05/03/2021
CHOOSING A SENIOR CARE FACILITY
Definitely Not a “One Size Fits All” Proposition
By: Hugh Cassidy
Choosing a senior care facility for a loved one is difficult at best, and in the Covid era, the choice is more important than ever. It can be a heart wrenching decision, perhaps the most difficult you’ve ever made, and there are usually multiple facilities to choose from. Which one is right for your loved one? Great question. And unless you’ve done it before, you probably have no idea how to make the right choice. And even if you have, there may have been better options available to you.
Making the right choice is imperative to the health and wellbeing of your loved one, and the wrong choice can cost you emotionally and financially. The monetary cost of a preventable hospitalization alone can put tremendous strain on your family finances. And the emotional strain of knowing your loved one suffered because of your decision, is more than many can bear. So it’s easy to see that this is a decision you need to get right the first time.
One thing is for certain, proximity to your own home is NOT the most important factor. There are many, more important factors that should be part of your decision. Primarily, what level of care does your loved one require? Options include Independent Living, Assisted Living, Inpatient Rehabilitation, Skilled Nursing, Long-Term Acute Care, Memory Care and Hospice Care.
What are the specific needs of your loved one? Do they require wound care? Diabetic care? Physical, Occupational or Speech Therapy? Are they a fall risk? A wandering risk? Do they require a special diet? There are many reasons why a senior may require long-term care and every facility has its strengths and its weaknesses. So, if Mom has diabetes and is prone to pressure ulcers, you don’t want to choose the facility that has a top notch Physical Therapy program, but may not be the best at wound care, just because it is the closest to your home. Likewise, if Dad has memory care needs and tends to become agitated in the evenings (sundowning), you don’t want to choose the facility that has the best wound care program but is not equipped with Wander Guard® or similar equipment to keep him from leaving the building unaccompanied.
Different facilities are good at different things, and sadly, some aren’t very good at much of anything. Knowing the strengths and weaknesses of facilities is a key factor in choosing the facility that is right for your loved one and making that determination requires not only professional knowledge of the industry, but also familiarity with a given market. Who are the owners? What is their philosophy? How many facilities are they operating? What is their reputation? Are their facilities properly staffed? Are they for profit or non-profit? And if they are non-profit, are they truly returning their surpluses to the facility in ways that benefit the residents? These are key questions, and you need the answers to make an informed decision.
The Centers for Medicare & Medicaid Services (CMS), in conjunction with the Louisiana Department of Health & Hospitals (DHH) conduct routine inspections of every inpatient facility in the state, known as an Annual Survey. They will also conduct a Complaint Survey whenever a complaint is filed against a facility. Upon completion of a Survey, regulators will issue a report of their findings and an understanding of how to interpret this report is essential to your decision.
Any deficiency (also known as a “Tag”) found by the regulators will be reported on a CMS Form 2567 – Statement of Deficiencies, and in most cases, management will be required to prepare and submit a written Plan of Correction on the same form. Deficiencies are categorized by scope and severity. There are four levels of severity and three categories of scope.
Level 1 indicates a deficiency where no actual harm occurred, but where there was potential for minimal harm. This may include a facility where the Business Office fails to keep sufficient hours to allow residents reasonable access to their funds. They are minor infractions which are usually resolved before the Survey has even been completed and so a written Plan of Correction is not always required for Level 1 Tags.
Level 2 deficiencies are probably the most common and they are deficiencies in which no actual harm occurred but there was potential for more than minimal harm, but not immediate jeopardy. This may include instances of deviation from a patient’s written Plan of Care. For example, if medical records indicate a patient’s physician has ordered nutritional supplements 3 times per day due to weight loss, and the chart indicates the patient is only receiving the supplements once or twice daily, this would be a Level 2 Tag.
Level 3 Tags indicate deficiencies in which actual harm was done, but not immediate jeopardy. An example of a Level 3 tag would be if a resident was allowed to fall during a shower because of insufficient nonskid strips or grab bars, and the resident suffered minor cuts and bruises, but nothing life threatening. Another example of a Level 3 Tag would be if a nurse was found to have skipped a resident’s routine medications. These are very serious deficiencies, and you want to see a viable and sustainable Plan of Correction to any Level 3 Tags.
Level 4 deficiencies indicate problems that cause immediate jeopardy to residents’ health and safety. Level 4 tags are known as “I.J. (Immediate Jeopardy) Tags”. Obviously, these are the worst of the worst and they require detailed Plans of Correction which must be approved by CMS and DHH. They should also be thoroughly reviewed and approved for viability and sustainability by anyone considering that facility for a loved one.
These four levels of severity are then scoped as either an Isolated case (where only a limited number of residents are affected), a Pattern (where more than a limited number of residents are affected) or Widespread (where most or all of the residents were affected).
So, as you can see, understanding the deficiencies cited by CMS and their severity and scope can be complicated. Even more complicated, is understanding the Plan of Correction submitted by the facility’s management and having the experience to know whether or not their Plan is workable and, more importantly, sustainable. For this reason, it is advisable that you engage professional guidance in this important decision.
After you have chosen two or three facilities of whose standards of care you approve, and who fit your loved one’s specific needs, you should request a tour of the facilities. Here too, unless you have a strong understanding of long-term care, these tours should not be taken without a professional to guide you. As a former Nursing Facility Administrator, I can tell you that facility tours are meticulously choreographed to show you only the best of what the facility has to offer and will specifically exclude the “underbelly” that they hope to keep hidden. These areas of a facility will not be shown to you unless you specifically request to see them, and there are numerous areas you need to see if you want to make the right decision for your loved one.
In addition, there are important questions that should be asked during the tour. Questions only a long-term healthcare professional will know to ask and to which only a trained professional will fully understand the answers.
There are local and national organizations available to offer you the advice you need. The national organizations, with their beloved celebrity spokespersons, have knowledge of the industry in general, but often lack thorough knowledge of the facilities in any one specific region. More importantly, most of these organizations are actually paid by the senior care facilities in their network – so who do they really work for? They work for the long-term care facilities – not you.
Cassidy & Burke Consulting is a local firm that offers guidance on choosing a long-term care provider from among the facilities in Southeast Louisiana only. We have first-hand knowledge of the facilities in this region because we have personally served as Administrators of several different Skilled Nursing Facilities, Assisted Living Facilities, LTACs and Inpatient Rehab Hospitals. Our rates are reasonable and affordable, and they are paid by you, so there’s no question whose interests we represent.
CBC’s consultants know the players in long-term care in Louisiana. We know how to interpret State Survey results and Plans of Correction. We know what to look for on a tour and we know what questions to ask to determine which facility is best suited to your loved one. If you or your loved one is in need of long-term care, contact Cassidy & Burke Consulting, LLC. Allow us to save you time, headaches, and most importantly, the heart ache that often results from choosing the wrong facility.
Hugh Cassidy is the Managing Director of Cassidy & Burke Consulting, LLC and a former Nursing Facility Administrator licensed in Louisiana and Texas. Learn more about Cassidy & Burke Consulting by emailing [email protected] or visiting www.cassidyandburke.com.
Allowing you to be 100% patient focused.
