Monitoring the quality of nursing home care

Nursing homes are very busy places and the nursing staff is in high demand. As a result, the quality of care can slip, so it’s important that you keep an eye on your parents to make sure they’re being properly cared for in the nursing home. When caring for aging parents, you naturally become their personal "Patient Advocate"

You do not need to be a doctor or nurse to pick up telltale signs that something's amiss. Below is a list of what to look for every time you visit your parents at the nursing home. Share this with other family members, and if you are long-distance caregiving, share it with your parents’ friends or with a volunteer who will visit regularly and report back to you. 

1. Look for bed or pressure sores by checking for any redness or bruises on the skin, especially near bony areas, such as the tailbone, heels and elbows. You can do this while you give your parents a massage or place lotion on their skin. 

2. Look for malnutrition and dehydration by checking for weight loss, changes in appetite, sores in her mouth, problems with dentures or chewing, or extreme thirst. Make sure there's always fresh water at your parent’s bedside. 

3. Look for potentially serious infections and problems in walking by checking for any ingrown toenails, infections, bunions or uncut nails on your parent’s feet. These could be signs of poor care, which can be particularly alarming if your parent is diabetic. 

4. Check for poorly kept hair or beard, clothing that is not clean or pressed, body odor, wet adult briefs, or unclean sheets. These are signs of poor care and can lead to pressure sores, infections and depression.  

5. Check out how long it takes for call bells to be answered, and note if aides frequently tell you: "We're short-staffed today." Are meal trays served late? Is there rarely fresh water in the room? These are signs of lack of staff, which can lead to poor care.  

6. Check to see if your parent's clothes or belongings are missing.  

7. Check for high staff turnover. Does it seem like every time you turn around there's a new director of nursing or head nurse, or your parent has a different nurse aide from one week to the next? Does staff morale seem pretty low? It won't take long for high staff turnover rates to result in poor care. 

All long-term care facilities have an ombudsman, whose job is to help solve problems among residents, their families and staff in long-term care facilities. Most ombudsmen are employed by Area Agencies on Aging; their name and phone number should be posted on a bulletin board in the lobby of the nursing home. You also can call the Eldercare Locator at 1.800.677.1116 for a nationwide listing. If you think there is a problem, report your concerns to the ombudsman immediately.

Research has shown that long-term care residents who are visited regularly by family and friends fare better in nursing homes. So, always stop by and let a staff member know you were there and give them an update on your parents. And take a minute to let them know how much you appreciate their help.

The bottom line

• Nursing homes are very busy places and the nursing staff is in high demand. As a result, the quality of care can slip, so it’s important that you keep an eye on your parents to make sure that they’re being properly cared for.
• There are a number of tell-tale signs that your parent is not being properly cared for in a nursing home facility. You need to visit often and look for bed sores, signs of malnutrition or bad hygiene, staffing levels and more.
• If you have concerns about your loved one in long-term care, contact the facility’s ombudsman, whose job it is to ensure that those in the nursing home facility are receiving proper care.