similarly, outdoor spaces should be clean, wheelchair accessible and well-organized to allow for plenty of socialization among residents. After all, growing and maintaining friendships supports higher levels of happiness at all stages of life.

    Choose a facility that creates a safe and welcoming environment for you, or your aging loved one, who could potentially wander around unsupervised.

  • 6

    No COVID-19 policy or enforcement

    If a nursing home receives federal funding, all staff - with some exceptions - are required to be fully vaccinated as part of a 2021 federal vaccine mandate. In 2020, the Centers for Disease Control adopted Occupational Safety and Health Administration guidelines to help reduce the spread of the COVID-19. Guidelines include recommendations for handwashing, cleaning and sanitizing and ensuring workers have access to personal protective equipment (PPE).

    In 2022, the federal Centers for Medicare & Medicaid Services released updated guidelines for safe nursing home visitation such as encouraging vaccination, masks and physical distancing.

    As a prospective resident or family member of a prospective resident, ask and get answers about the vaccination rate for staff and residents. Learn if there is a COVID-19 testing policy and how to review said policy. If the administration fails to share details, you will not know how the facility works to minimize spread of infection. It's a red flag if the COVID policy is outdated or ineffective.

  • 7

    No schedule of fees available

    Choosing a nursing home means asking a lot of questions and doing plenty of research, including how much the stay will cost. Private insurance or Medicare will pay a portion of a nursing home stay. The remaining costs will need to be paid out of pocket. Ask for a breakdown of fees when considering a facility. If the facility is unwilling to provide costs up front, this could be a red flag. You may end up with unnecessary higher costs of care for your area.

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