What questions should you ask a nursing home?

I visited a nursing home and will visit another after the holidays and I have a question. Are all nursing homes having two people to a room unless it's private pay? The reason I ask this is because the nursing home I visited was bragging about how they had 30 single rooms. I was excited about this aspect especially seeing how the rooms were set up and were decked out with their personal furniture and looked sort of homey in a not quiet home way. She was bragging about how people there felt that this was home and that they would die peacefully there even sometimes surrounded by their loved ones since it was their home. She talked about how so many residents have their relatives come to have Christmas there with their loved ones instead of checking them out to go home (as we asked if we could do). Then she avoided a section of the hallway and I asked why. I don't like it when areas are avoided and not shown because it makes me think there is something to hide. After my insistence she admitted that it was a few rooms that had up to three residents at a time. I asked if it was a sort of holding room for people who needed care and were unable to get into the real personal rooms. She told me it was the other way around. The personal rooms were private pay individuals or individuals who needed care and were on Title 19 and were not lucky enough to get right into the multiple resident rooms. I asked what that meant and she said all people who are on state pay get a room with multiple people. If you are placed in a personal room while on state, you will be moved at first opportunity to a multiple room. Those rooms were filled with the normal things such as a hospital bed (all rooms were required to have that), a nursing home chair (not always required as some were able to bring their own personal lift chairs with them) and a single dresser. There were no pictures on the wall and the room was completely cramped. There were three chairs to the room which were one per bed. There wasn't much room to even move around. The closet was shared between all members of the room but we were informed, if you labeled any belongings it should be fine. This bothered me as I assumed we are moving our loved ones into a nursing home so that they could have a room away from home and instead we are moving them into a room similar to a dorm room (which is meant to be temporary and usually not used except for sleeping) and instead they are living in it. Is that how all nursing homes are? Do people adapt well to this kind of environment?

The other question I have is about bed alarms or something to prevent falls. We right now follow her around assisting her as she walks. She has fallen 4 times this past year and now we have her on around the clock care at our house even walking her to the bathroom but still she forgets sometimes and tries to get up on her own. We use a bed alarm and a tithered alarm but the nursing home said they do not use this as it's disturbing to other patients in the home. Is this normal? Right now my mom and I are taking turns on the night shift and not leaving her alone in rooms unless the baby video monitor is on her, making sure she doesn't get up by herself and fall because when she wakes up she has to go to the bathroom and is so groggy she will almost fall without us there to assist her in reaching the toilet and bed. She has diabetes so her head is always dizzy feeling. So if there are no bed alarms to alert them when people are getting up out of bed or out of their chair, how do they ensure the people don't fall? She answered saying they do hourly rounds but if grandma got up right after they left (which she probably would since she tries to avoid asking for help when she is able), she would fall and be there for an hour before found? Is this normal?

For that reason we are very nervous about ever putting her in a nursing home since we would be putting her there after an injury which required more care than we would be able to do alone.

Should we keep looking and trying nursing homes or is this how they all are? We are so new to this process I feel so overwhelmed by what we saw. I still don't even know if I asked the right questions. The nursing home was supposed to be a really good one for the area in CT where we live. The place looked clean and the walls were bright. There were Christmas decorations and the people looked clean. This is where grandma had gone to rehab and it seemed like an ok place temporarily but long term, it didn't. What are you guys' suggestions as to what is normal and what is not? Are we expecting too much from a nursing home?

From the 4 nursing homes I toured they all had bed alarms and some for wheelchairs depending on the resident's needs. Nursing homes usually are converting lately to one per room it seems, but I have never heard of more than 2 residents to a room as this seems a bit packed in. I would definitely do a little more checking around to see what other nursing homes are doing. I would think that alarms would be required for safety reasons.

great comments. Thanks to all of you.
Along with questions prior to admission to a facility, a most important thing is to visit your loved one often, at different times of the day. I am fortunate to have two brothers and a sister and someone is there everyday. We go to activities with mom at times and watch how the staff treats the people who are in the activity class. So far, everyone I observed has treated the patients with respect and kindness ( and I don't think it is because I am there). I watch when call lights go on and how long the resident waits for it to be answered. Also how quickly things are taken care of--my mom needed a consult with a GI doc. I wanted her to go to a certain group;the unit secretary got her an appt. within 5 days (it was not an emergency visit, just a routine consult). The social worker calls you back within 24 hours and agreed to stay late one night to meet with my siblings since that was the only time we could all get together. It hasn't been easy for mom but she is learning to trust her caregivers and adjust as best she can. I don't know how I would react in her situation. It is hard to make changes when you are 95.

To littlemisskitty:
The facility where my mom is does not like to use bed alarms either. They do rounds at night every 1/2 hour. However, your point is well taken; if your parent/loved one wakes up right after the "round" they could get up on their own. Or if they are like my mother, who is feisty and stubborn, she does not want to ring the call light. she will get up on her own. I spoke with the head nurse/manager for the unit and insisted on an alarm anyway. Mom got it right away and I noticed that several other people had them also ( on their wheechairs and I assume on their beds). I understand the philosophy but I don't want my mom to fall and break a hip, etc which could have severe consequences. I have been there when she did get out of bed (with me assisting her). The alarm went off and everytime someone was in her room within a minute or two. I deliberaately did not turn the alarm off, because I wanted to see how long it took them to get there. Mom told me that they do come right away when she is alone and the alarm goes off which aggravates her because she wants to do things on her own. Unfortunately, she is not steady enough on her feet to walk (with walker) unassisted. So I think they are not just responding quickly when they know I am there.

Re the multi-occupancy rooms: yes, the Medicaid residents do have multiple occupants per room. And yes, the salesperson will purposely not show those rooms (if you are shopping as a private pay customer they will show you the private pay rooms.......). And yes, you can enter as private pay and 3 years later after spending your entire life savings on your private, homey room, the facility will as quickly as possible move you to multi-occupant room, to make way for another private-pay customer to occupy your former room. All nursing homes, assisted living, they all do this. They have to make lots of money from thr private pay clients to keep themselves solvent. If every one was on welfare, they would go out of business.

I can only speak from my experience with my mom's nursing home, St. John Paul in Danbury, CT. They have both private and double rooms. My mother is private pay and is in a double, since it's about $1000 less per month.

Having a roommate has been a good thing;once, mom fell transferring from her lift chair and the room ate buzzed for help.

Mom's bed is alarmed. There is room for personal furniture. There are no triples or unusually cramped rooms that I have seen in any of these facilities. There is a large community room that they allow us to use for family celebrations several times a year. We don't take mom out, except for a rare followup doctor appointment following a hospitalization. She goes by ambulette.

Babalou, yes some roomies are great and even helpful. In our family we had a grandparent who could only afford 2-bed room, and the roomie was noisy and even destructive. Eventually they moved him out but th next roomie was not any better. Grandparent lost so much sleep from bad roomies, we feel it contributed to pneumonia and death but of course that is impossible to prove, but OTOH if they were in private room there would be better sleep and fewer germs from both roomie and roomies visitors. When they did get penumonia, instead of moving to a private room to die, they moved him to an even smaller (!) room which had a half-curtain separating him from the other death bed. I distinctly remember 4-5 family trying to pray around his bed and feeling like we were bothering the family crammed in aaround the other death bed. It was not a good "death experience" and do you know what, the NH charged us MORE money for that crappy little death room. So sad. Nowadays I would hate to have either of my parents stuck with who knows what faith tradition 3-feet and a half-curtain away.....while were reciting the 23rd Psalm they might be reading the Koran or witchcraft. In our current complex and diverse culture, and especially upon one's death bed I would expect a little more sensitivity to the situation, but it didn't happen for Grandpa and it won't be getting any better (for most of us).

Medicaid pays a certain set amount. It does not specify that the room has to be shared, but most nursing homes charge so much more than Medicaid pays for a private room that they can't afford to absorb the difference between Medicaid's payment and what the room could rent for to private payers. Sad? Yes. And I think that is going to change as the Boomers become the residents, but for now that is how things are. In the small town where two of my aunts were in the nursing home, all of the rooms were singles. They were tiny, but the home was built with government payments in mind.

I will say that the level of care does not seem to depend on private/Medicaid payment. Most aides and nurses and staff want to do a good job for everyone. (Or bad staff are equally bad with everyone.)

Nursing homes seem to have a wide variety of ways to prevent falls, None of them include 24-hour monitoring, as you do at home.

I'd suggest you look a little further, just to satisfy yourself about what is available. You may never need to use a NH at all, but it is wise to be informed in case the need arises.

I'm so glad to have checked here. I have to start planning ahead to move my dad out of AL into NH. Great, great questions and resources. Thank you!

Colleen1
one thing this whole experience has taught me: plan ahead. Mom is 95 and lived on her own (successfully) until October 2014. Then her health declined rapidly and was in hospital 2 times in 30 days and went to subacute rehab and now in skilled nursing. I think I was a victim of "magical thinking" that nothing like that would every happen to her. it was easier to ignore the possibility ( my fault) even though I had seen many friends go thru the same thing with their parents. The last three month have been hectic with meetings with an elder attorney, social workers, healthcare professionals, even a funeral director. It would have been so much easier to preplan for some of these issues. I am lucky to have two brothers and a sister who have been very supportive and helpful but I believe it would have been easier for all of us, esp. Mom, if we had discussed some of these issues in detail prior to this point when she was not in such a frail state and there was so much to consider.

Ah, Betty; yes, you're in good company here in the "magical thinking" department! As my brother and I raced from nursing home to nursing home last year, we said " what were we thinking? She was going to live forever?"

Babalou
Yes to that. I had 48 hours and a list of 50 facilities to consider so my mom could be discharged from the hospital.I was very fortunate to have a good friend(social worker) who went over the list with me and said yes or no to the various places. In a previous job she had been working with medicare patients and helping families with placements. She was a great source for me and has kept in close touch and given me a lot of "hints" on how to get things done.
Still I only saw 6 of them in two days. and could only give the hospital 2 names. I was working on looking at more when the place who was our number 1 called and said they would take her in sub acute. She has since transitioned to skilled/long term care and we couldn't be happier with the facility. She is adjusting slowly, has started to trust the staff and go to a few activities. I give her a lot of credit to be doing this when she is 95. I hate change myself and I am a lot younger than she is and don't know how I would cope with it.