Conduct an Onsite Visit
Families looking for a care facility should next actually visit and tour the short listed facilities. Facilities will usually have a set procedure to allow for such visits which will include a tour and a question and answer session during which materials such as major policies, fees, and enrollment forms are made available. There are a number of things to consider while visiting each facility:
Types of nursing care provided. It is important to record whether each facility provides nursing care, and which types of nursing care (e.g., basic, skilled, or both) are available. Also important to note is the professional backgrounds of the caregivers who will actually provide services. Ask to view each facility's "patients bill of rights" and policies regarding elders who complain about particular caregivers or service. Also note whether the facility has an "ombudsman" office whose job it is to investigate patient complaints.
- Types of recreational and social activities available. Note the activities that are scheduled and taking place during the visit. Ask to view the common areas where events take place. Obtain a calendar of upcoming events if possible.
- Safety and Emergency Guidelines. All facilities should have established guidelines and policies covering facility safety and resident security, policies and services regarding transportation and crisis plans for emergencies such as severe weather. Ask for copies of these procedures and plans, and documentation of employee training in implementing these plans. Look for visible manifestations that these policies are taken seriously. The facility should conduct regular drills with the residents and staff. The facility should also be able to provide copies of any inspections that have been done by an applicable state or city organization, showing that the facility is up to code in all areas, as well as proof that the facility is properly insured.
- Visitor Policies. Facilities should explain their visiting hours and policies. Note whether there are specific visiting hours (often the case for nursing homes), or whether visitors may be received at any time (as is often the case in assisted living facilities).
- Financial Policies. All financial costs, procedures and policies regarding acceptable payment should be documented in writing. In particular, make sure that information regarding frequency of payments, and acceptable payment methods (such as cash, check, charge, Medicare funds, etc.) is clear before ending the visit.
- Food and Nutrition Practices. Menus should be available for viewing in facilities that provide residents with meals and snacks. Examine menus (and actual food if possible) for nutritional quality and care of preparation.
- Personal Living Spaces. Make sure to view the type of apartment or living space that will be made available to the elder should he or she come to live at each facility. Note the condition of such living spaces including the quality of bedroom and toilet facilities. Note whether there are call buttons located in bedrooms and toilet areas (to allow residents to get staff's attention if it should become necessary).
- Optional Services. Any optional services, such as laundry, housekeeping, cable television, magazine subscriptions, and internet access should also be described during a tour.
A sample listing of things to look for in evaluating a live-in care facility is provided as Appendix C.
Screening Home Health Workers
Families wanting to hire a home health worker will experience the interviewing and screening process differently than will those evaluating a care facility. The home health worker screening process necessarily focuses more on candidates' individual qualifications and less on the quality of the physical environment in which the elder will receive care. The candidate screening process should, at a minimum, include an interview and thorough reference checks. Important questions to consider and/or ask during the interview include:
- What training, previous experience, professional degrees or certifications or other qualifications does each home health care worker candidate have that qualify him or her for the position?
- What care services are available?
- What are the fees for each type of service provided?
- What hours of service are available?
- Who will employee the home health worker? The elder, or a family member?
Several additional questions make sense to ask if the candidate has been recommended by an agency:
- What sort of ongoing training is provided to the worker (if any), and how often is it provided?
- What provisions are made for worker illness or vacation? Will a temporary worker be made available to fill the gap?
If the family has decided to use the services of an agency to locate care workers, that agency should offer a prescreened short list of applicants who are known to match the family's expressed needs and preferences. The family should then be able to contact the candidates on this short list for telephone or in-person interviews. Should the family not wish to perform interviews, the agency will also be able to recommend a qualified worker on behalf of the family based on expressed care and services needs. Those hiring a health care worker on their own without an agency will have to do more work locating and screening candidates, but the interview process is similar.