The New Nursing Homes: A 20-Minute Way to Find Great Long-Term Care F Marilyn Rantz, PhD, RN; Lori Popejoy, RN, GCNS; and Mary Zwygart-Stauffacher, PhD, RN Fairview Press 2450 Riverside Ave Minneapolis, MN 55454 800-544-8207 http://www.fairviewpress.org $14.95 (paper)
This direct, easy-to-use book is a welcome resource for anyone who faces the difficult task of selecting a nursing home for a family member or friend. Based on an observation tool developed by Dr Rantz, the book puts important selection criteria in the form of a plain language checklist that can be completed as one walks through a nursing home.
The 42-item checklist, which the authors claim can be completed in a 20-minute walkthrough, covers the basics: hygiene, safety, staff-resident interaction, visibility and availability of staff, therapies and activities, environment, and ability to personalize rooms. The checklist is intended as a quick screening tool for families, something that will help them rule out certain homes. For example, the following guidance is provided on item 26, concerning odors of urine or feces: "These odors should not be pervasive. If they are, do not consider moving into this nursing home." To nursing professionals, this is perhaps obvious, but family members with no experience are likely to struggle with what is 'normal' in a nursing home, and this unequivocal advice is useful.
If a home passes the walkthrough screening, the book allows users to explore additional important areas by conducting interviews with administrative staff and family members of existing residents. A questionnaire is provided for each interview. Important issues addressed in the questionnaires include turnover of ownership and management staff, level of RN coverage on all shifts, and degree to which residents can make choices. A welcome addition would be a questionnaire that visitors could use directly with residents of the facility. The federal Centers for Medicare and Medicaid Services (CMS) has come to understand the value of direct resident input and has incorporated resident interviews into its nursing home survey and certification process.
A few areas are notably absent in the tools provided in the book. The interaction between RNs and LPNs and nurse aides has been identified as critical to promoting a positive working environment in nursing homes, yet it gets no attention in this book.
Likewise, staff turnover questions fail to address turnover among nurse aides and other direct care workers, despite that residents interact most and develop relationships with these front-line staff. Recruitment and retention of direct care workers has become such an important issue nationally that the Robert Wood Johnson Foundation and the Atlantic Philanthropies have joined forces to develop a demonstration initiative to improve it, the Better Jobs/Better Care Program, administered by the Institute for the Future of Aging Services at the American Association of Homes and Services for the Aging.
The book includes great messages to families about staying involved and visiting regularly once a family member has been admitted. Surely this is key to checking that one's initial impressions of a home are accurate and promotes ongoing accountability to deliver quality care. Unfortunately, the book strays from its central purpose of providing useful selection tools when it assures family members that they are doing the right thing by admitting their loved ones to nursing homes, an added message that unnecessarily inserts bias into a good resource. The purpose of the book was not to take a stand in the nursing home vs home care debate, and the authors should either have stayed clear of the topic or treated it more comprehensively. Although many readers will undoubtedly relate to the case study provided, it did not focus enough on how the tool was used and overemphasized the needs of caregivers relative to the needs of the people facing admission. Those admitted to the nursing home are portrayed as selfish and manipulative, as in this passage, written from the perspective of the daughter, about her mother: "Everyone but me understood that she would become 'ill' whenever she wanted something or disapproved of something." The point of the case study is that family members are justified when they admit loved ones to nursing homes. Nowhere does the book acknowledge the complex ethical issues raised when the interests and desires of the family member collide with those of the person being admitted.
The book also falls short in the information provided about Medicaid-funded alternatives to nursing homes. The following statement is particularly egregious: "In a few states, Medicaid may also pay for other long term options, including...some community-based services." In fact, all 50 states and the District of Columbia offer at least 1 Medicaid-funded home- and community-based waiver program that is specifically intended to serve as an alternative for people who are eligible for nursing home care, and the majority of states have multiple programs. This book was not intended to be a resource guide to community-based services, and providing no information on the topic would have been preferable to providing misinformation that may discourage families who would otherwise be inclined to consider alternatives to nursing homes.
Despite these shortcomings, this book is helpful to anyone selecting a nursing home. The value of the book lies in the walkthrough survey tool and questionnaires. Had the authors remained focused on the tools and how to use them, the book would have been better.