Shopping for a nursing home

YAKIMA — When Ben Herres needed to find a nursing home to care for his wife, Ollie, he followed his nose.

He visited nursing homes all over Spokane and later the Yakima Valley in search of a safe haven for Ollie, who had multiple sclerosis. He visited them, he questioned staff members, he talked to doctors.

"I primarily sniffed," quips Herres, 89.

He now lives at Summitview Healthcare Center, the place he had picked out for Ollie. She died two years ago; he is recovering from heart surgery.

He was only half joking about his nose. Experts and advocates recommend a smell check when picking a nursing home for a loved one.

But it's only one tool. There are specialties to consider, complaint statistics to check, location, turnover of employees and many other things. Shopping for a nursing home isn't easy. But there's information available -- lots of it -- and ways to tell a good one from a bad one.

It just takes some homework.

"Some people really do dig into it," said Dennis Malgesini, administrator of Summitview Healthcare in Yakima.

The first step is to realize you have a choice. Too often, administrators say, families rely solely on the first suggestion of their physician or hospital. They often are reacting to a crisis -- a stroke or a nasty fall -- and can't take the time to shop around.

"A lot of times consumers don't even realize they have a choice of where they are going," said Jeff Hyatt of Hyatt Family Facilities, a three-generation family of nursing home owners.

The family of Richard Eckel, who suffered from diabetes, had only a day or so to select a nursing home after he had a fall. Doctors had given them a list of homes. They picked Summitview, attracted to the Christian beliefs of its founders, the recommendations of friends and its ratio of nurses to residents.

"I don't think I've seen my dad this happy in a long time," said Suzanne Winquist, his daughter.

A visit is the way to go

Almost everyone in the industry recommends visiting nursing homes before deciding.

A visit will give you a chance to watch activities and see how residents and staff members interact. It will also reveal the overall cleanliness of the facility and allow you an opportunity to use that sniff test.

Inevitably, messes will happen in a nursing home, but odors build up when staff members do not clean them up quickly enough or when soiled linens sit too long in a hamper, for example.

While you are there, ask questions. Speak to the administrators, the nurses and residents. Most nursing homes have resident councils. Interview the officers.

Also, go to the computer. Many Web sites offer checklists of things to look for.

Washington's long-term care ombudsman, a federally mandated office with a branch in Yakima County, recommends asking nursing home leaders about turnover among the head positions of administrator and nursing directors, the number of temporary contract aides compared to permanent staff, and the variety of activities that are offered.

Nursing homes are one of three types of long-term care facilities licensed by the state. They are required to provide 24-hour nursing care and range in cost from $3,000 to $6,000 per month, according to the state long-term care ombudsman.

Boarding homes, also called assisted living facilities, provide a more independent environment with help cooking and cleaning. Many families hire nurses, but it's not required. They cost from $1,500 to $5,000 per month.

Surveys offer inside look

Then, check the report cards.

Medicare maintains a Web site with a database of every licensed nursing home in the country. The site compares them by geography, size and regulatory results.

State regulators, called surveyors, with the Department of Social and Health Services are contracted by Medicare to investigate nursing homes in two ways. They perform annual surprise surveys on the entire home along with investigating individual complaints. By law, nursing homes must display these survey results on a front counter or some other conspicuous place.

For the surveys, a zero score is perfect. That means the nursing home had no deficiencies related to errors by its staff -- such as failure to give a resident medicine on time. For example, the surveyors receive numerous complaints about bedsores, but "bedsores can happen even in the best of care," said David Moon, the DSHS residential care services regional administrator.

The whole system is "inherently negative," as Jeff Marshall, CEO of Eagle Healthcare, likes to point out. Industry lobbyists are trying to persuade the federal government to post family and resident comments on the Web site next to results of complaint investigations.

"Usually it's very difficult for lay people ... to get an idea of what a facility is like just by looking at a bunch of statistics," Marshall says.

When Eagle, a Kirkland, Wash.-based company, announced plans in February to possibly purchase the 36-bed nursing home from Prosser Memorial Hospital and build a new facility in Prosser, critics armed with those statistics accused the company of providing substandard care. Some were former employees.

One of Eagle's facilities, Parkside Nursing Care Center in Union Gap, had 28 health deficiencies on its record between March 1, 2007, and May 31 of this year, second most among the county's 14 nursing homes, according to the Medicare Web site.

However, another one of its facilities, Hillcrest Manor in Sunnyside, is perfect, with zero health deficiencies, the Web site notes.

But those scores don't tell you that Hillcrest employs the Eden Alternative, an experimental approach to nursing homes that gives residents more independence and encourages pets and unscheduled visitors. Likewise, Willow Springs Care in Yakima, owned by the Hyatt family, also has a relatively low eight health deficiencies, but you'd have to talk to staff members to learn that they specialize in treating obesity among seniors. Other homes specialize in dementia care or physical therapy.

Making the right choices

Few people do as much homework as Vicki Oviatt did in November, when she placed her mother, Millie Becker, in Selah Convalescent Home. Few have the time.

Dementia had been slowly encroaching into the mind of Becker, who at the time lived in her own apartment in Edmonds, Wash.

Oviatt, who lives in Selah, began researching facilities in and around the Yakima Valley while her daughter, Trina Galen, did the same for the Everett area. They had a list of about 50 between them.

They needed a home that accepted Medicaid payments, so using the Medicare Web site and other online resources, as well as making dozens of phone calls, a few visits and long interviews with administrators, they whittled that list down to two -- Selah Convalescent and another facility in Everett. They gave the 83-year-old Becker the final choice.

The oil-painting and poetry-writing woman picked Selah Convalescent, where she has her own room and a staff willing to work with her "unique kind of dementia," Oviatt says.

Oviatt believes her mother picked wisely.

"They're doing wonders with her," Oviatt says.

* Ross Courtney can be reached at 930-8798 or rcourtney@yakimaherald.com.

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