WHEN HOME CARE ISN'T ENOUGH...
	When faced with finding post-hospital placement for themselves or a loved one, many people feel overwhelmed by the choices offered in terms of Sub Acute and Skilled Nursing Facilities.  Aside from the sheer number of facilities available, there are often social, geographic and economic factors to be considered.  What town should I choose so that family and friends will be able to visit with ease?  How long a stay will my insurance cover?  What if I'm not well enough to return home when my insurance runs out?  What are the other patients like there?  Will I be forced to give up my home if I have to stay longer than expected?  These are important questions which are faced by every family in this position, and while many may be resolved with a family conference, others will require the expertise of a medical professional. When selecting a facility for a post-hospital or even a long-term (or permanent) stay, it is important to find a facility in which a Social Worker or Case Manager is able to spend time meeting with you and your family to address these concerns.  In most cases, Social Workers and Case Managers should be able to answer all of your questions and assist you to find additional resources - including financial assistance, should you qualify - to make your stay as successful and worry-free as possible. These questions aside, one significant problem remains - how to find a facility which will provide the quality of care that you or your loved one need?  Unfortunately, many individuals see no other option than to gamble on the advice of hospital discharge planners, friends, neighbors, etc.  While this certainly is valuable information (as we'll discuss later) which should not be disregarded, remember that hospitals are often affiliated with Skilled Nursing Facilities through relationships with their parent organizations and are encouraged to refer patients to them.  Your acquaintances may be biased towards a facility because of a negative experience that they or someone they know had.  Again - this information is not without merit, but it is important to keep in mind that Skilled Nursing Facilities are dynamic entities which are constantly evolving based on changes in staffing levels, ownership, management, and financial resources. The purpose of this article is not to point you in the direction of any specific facility, but rather to provide you with some resources to assist you in making an informed decision regarding placement in a Skilled Nursing Facility.  This decision is not an easy one, but armed with knowledge and insight, it is one that you may be able to make with confidence.
		http://www.medicare.gov/NHCompare/home.asp
	All Skilled Nursing Facilities within the Commonwealth of Massachusetts are required to submit to an annual survey by the Department of Public Health.  This survey is a comprehensive five- to seven-day review of the facility's physical structure, staffing, patient care and documentation, among other things.   The results of the annual survey as well as any necessary follow-up visits are available for viewing on Medicare's website as well as in the facility itself.  We'll begin by reviewing the information that can be accessed using this website and how to best interpret it. First, click on the link above to visit Medicare's Nursing Home Compare site.  The page that opens will offer you several choices for locating a Skilled Nursing Facility by searching by State, County, City, Zip Code or by directly entering the name of the facility in which you are interested.  Once you have located a specific facility, click on the View all information about this Nursing Home link. The next page will give you some general information about the facility, including the contact information for their Ombudsman, Survey Agency and State Quality Improvement Organization.  Also on this page are several informative links under the heading Delivery of Care: Quality Measures:  Compares facility-specific statistics (such as number of residents with restraints or suffering from depression) to state and national averages. Facility Staffing:  Compares staff/resident ratios to state and national averages. Inspection Results:  This reflects the results of the most recent DPH survey.  It’s important to note the “Date of Inspection,” since the information on this page may be outdated and not reflective of the facility’s current condition.  The information on this page is fairly self-explanatory.   The “Date of Correction” column refers to the date that DPH surveyors revisited the site and found that specific issue to be satisfactorily resolved. One of the most helpful items on this page is at the very bottom, where you'll find a link to the Nursing Home Checklist - an invaluable tool to take with you during visits to any of the facilities in which you are interested. Now that you have gained access to this information, what do you do with it?  There are several things to keep in mind.  First, if a particular facility is located in the town or community that you want, don't rule it out based solely on it's Inspection Results.  As a matter of fact, facilities who have recently undergone a survey with negative results often strive to improve their deficient areas in the following weeks and months.  Also - while the Quality Measures stated on this site are a valuable tool, negative statistics may not be indicative of any wrongdoing on the part of the facility or it's staff.  For example, urinary incontinence is for many an unfortunate side effect of the aging process, and may often be brought on by the progression of illness or disability or by the onset of an infection.  These factors may elevate that facility's numbers above the state and national averages regardless of the quality of care being provided to these residents.
	CONTACTING THE LONG TERM CARE OMBUDSMAN FOR A FACILITY
	http://www.mass.gov/portal/site/massgovportal/menuitem.14191bbddbe631c14db4a11030468a0c/?pageI D=eldersterminal&L=3&L0=Home&L1=Service+Organizations+and+Advocates&L2=Long+Term+Care+O mbudsman&sid=Eelders&b=terminalcontent&f=ltc_ombudsman_overview&csid=Eelders
	A Long Term Care Ombudsman is an agent of the Massachusetts Executive Office of Elder Affairs whose role is to improve the quality of life for residents of Long Term Care / Skilled Nursing Facilities.   These individuals visit facilities and meet with residents on a one-to-one basis or as a group in the facility's Residents' Council.  The Ombudsman, by nature, is a valuable source of objective information regarding the quality of care in local Skilled Nursing Facilities. You may find contact information for a facility's Ombudsman using Medicare's Nursing Home Compare website (see above), or by calling or visiting the facility itself.  The Ombudsman's name and contact information should be posted in conspicuous places throughout the facility.
	VISITING A SKILLED NURSING FACILITY
	The best way to get a feel for what a Skilled Nursing Facility has to offer is to visit the site itself.  By contacting the facility's Social Services department, you should be able to arrange a time for a meeting with facility staff and a tour of the facility.  Be sure to visit Medicare's Nursing Home Compare Website and print out a copy of their Nursing Home Checklist to take with you on your visit. If you haven't already viewed the facility's most recent Department of Public Health Survey Results on the internet, you may do so at the facility during your visit.  All nursing homes are required to keep a copy of their most recent survey results, as well as their Plan of Correction, available for public viewing.   There should be a sign in the lobby directing you to the document’s location – if not, ask someone where you can find it.  A staff member will most likely review the document with you.  If you have questions, don’t be afraid to ask! When touring the facility, be sure to ask to see the units where beds are currently available.  Below is a list of positive and negative things to look for during your visit.
	POSITIVE		NEGATIVE
	Nurses and Aides are interacting with residents. Residents appear well-groomed, clothing is clean, wheelchairs and walkers appear clean and in good repair. Residents move about the unit freely in walkers or wheelchairs.  Some residents are wearing seatbelts. Unit is reasonably quiet.  Staff and residents are speaking in conversational tones of voice.  Call bells may ring in the hallways but Nurses or Aides answer them in a reasonable time frame.  Name tags are clearly displayed. Residents appear happy and content.  Some are gathered in small groups conversing or participating in an activity. Nurses and Aides are courteous to each other and to you.  They speak pleasantly and respectfully to residents when assisting them. Common areas smell pleasant or there is no odor at all. Hallways are clean and free from clutter.   Articles stored in hallways (linen carts, empty wheelchairs, laundry receptacles) are lined up on one side of the hall. Food delivered to residents during your visit appears hot, nutritious and appetizing.   Residents who need assistance feeding themselves are attended by Nurses or Aides.  Trays are returned to the delivery cart with meals mostly consumed. Residents who are being bathed or toileted in their rooms are behind closed doors or privacy curtains.		Nurses or Aides are behind the desk; residents are unattended. Residents' clothing is soiled, hair does not appear clean or is unkempt or slicked back, food is visible on chin or lips.  Wheelchairs and walkers are visibly soiled or damaged. Residents are seated in hallways or at tables with brakes locked.  Many residents are wearing restraints which prevent them from rising from their chairs.  Residents seated in regular armchairs do not have walkers or canes available. Unit is loud and busy.  Staff speak loudly in the halls and common areas.  Call bells are not answered, or Nurses and Aides enter a room to answer a call bell and emerge only a moment later having turned the call bell off.   Name tags are not present or are difficult to read. Residents are sleeping in common areas or are arguing amongst themselves.  Residents call for assistance from bedrooms or common areas and are ignored by staff. Nurses and Aides frown, speak sharply to one another, look away when you pass. They speak sharply to residents or not at all when they assist them.  Staff speak in foreign languages in front of residents or while assisting them. Common areas smell of feces, urine or body odor. Hallways are cluttered or congested.   Laundry receptacles are overflowing.  Doors to storage or utility rooms are propped open with furniture.  Articles such as linen carts and laundry receptacles are lining both sides of the hallway or are left in the middle of the hallway. Food delivered to residents during your visit appears to have cooled to room temperature and looks unappealing and/or non- nutritious.  Residents are left sleeping in chairs or in bed with meal in front of them.   Trays are returned to the delivery cart only partially eaten or untouched. Residents who are being bathed or toileted are visible from the hallway.  Residents are in common areas wearing only johnnies with backs exposed.
	RESOURCES ON THE WEB
	The internet can be one of the best sources for finding information about Skilled Nursing Facilities in your area... if you know where to look.  Below is a list of websites which can provide you with valuable information to aid in your search.
	South Shore Elder Services, Inc. - "Your Age Info Specialist" "South Shore Elder Services, Inc. (SSES) recommends and coordinates resources for elders to help them to remain as independent as possible. The private, non-profit agency also advocates for elders and their caregivers, always with the goal of promoting an optimal quality of life."  SSES produces A Resource Guide For Older Adults and Caregivers On the South Shore - this easy-to-use booklet is a must-have for anyone seeking services for themselves or a loved one.  Servicing the towns of Braintree, Cohasset, Hingham, Holbrook, Hull, Milton, Norwell, Quincy, Randolph, Scituate and Weymouth CONTACT INFORMATION:        South Shore Elder Services        159 Bay State Drive        Braintree, MA 02184        Phone: (781) 848-3910        Phone: (781) 383-9790        Fax: (781) 843-8279        TDD: (781) 356-1992        http://www.sselder.org
	800AgeInfo "This website is designed to assist consumers and caregivers as well as professionals seeking information and resources on eldercare services. The site lists information on approximately 40,000 services and programs in Massachusetts for elders."  800AgeInfo is a state-run website in partnership with the Massachusetts Executive Office of Elder Affairs and the Mass Home Care Association. CONTACT INFORMATION:        Phone: 1-800-AGE-INFO (1-800-243-4636)        http://www.800ageinfo.com
	Massachusetts Executive Office of Elder Affairs "The information provided on this website is designed to assist elders and their families with answers to questions about services and opportunities available to seniors and their caregivers in Massachusetts.   On this website, you can obtain information on caring for an aging parent, securing help for an elderly neighbor, getting nutritious meals delivered to a senior's home, getting help parenting a grandchild, or learning more about prescription drug programs for elders." CONTACT INFORMATION:        Executive Office of Elder Affairs        One Ashburton Place        5th floor (The McCormack Building)        Boston, MA 02108        Main number: (617) 727-7750        Agency hotline: 1(800) 882-2003 (Mass Only)        Voice/TTY: 1(800) 872-0166 (Mass Only)        Alzheimers hotline: 1(800) 548-2111 (Mass Only)
	HESSCO Elder Affairs "HESSCO Elder Services is a nonprofit organization serving older adults and the people who care for them.  Our mission is to give older adults the opportunity to live independently and with dignity at home.   Serving the towns of Canton, Dedham, Foxboro, Medfield, Millis, Norfolk, Norwood, Plainville, Sharon, Walpole, Westwood and Wrentham." CONTACT INFORMATION        HESSCO Elder Services        One Merchant Street        Sharon, MA  02067        Phone: (781) 784-4944        http://www.hessco.org
	Elder Services of Cape Cod and the Islands "Elder Services is a private, not-for-profit, community-based organization. Since our founding in 1972, we have been dedicated to promoting the welfare and enhancing the quality of life of elders, as well as helping them to maintain maximum independence and dignity. Our organization works with the community to identify and respond to the needs, problems, and concerns of elders and their families. Servicing Barnstable, Nantucket, and Dukes (excepting Gosnold) counties." CONTACT INFORMATION Main Office 68 Route 134 South Dennis, MA 02660 Phone: (508) 394-4630 TTD/TTY: (508) 394-8691 http://www.escci.org Upper Cape P.O. Box 3207 Pocasset, MA 02559 Phone: (508) 563-5966 Martha's Vineyard P.O. Box 2337 Oak Bluffs, MA 02557 Phone: (508) 693-4393 Nantucket 144 Orange Street Nantucket, MA 02554 Phone: (508) 228-4647 Elder Abuse Hotline After Business Hours 800-922-2275
	CONTACT AMAZING GRACE...
	If you are unable to find what you are looking for, please contact us at (781) 337-1516.  Amazing Grace Private Nursing Care, Inc. is owned and operated by Health Care professionals who have over twenty years of experience in Acute, Sub-Acute, Long Term and Home Care settings.  With our knowledge and contacts throughout the Health Care Industry, we may be able to locate the information you need.  In addition, the information above will be updated regularly so check back often!

ACCESSING FACILITY STATISTICS AND SURVEY INFORMATION VIA
MEDICARE'S WEBSITE