Picking a nursing home

Wether for yourself or someone else choosing a nursing home is one of the toughest things a person does. Sometimes you get it right and sometimes not. It is easiest to do it right the first time. It is no big secret that one of more beloved career turns has been inspecting nursing homes. It is probably the most rewarding job I have ever had in terms of actually doing something worth while. So I have a few insights on choosing a nursing home.
Naturally the best thing to do is return home. If family or friends cannot help out with care issues home health may be available for a short period or employ outside help. I recommend investigating long term care insurance, trust set up for care issues, and being knowledgeable about alternatives before the time comes. Money issues will arise when it comes to Medicaid so plan ahead as they sometimes "look back " up to 6 years.
Nursing homes can have dual purpose with dual payor source. Medicare pays for 6 weeks nursing home care following 3 nights stay in hospital for what ever reason. Usually this is because the patient needs therapy in order to go back home. The other more typical is long term care for some one who cannot return home and care for themselves.
So the first thing is to do research on the homes and find which homes your doctor goes to, if any. You will also need to find out if they take Medicare, Medicaid and or Medicaid pending. Some facilities will not take Medicaid pending because there is no guarantee Medicaid will be approved leaving them stuck with a bill in the thousands.
Ask friends and family what they have heard about a building and the staff. Talk to your neighbors and listen to what they say about a facility.
Make an unplanned visit. Best if you go to see a friend or someone who is actually a patient there but if that doesn't happen pop in. More than likely they will ask you to make an appointment with a social worker or customer service representative, if they do this you might wonder what they are hiding.
While are waiting for your tour to start find the survey book. Any time the state comes and inspects the facility they write a report called 2567. These are the deficiencies found during the states visit.
The first column has the F tag it will appear as F 222 or F 323 followed by SS=A or SS=F. The F tag is the rule that the government has deemed necessary for all nursing homes to comply with you can find those online just search for appendix P and PP. The SS is scope and severity or how many people can or are affected by poor practice.The following is a copy of the grid.

Tags with SS of A, B, C are usually minor, D, E, are more serious  higher than F you might want to start asking a lot of questions. If they have G to I consider going someplace else and J, K, L you need to leave and go someplace else. The yellow plots on the grid are tags in care areas. Care areas are the greatest concern. This means that the care staff are providing is substandard and possible harmful.
The first part of each tag will tell you what the requirement is. These range from providing private place to make phone calls to administering medications correctly. I consider "paper tags" those dealing with Frequency of assessments and doing care plans as drivel. Actual care tags are what you need to look at.
Go during a meal, lunch and supper are best. Go to the dining room and see what is happening. You need to see what the food looks like and smells like. Are the residents eating it or pushing the food away. Ask someone how the food is. Are office staff passing trays? Is the food left on trays or placed on the table like at home. Dining should be as home like as possible. Are staff offering alternatives? Is the food hot, cold food cold? Watch to see if staff are handling residents food with their hands. Are residents being fed? If so is the person doing the feeding sitting or standing over them, or feeding more than one person. Stop and think about how you would want to be fed and what you want to eat.
Will visit this more in Part 2. I do answer questions if there are any.