Connecticut Long Term Care Ombudsman Program

Choosing a Nursing Home

 

Consumer’s Guide to Choosing a Nursing Home (PDF)

 

Placing a loved one in a nursing home is very hard.
When it must happen, families need clear, honest information.
This page helps you find resources, understand the facts, and make a good choice.

 

FIRST, EXPLORE ALTERNATIVES


Try to plan for long-term care needs before there is a crisis.
Talk with your loved one and close family or friends about care wishes.
Planning early makes later decisions easier.

Before you look for a nursing home:

  • Make sure your loved one’s health has been carefully checked.
  • Review the support they already have at home.
  • Ask doctors if treatment could improve their condition.
  • Ask if they can stay at home with more help.

Many people can stay at home if they get the right support.
Most people want to stay in their own home.
So it is important to look at other options besides a nursing home.

Possible options include:

  • Home care
  • Adult day care
  • Assisted living

You can learn about services from:

If nursing home care is needed, decide if your loved one needs short-stay rehabilitation or long-term care.

Do Your Homework

Before you visit any homes, do some research. This will help you know what to look for when you go in person.

Think about these points when you compare homes:

  • Quality of care
  • Quality of daily life for residents
  • Whether there is a bed open
  • Whether the home offers the services your loved one needs
  • Cost and how care will be paid for
  • Location and how easy it is for family and friends to visit

Ask for opinions from:

  • Current nursing home residents
  • Residents’ family members
  • Citizen advocacy groups
  • Your loved one’s doctor
  • Hospital discharge planners
  • Clergy or faith leaders

Use CoreQ Resident and Family Satisfaction Scores

Use more than one source of information when you choose a home. One helpful tool in Connecticut is the CoreQ Survey.

The CoreQ Survey:

  • Gives ratings from residents and family members
  • Covers all Medicaid-certified nursing homes in Connecticut
  • Shows how people feel about care, staff, and the building

You can use CoreQ scores to:

  • Compare nursing homes
  • Set your expectations
  • Decide what questions to ask
  • Raise concerns or suggest improvements

For more details and results, visit the CoreQ Resident and Family Satisfaction Survey page.

Experts to Consult

The Prospective Resident

The most important expert is the person who will live in the nursing home. Ask your loved one:

  • Do you want to live near a certain family member or friend?
  • Do you want to stay in your hometown?
  • Do you prefer a large or small facility?

Long-Term Care Ombudsman and Citizen Advocates

A Long-Term Care Ombudsman Program or a citizen advocacy group can help you put together all the information you find. They can help you compare homes and understand your options.

An ombudsman:

  • Is funded by the state or county
  • Works for people in nursing homes, board and care homes, and assisted living
  • Knows many local homes, staff, and residents

Ombudsmen:

  • Teach residents, families, and providers about residents’ rights and good care
  • Look into complaints and speak up for residents’ rights and quality care
  • Share information with the public about nursing homes and long-term care issues

The ombudsman can help you find state inspection reports and understand “quality measures” shown for each nursing home on the Medicare Care Compare website: Medicare Care Compare nursing home search.

Cost Information

Most nursing homes take Medicare, Medicaid, or both. These programs help pay for some or all of the cost of care.

  • Medicare usually pays for short-term rehab after a hospital stay and for hospice care.
  • Medicaid pays for longer-term nursing home care for people who qualify by income and assets.

Many people start by paying with their own money. Because care is very expensive, most people cannot pay on their own forever. Many residents later apply for Medicaid to pay for their care.

If you are not sure the resident can pay privately for a long time, choose a home that accepts Medicaid. Ask about your state’s Medicaid rules.

Spouses can often keep some assets and income even when their partner is on Medicaid. To learn more about rights for residents on Medicaid, contact the Long-Term Care Ombudsman Program or a local consumer advocacy group.

Nursing Home Care Compare Website

The federal government provides nursing home data on the Care Compare website: Medicare Care Compare.

On this site you can:

  • Search for homes by state, county, city, or ZIP code
  • Select one or more nursing homes
  • View information about each home

You can see:

  • Basic facts about the home
  • Inspection results
  • Staffing levels
  • Quality measures

Facility Overview

The “About Homes” section on Care Compare gives a quick overview. You can see:

  • Ownership type (for-profit, non-profit, church-related, etc.)
  • Types of payment accepted (Medicare, Medicaid, or both)
  • Size of the facility (number of beds)
  • If the home is part of a larger chain

Complaint Information

You should also look at complaint history. You can see how many complaints were made, what kinds they were, and which ones were “substantiated” or proven.

Care Compare shows complaint results along with inspection results. You can also ask for complaint information from the state survey and inspection agency or the Long-Term Care Ombudsman Program.

Staffing Information

Care Compare shows how many hours of nursing care residents get in each home. Staffing is a very important part of quality.

The site shows:

  • National average staffing levels
  • State average staffing levels
  • Each home’s daily average staffing per resident

Tips:

  • Look closely at Certified Nursing Assistant (CNA) hours. CNAs give most hands-on care.
  • Look for homes with higher Registered Nurse (RN) staffing. RN involvement helps quality.
  • When you visit, ask staff and families how many staff are really on each shift.

Cautions:

  • Reported staffing hours include some administrative time, not just direct care.
  • Staffing numbers are reported by the home and are not checked for accuracy.

State Nursing Home Inspection Reports

Care Compare lists inspection, or “survey,” reports for each home. These reports show any problems found during inspections, which happen at least every 9 to 15 months.

You can also get inspection reports from:

  • The state survey agency
  • The facility itself
  • The Long-Term Care Ombudsman Program

By law, each facility must keep the latest inspection report in a place that is easy to see. On Care Compare, you can click the “Inspections” tab to see a summary.

Quality Measures

Care Compare shows “Quality Measures” for every nursing home. To see them, search for a home and click on the “Quality” tab.

Quality measures are:

  • Based on regular assessments of each resident
  • Combined to show scores for the whole facility
  • Given for long-stay and short-stay residents

These measures:

  • Help you compare homes
  • Are not a full rating system
  • Are only one part of your decision

Use these numbers along with your visits, talks with residents and families, talks with staff and the ombudsman, and inspection and staffing information.

Measures for Long-Stay Residents

Long-stay residents live in the nursing home for a long time. Quality measures for them include flu and pneumonia shots, changes in daily living needs, time spent in bed or in a chair, use of restraints, incontinence, urinary tract infections, pressure sores, mood, pain, and weight loss.

Measures for Short-Stay Residents

Short-stay residents need care or rehab for a short time and plan to go home. Measures include flu and pneumonia shots, delirium, pain, and pressure sores.

Tips for using quality measures:

  • Compare each home’s scores to state and local averages.
  • Remember: these measures track problems. Lower scores are better.
  • If you have questions, call 1-800-MEDICARE or your state Quality Improvement Organization (QIO).
  • Do not make your choice based on numbers alone. You still need to visit and ask questions.

Cautions:

  • The numbers come from the facilities and are not checked for full accuracy.
  • A home may do well in one area but not in another.

Visits to Nursing Homes

Always visit a home before you decide. Visits help you see how staff and residents interact. Talk with residents and families about life in the home. Ask about both care and costs.

Try to visit more than once, at different times, including evenings and weekends. Bring your loved one, if possible.

What to Look For

Use your senses to guide you:

  • Are call lights answered quickly and kindly?
  • Do staff respond when residents call out?
  • Do the meals look good? Are people eating?
  • Do staff help residents eat in a patient way?
  • Are any residents in restraints? Why?
  • Do rooms feel personal and homelike?
  • Are rooms, halls, and dining areas clean?
  • Is it too noisy?
  • Do staff speak to residents with respect and warmth?
  • Does the administrator know the residents and talk with them?
  • Do staff and leaders seem to work well together?
  • Do residents look clean, well-groomed, and well-fed?
  • Do many residents look alert, happy, or calm?
  • Are residents seated comfortably?
  • Does the home smell clean?
  • Are residents doing activities they seem to enjoy?

Questions to Ask Staff

  • Is there enough staff on each shift to give good care?
  • Do staff like working here? Do leaders listen to their ideas?
  • What activities do you offer?
  • Are staff assigned to the same residents most of the time?
  • Do you use temporary agency staff? How often?
  • How are nursing assistants included in care planning?
  • Are you using “culture change” or “Pioneer Network” practices? (Pioneer Network website)
  • How much training do staff get?
  • How often do residents get help with toileting?
  • If residents wear briefs, how often are they changed? Why are briefs used?
  • How do you avoid using physical or chemical restraints?
  • How do you include families and residents in care plan meetings?
  • What do you do to keep staff from leaving?
  • How long has the current administrator been here?
  • Has the home had recent ownership or management changes?
  • Do you provide rides to community events?
  • What therapy services are available?
  • Can you give an example of truly personalized care?
  • Is there a resident council or family council? Can I contact them?
  • How do you handle complaints or problems?
  • Are residents involved in picking roommates and meal seating?
  • When might a resident be moved or discharged?
  • Do you employ a social worker with a college degree in social work?

Questions to Ask Residents and Families

  • Are residents treated with respect and kindness?
  • Do residents get help with meals?
  • Can residents choose their schedule for sleep, baths, and meals?
  • If residents are awake at night, do they get attention and things to do?
  • Does the resident usually have the same nursing assistant?
  • Is there a family or resident council? Who leads it?
  • Do staff respond to requests, including help with toileting?
  • Are snacks, like fresh fruit, easy to get?
  • Do residents take part in care planning? Are their views valued?
  • Have there been problems with missing items?
  • Who handles concerns, and do they follow up?
  • Can residents go outside as often as they want?
  • What do they like best and least about this home?

The Importance of Fire Safety

Nursing homes must have strong plans to prevent and handle fires. This is very important because many residents are weak or cannot walk alone.

Federal rules require sprinklers in new or majorly rebuilt homes. Older homes may not have full sprinkler systems.

Ask about fire safety:

  • Is the building in good repair?
  • Are halls and doors clear of clutter and paper?
  • Are sprinklers, smoke alarms, and emergency lights in all areas?
  • Are these systems tested often?
  • Is there a written fire plan? Do staff practice drills?
  • Does the system alert the fire department right away?
  • What is the smoking policy?
  • How many staff are on duty for each shift, especially at night?
  • How will families be told if there is a fire?

The Emergency Evacuation Plan

By law, each nursing home must have an emergency plan. This plan covers natural disasters and other emergencies.

Ask staff about these areas:

The Plan

  • What is your evacuation plan?
  • What is your “shelter in place” plan for storms or other events?

Staffing

  • Are there enough staff on all shifts to carry out the plan?
  • How are staff trained for emergencies?
  • Do you hold drills on all shifts?

Coordination

  • Do you have plans with other facilities for housing residents if you must move them?
  • Do you have contracts with transportation companies?
  • Can those companies move everyone if more than one home needs help?
  • Do you work with city, county, and state emergency teams?

Supplies

  • What emergency supplies do you have (food, water, oxygen, generators, flashlights, etc.)?
  • Can you move these supplies if you must evacuate?
  • Can residents keep some emergency items in their rooms?

Resident Information

  • How do you tell residents about the plan?
  • How will you identify residents during an evacuation?
  • How will you move medicines and medical information?
  • Will these go with each resident or separately?

Role of the Family

  • How and when will you notify family members?
  • How can families help during an emergency?
  • Can families meet residents at a safe place?
  • Can they come to help at the facility?

Families may choose to move their loved one on their own to a special needs shelter.

Information That Must Be Posted

Every nursing home must clearly post certain information. When you visit, look for it in a public area like the lobby. If you cannot find it, ask staff where it is.

Homes must post:

  • Daily staffing for each shift, including Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and nurse aides
  • Contact information for state advocacy offices, including:
    • The State Long-Term Care Ombudsman Program
    • The state survey agency
    • The protection and advocacy network
    • The Medicaid Fraud Control Unit
  • Results of the most recent state or federal survey, easy to see without asking staff

Family Involvement: Getting Good Nursing Home Care

Family involvement is key after your loved one moves into a nursing home. Your care, support, and presence help protect their quality of life.

You can:

  • Visit often and invite others to visit.
  • Speak up about concerns and complaints.
  • Attend care plan meetings and ask for personal, detailed plans.
  • Make sure the doctor knows what is in the care plan.
  • Ask for another meeting if the plan is not followed.
  • Help staff know your loved one by sharing written notes about likes, dislikes, and daily routines.
  • Join the family council, or help start one if it does not exist.
  • Stay in touch with the ombudsman and local advocacy groups.
  • Learn basic state and federal rules for nursing homes.
  • Write down any problems, including date, time, people, and what happened, so leaders or state agencies can investigate.
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