Finding a place which implements person-directed care can be difficult. Here is a set of questions that we have developed to help families determine whether or not a nursing home is engaged in person-directed care.
Person-directed care allows the elder to make their own choices, continue familiar routines and maintain their dignity after moving into the new setting — or in other words, be at home wherever home may be. Below are some questions you should ask when visiting a nursing home or an assisted living care community. Just click on the down arrow to the left of each question to read the answer.
Key Questions to Ask the Staff in Nursing Homes to Find Out If They Provide Person Directed Care
How is your nursing home involved in culture change?
How will you get to know my family member?
Do the care partners take care of the same group of individuals each time they work, or do you rotate the assignments after a period of time?
Will my loved one be awakened at a set time in the morning or will she have a choice?
What is your policy regarding food choices and alternatives?
Can my loved one be given a shower/bath when he or she chooses?
What type of recreational activities are offered here?
How do you build a sense of community, and give those who live here a voice in the decisions about how things are done?
How do you meet the special needs of people who have some type of dementia?
What is the role of family members? Do you have a Family Council?
Do you have a rehabilitation team and access to therapists such as speech pathologists, physical therapists and occupational therapists?
Do you measure the turnover of your staff (defined as the average percentage of staff who stop working at the home each year)? If so, what is the turnover rate for your direct care workers?
Do you measure the turnover rate of your licensed nursing staff? If so, what is your turnover rate of licensed nurses?
Do you measure staff satisfaction? If yes, what do you do with the satisfaction survey results?
Do you also measure resident satisfaction each year?
Do you measure family satisfaction?
What is your organization's policy regarding the use of agency nurses and agency nursing assistants (people who are brought in from the outside who are not your regular staff)?
What is your mission statement? Is staff able to share the mission in their own words and indicate that it is meaningful to their work?
Download a copy of Key Questions to Ask Nursing Home Staff.
What should I look for on a tour?
To get a feel of the tone of the nursing home during your “walk-about,” look at the colors (furniture, walls, floors), lighting, real or artificial plants, bird cages and fish tanks, other animals, smells, lighting, signs, elements of privacy, options for sitting alone, conversation areas, and individuals’ facial expressions. Are staff and individuals interacting in what looks like interest and kindness?
How can I assess activities, services, and quality of care?
Look at the types of activities that are posted. Check to see if Resident Council and Family Council materials, and ombudsman contact information, are posted in obvious places and at a level where a person in a wheelchair could read them. The last report of the state survey should be available for you to review. Talk to individuals and families when you are visiting. Ask them how they feel about the place and if they would recommend it. Remember that if you ask this in the presence of a staff person, individuals may fear sharing negative comments and so may give you an inaccurate impression.
Key Questions to Ask the Staff in Assisted Living to Find Out If They Provide Person Directed Care
There is a need to ask more specific questions about person-directed care and what the assisted living community is doing, if anything, with person-directed care. Listed below are some general and specific things to ask and to listen for in the response. These are not the only “correct” responses, but they will give you a general idea of what you might hear that indicates work toward creating home for individuals.
How do you welcome a new resident?
How will you get to know me/my loved one? (or whoever is the potential resident)
Do you provide training for your staff on how to provide person-directed care?
Are individuals involved in developing their individualized service plan so it is based on their needs and preferences?
For those individuals needing personal care, is the same caregiver consistently assigned to them?
How are a resident's sleep and wake times chosen?
How and when does a resident receive bathing assistance if she or he needs it?
What kind of meal service do you offer and do individuals have many choices as to what to eat?
Can individuals have a snack or unscheduled meal 24 hours a day?
What types of recreational activities are offered here? What if a resident prefers an activity that hasn't been offered in the past?
How do you build a sense of community?
How do you give those who live here a voice in the decisions about how things are done?
What is the role of family members?
How do you meet the special needs of people who have some type of memory loss?
Do you measure resident satisfaction each year?
Do you measure family satisfaction each year?
Download a copy of Key Questions to Ask Assisted Living Staff.
What should I do on a tour?
Show up 10 minutes early for the tour and sit and wait patiently and observe general feel of place and environment. Talk to individuals and families when you are visiting. Ask them how they feel about the home and if they would recommend it. Remember that if you ask in the presence of a staff person, individuals may fear sharing negative comments and so may give you an inaccurate impression. Ask to see the assisted living community’s most recent state survey–even if you have already seen it online.
What should I look for in a surprise visit?
If after the tour, you are sincerely interested in the home, return for an unannounced visit preferably during a meal or scheduled activity. How does the staff handle your surprise visit? Do things look different than they did during the tour? Talk to individuals and family members without staff present to find out how they like the home.
Developed through the support of the Picker Institute, adapted with permission from the work of David Farrell and the California Culture Change Coalition.