How to Select the Best Nursing Home for Your Loved One.

Written by Bonnie Navin,  Attorney, Medical Malpractice/Nursing Home/Dental Negligence

Florida law mandates persons who are residents in an Assisted Living Facility (ALF) or Skilled Nursing Facility are to be afforded good health, safety, and comfort. (Chapter 400 of the Florida Statutes). Residents deserve basic rights.

It is important to note the use of the word “resident” because this group of people live in group facilities because they are unable to live alone or need social interaction with their peers.  Residents have the right to be treated courteously, fairly and with the fullest measure of dignity. They must be kept free of mental and physical abuse.

Imagine you find yourself needing to place a loved one in an ALF or nursing home but you have no idea which ones are better than others. Thankfully there are resources available for you in Florida (and most States) to assist you in your placement.

In Florida, you can easily access the Florida Nursing Home Guide for answers.  Here you can learn about ratings and inspections of various facilities. You must keep in mind that it's rare for a facility to be accident-free but your concern should be how those accidents are reported and what prevention is in place to avoid more. The Florida Agency for Healthcare is the watch-dog for such facilities and they have an excellent website full of statistics and data pertaining to each facility. On the national level, the National Center for Assisted Living is a great resource. 

Once you have conducted your online research, arrange for a visit to each facility.

• Be sure to visit during what is known as the busy hours (breakfast, lunch or dinner). This affords you the opportunity to see how the staff interacts with the residents and what type of sustenance is provided.
• Make a point of visiting on a weekend as well to see how the facility is staffed. This is an excellent chance to meet other family members and ask them what they think of the facility.

If you decide a particular facility may be appropriate for your loved one then you should try and meet other families that visit often and swap contact numbers. This will give you additional eyes on your loved one should there be concerns.

Try to select a facility that is very close to the family so visits can be more frequent. A facility with a lesser rating may be better because the family is nearby closer and able to visit more. Regular visits are necessary for a variety of reasons.

• Visits help the family member not feel isolated and they also remind staff that the resident has family advocates.
• It's proven time and time again, that residents with more family visits get better care.

When visiting your loved one what should you look for to ensure they are not being neglected or abused.

• First, make sure you sign in and out at the front desk EVERYTIME you go to visit. This is vital as proof you were present on particular days. Your recall of events will inevitably be inconsistent with the staff notes.
• Keep a small journal of your visit.
  • How was your loved one’s mental state?
  • Where they talkative or quiet?
  • Is this usual or unusual?
• Always take off your loved one’s shoes and socks and inspect their feet. It's surprising how many problems are hidden by socks and shoes, including:
  • Ulcers 
  • Wounds
  • Overgrown toenails

These type problems cause incredible pain when walking. Pain while walking increases the chances of falls. Falls of the elderly or weak usually result in fractures and such events are often so stressful to the resident that they have difficulty healing. This spiral often triggers more health problems for the resident.

• Always check your loved one's buttocks, usually above the fold of their bottom and inspect for red areas or skin breakdown.
• Look for areas that have direct contact with the bed such as elbows, shoulders, heels, and back.

This can be the start of horrible ulcers that once started require constant attention. Should you find such evidence of skin breakdown there is likely evidence of the resident not being turned or allowed to get up and move around. This happens often with bedridden residents and those relegated to diapers and wheelchairs.

• Ensure the diapers are being changed.
  • If you are concerned take a black marker and date and time the diaper and check the diaper when you return.
• Insist on your loved one maintaining their independence by getting therapy and ensuring the facility has many mental and physical activities for them to attend.
• Try and attend some activities to see and meet the activities personnel.

It's important to meet face to face with the facility administrator, the Director of Nursing and the Charge Nurses on the day and night shift.

• Introduce yourself and discuss the goals of your loved one, so they are clearly stated.   
• If you cannot get such face to face time then you should not place your loved one at that facility.

Also, you should:

• Learn the names of each and every staff member assigned to your loved one
• Be sure to say Hi and acknowledge them by name when you call or visit
• You should call and/or visit the facility often and at random times 
• And of course, Thank the staff & healthcare team for taking of your family member

This type of interaction will ensure the best care. Working in these facilities can be overwhelming because most are understaffed and many residents require a lot of attention.

If you visit with your loved one and start to see changes in the health or well-being of your family member - ask questions immediately.

• Always provide a question or concern in a WRITTEN format and keep track of who received the document.
  • If you can’t make a copy then use your cell phone and take a screenshot of your written concerns.
• Be sure you get a proper response and specifics of what will be done to address your concern.
  • Memorialize the assurance back in writing so there is a paper trail.
  • Be vigilant.

If your concerns go unattended to then you contact the DCF in the following ways:

• By Phone: Call Florida Abuse Hotline at 1-800-96-ABUSE (1-800-962-2873)
  • Press 1 to report suspected abuse, neglect or exploitation of the elderly or a vulnerable adult. This toll-free number is available 24/7.
• TDD (Telephone Device for the Deaf): 1-800-453-5145
• By Fax: To make a report via fax, please send a detailed written report and this form with your name and contact telephone to 1-800-914-0004.
• To report online: Go to DCF Website ​

If you see any of the following it is important to report the problem as soon as possible:

• Presence of Bedsores
• Withdrawal from Social Contact
• Obvious Changes in Behavior
• Unexplained Changes to the Will
• Unexplained Changes to Power of Attorney
• Unpaid Bills and other Financial Problems
• Bruises or cuts or scratches
• Bleeding Wounds
• Lack of Hygiene
• Unexplained Infections or Diseases
• Multiple falls leading to injury

If you feel you have done everything to address the problems and you believe your family member is the subject of abuse and/or neglect then you should seek experienced legal advice from Rubenstein Law. Call our Nursing Home Attorney Team today at 800-FL-LEGAL.  In Florida, you only have two (2) years to make a claim from the incident being discovered or should have been discovered with the exercise of due diligence.