Attorneys advise on what to ask the nursing home

by Lauretta K. Murphy and Kathleen Hogan Aguilar of Miller Johnson

Laurie Murphy was the subject of  a profile in Wednesday’s Grand Rapids Legal News. Here is an article she coauthored for the Miller Johnson newsletter, used by permission.

You or your loved one needs nursing care. Here are 10 questions to ask when you look for nursing home placement.

1. What about my source of payment?

Is the facility licensed as a skilled nursing facility? Many facilities that provide a relatively high level of care are licensed as homes for the aged, not skilled nursing facilities. When private pay money runs out, Medicaid generally only assists people in skilled nursing facilities. Does the facility accept Medicaid? What are the consequences of a change from Medicare or private pay to Medicaid? State and federal reimbursement rates are so low that most nursing homes prefer to accept private pay residents before someone who is likely to need Medicaid assistance.

2. How are care plans created and modified?

Nursing homes should arrange periodic care conferences to discuss medical care, activities, and therapies. Care plans should be updated periodically and immediately when there is any change in a resident’s condition. Ideally, a medical director will respond to questions and concerns about medications, pain control, sudden changes in cognitive functioning, and other medical problems within 24 hours.

3. When were the last three inspections, and what deficiencies were found?

Nursing homes must be inspected at least every 15 months. Inspection reports are available at the nursing home and at If there are deficiencies, ask about them and find out what is being done to correct the problems. Note that some deficiencies may be very technical and have little impact on care. If the facility has had any major penalties, ask why they were imposed and whether the underlying problems have been resolved.

4. What about the use of restraints?

Restraints are anything used to keep a resident from moving freely, including but not limited to cloth ties, bed rails, chair trays, and hand mitts. Restraints can contribute to agitation and depression, development of bed sores, increased likelihood of injury in case of a fall, broken bones, and strangulation. Does the nursing home use safer, less restrictive alternatives like pillows to help a person sit straight, reclining chairs, chair and bed alarms, lowered beds, and floor padding?

5. Can I have a tour?

Tour the facility. Do not be limited to public areas; ask to tour the residential areas too. Check out the food that is served. Look at the activities chart. Pay attention to how the staff treats the residents. Talk to residents and family members who are visiting. Try to tour on both a weekday and a weekend and look for any differences.

6. What is it like living and working here?

Find out what the current residents think about their care. Talk to them, their family members, and caregivers.

Talk to the staff and ask about turnover. Low turnover could mean higher job satisfaction, which results in better care for the residents. It also means that the residents can develop relationships with the staff and receive more consistent care.

7. How many staff members are on duty?

Facilities are required to post the number of licensed and unlicensed direct care staff for each shift. Check it out on weekdays and weekends. Do they use temporary agencies? Are staff members permanently assigned to residents? The better the staff knows the resident, the better the care should be.

8. Is there an active resident or family council?

Resident and Family Councils benefit residents by providing education about residents’ rights and a means to express concerns and solve problems. The Council helps provide support for family members, alerts the facility to problem areas, helps the activity director increase resident participation, and provides ongoing appreciation for staff.

9. How much control do I have over my schedule and care?

Can I participate in social, recreational, religious, or cultural activities that are important to me? Do I get to choose what time to get up, go to sleep, or bathe? Can I get food and drinks that I like at any time? What if I don’t like the food? Is transportation provided to community activities? Do I get my own TV? My own TV remote? Can I decorate my living space any way I want?

10. How about friends and family visiting?

Is the location convenient for family and friends? Are there restrictions on visiting hours? Not only do visitors brighten the resident’s day, but residents who have lots of visitors generally receive better care. Visitors can also raise concerns with staff members and ensure that a resident is receiving appropriate and adequate care.

Please contact the authors or a member of Miller Johnson’s Elder Law group with any questions: Lauretta K. Murphy,; 616-831-1733; Kathleen Hogan Aguilar,; 616-831-1763.