Quality long term care—regardless of the category—should be an automatic public expectation. There should only be two kinds of providers: The EXCELLENT and the NON-EXISTENT. Not the perfect—the care you give in your home to a loved one isn’t perfect.

In recent days, the major national press has once again drawn attention to quality problems in assisted living. A generation ago, similar articles and television shows had also shined an unflattering light on nursing homes. So, in 2002, the Department of Health and Human Services, the three major nursing home associations and consumer groups joined together to develop a national nursing home quality improvement program called “QUALITY FIRST.”

It is successful as measured by independent agencies. In more than a decade, improvements have been made in measures like reduced number of bedsores, better pain management, reductions in the use of psychotropic drugs, reductions in the use of restraints, and improved staffing in numbers and incompetence. These efforts eventually resulted in a government measure “5 Star Rating System” which is transparent to the public on federal and state web sites, along with inspection reports and complaints.

A similar provider national quality initiative is needed for assisted living and personal care. It needs to be provider and consumer-driven, an accreditation, peer review type approach because there is not enough money to have a national government-run inspection program to cover the thousands of providers.

Until such a system is in place, allow me to reference my recent book, “Hallowed Ground: Stories of Successful Aging”, which has two chapters on types of services available to consumers and tips on how to discern who is providing excellent care. There is a brief list of things to look for in selecting a good place for seniors to live.

What is Their Reputation in the Community?

Locals know the good ones. In addition, ask physicians which facility they would recommend. Doctors don’t like to hear the complaints of families when a bad facility is selected.

Trust Your Senses

Does it smell like fried chicken or urine and Pine-Sol?

Does it Look Like an Ant Farm?

Any good senior community should be buzzing with activity. Caregivers in good facilities do not let residents vegetate in their beds or chairs, but rather they actively involve them in dining, crafts, singing, and community activities, if health allows.

Do the Staff Members Have a Good Attitude?

Are folks interacting with the residents? Do they seem to take an authentic interest in them? Dr. Robin Stone, an international research expert on quality care has asserted for years: “Staffing is the best proxy for quality.”

Would you Want to Eat in that Dining Room with that Food Three Times a Day?

If it doesn’t appeal to you, it probably won’t appeal to them, especially since taste buds become duller as we age.

Do They Have a Good Emergency Response Plan?

Do they have a well thought out plan to respond to an emergency, one on which the staff has been well-briefed and the families and residents can understand and be ready to respond to? We have all read national headlines about the nursing home residents who died after Hurricane Katrina. I personally know many nursing homes in New Orleans who safely evacuated their residents—some to as far away as Pennsylvania—far in advance of the storm. The time to come up with an emergency plan is far in advance of an emergency.

Do They Have Good Health Care Oversight?

How many doctors, if any, are scheduled for regular visits? Is there an association with a practice group or a local hospital? Is a nurse practitioner available, perhaps one who holds a regular clinic? What happens if someone gets sick in the middle of the night? Who responds at three a.m. when the sick person pulls that alarm code in the bathroom?

Who Owns or Governs the Facility?

Is it a local non-profit governing body whose board members are well known in the community? If it is for profit, is it locally owned by a reputable family or is it part of a national chain with few ties to the community? If it is investor owned? Who is on the board and how do stockholders ensure quality care? If it is investor-owned, how healthy is the facility economically, and if struggling, how likely is it to be sold? One great advantage of a non-profit is that the organization tends to be more committed to the community, and some are over a hundred years old.

Are There Public Inspection Reports?

Have they been cited for health violations or poor care? Have there been successful lawsuits against them?  These facts are often available through public channels and news reports.

Who is Leading the Organization, both in Administration and Nursing Care?

Are they readily available if you have a concern? Are there regular care conferences so family members can understand what is happening to their loved one? Do the leaders seem to care about the residents? (One way to know how connected they are is to notice if they know the names of the residents and staff.) How well do they compensate those who work for them, an important consideration in retention? How much turnover have they had in staff?  What about weekend care? What are staff levels on Saturday night, and is nursing care provided by regular staff or temps?

It seems daunting to try to gather this information, especially if you are in the grip of a family crisis. You can never judge perfectly, and things can happen in the best facilities, but your chances of making a good choice increase with information.

Too many consumers wait until the absolute last minute after there has been a serious fall, or fire, or crash, to make these decisions. Needing to get a loved one into a facility immediately, or transfer them out of a hospital bed with the hospital pressuring you to leave, makes a tough situation even tougher. Visit places you might be interested in when there is no crisis, and have a meal with them, if possible. Find out about waiting lists, how to get help with moving, and all the practical considerations involved.

These can be hard things to talk about, but it is important to speak with your family about what they want and get input from folks about their opinions. Above all, if the senior is able to communicate, talk with them about what is on their “wish list” for a facility. That will give you an opportunity to evaluate how realistic they are, and talk about what the amount of resources available can provide. So many assisted living places are more sizzle than steak, or, as folks say in Texas, “all hat and no cattle.” More important than silk drapes and crown molding is the care you or your loved one will receive.

Check out Hallowed Ground on Amazon! It could be helpful to you and your family or friends. And check out my website:.www,larryminnix.com