Your aging mother suffers a debilitating stroke; your widowed father shows evidence of serious cognitive decline. In both cases, their independence is permanently compromised.

The people that took care of you now need to be taken care of themselves.

Twenty-four hours a day, seven days a week.

Time is frequently an issue when it comes to selecting a nursing home to accommodate the needs of a loved one. Choices are often imposed on family members caught in the midst of an unanticipated health crisis.

The rush to find a suitable place undermines the best of intentions, creating a feeling of helplessness. The system, you are horrified to discover, is not very sensitive to the problems of an elderly person no longer capable of caring for themselves.

“People get railroaded,” says Celia Strow, chief operations officer for MyZiva.net, an online nursing home guide based in Lake Success, New York (www.myziva.net).

“The discharge planner at the hospital is instructed to get mom out of the hospital as fast as possible, so people have to research quickly and hope that a nursing home has a bed. What they don’t realize is that there is a hierarchy of acceptance in nursing homes. They prefer private paying patients because there’s no wait for government funds. The most difficult patient to place is the little old lady who has Alzheimer’s disease but no really acute medical problems. They score low. Families should be aware of these facts.”

Accessing a data resource like MyZiva.net or such websites as the California Nursing Home Search (www.calnhs.org ) is an important first step for those in search of a nursing home.

What soon becomes apparent is that nursing homes have evolved into the role of step-down hospital units. Formerly the average stay at a nursing home was four years, but today it’s less than half that duration. Institutional care is discouraged by governments, which provide incentives to keep invalids at home.

Many nursing home residents are short-term patients, who depart after a few months of rehabilitative therapy.

No matter what a patient’s status, the dynamic that determines their quality of care is staff.

“The bottom line is personnel,” comments Strow, a former nursing home administrator.

“The number of staff and the ability and enthusiasm of staff to take care of the residents is the most important aspect of a nursing home. Turnover rate is a good indicator of a facility’s stability. I think families walk into a beautiful new building, see a lovely surrounding and don’t look any deeper. They don’t observe how the staff is responding. I think they can be misled by some of those bells and whistles.”

Non-profit facilities have traditionally provided better care than their for-profit counterparts, particularly in the United States, which is experiencing a crisis in nursing home care.

Dr. Charlene Harrington, a professor of sociology and nursing at the University of California’s Department of Social and Behavior Sciences in San Francisco, has conducted numerous studies of for-profit institutions:

“They always have less staffing, and more deficiencies in identifying quality problems. There are only so many areas where you can cut costs, so their main target has been staffing. They attempt to keep under the Medicaid rates and make profits when it’s really not a profitable business. Medicaid sets a rate of so much per day, but does almost no monitoring in respect to how that money is spent. Companies cut staff and then take a huge amount of money off the top for administration and manager’s salaries. A big worry for countries like Canada and England is this growing trend towards privatization of nursing homes. The public needs a better understanding of how the for-profits function.”

The ratio of for-profit and non-profit facilities in the U.S. is heavily weighted in favor of the for-profits, which account for 90 per cent of the total.

Dr. Harrington has more confidence in mid-sized establishments, those numbering 50 beds, and cautions against trusting in ones with less than 25 beds or more than 100.

The Home Guard:

“Families have great difficulty placing a loved one in a nursing home,” says Strow.

“They really feel bad about it. Just think of the language: We enroll children in school, we admit people to hospitals, but we put the elderly in nursing homes. ‘There you go mom, we’re putting you in that nursing home.’”

Before committing to a facility, Strow recommends the following:

• Determine if a physician is readily available.
• Ascertain the percentage of staff to patients.
• Inspect the kitchen.
• Observe a meal.
• Ask pointed questions.
• Talk to residents.
• Learn about the nature of recreational activities.