A Consumer’s Guide to Finding a Facility on the Culture Change Journey

For family members interested in determining whether a nursing home is engaged in person-centered care, we have developed a list of questions to help you.

A Consumer’s Guide: Key Questions to Ask the Nursing Home Staff to Determine if They are Focused on Providing Individualized Care

1. What type of nursing assistant assignment plan do you utilize? In other words, do your nursing assistants (CNAs) care for the same group of residents each time they work or do you rotate the assignments after a period of time?
• Best response – "We use consistent assignments. With few exceptions, our caregivers care for the same group of residents each time they come to work."
• Rationale – Backed by research studies, consistent assignment of the same nursing assistants (CNAs) to an individual resident allows for the caregivers to remember the routines and preferences of each individual resident and provide individualized care.



2. Do you measure CNA turnover? If so, what is your nursing assistant (CNA) turnover rate?
• Best response – Any number under 40%.
• Rationale – The national average is 70%. Research studies indicate a correlation between caregiver turnover and poor clinical care and service.



3. Do you measure your licensed nursing staff turnover rate? If so, what is your turnover rate of licensed nurses?
• Best response – Any number under 30%.
• Rationale – The national average is 50%. Research studies indicate a correlation between licensed nurse’s turnover rate and poor clinical care and service.



4. What is your facility’s policy regarding the use of agency nurses?
• Best response – "No. Only our own nurses work here. However, in a dire short staffing emergency, we would call-in an agency nurse."
Rationale – Agency nurses are temporary workers who travel to various healthcare centers. Therefore, they do not have time to develop a detailed knowledge about individual residents.



5. What is your facility’s policy on bathing and shower schedules? In other words, can my loved one be given a shower/bath when they choose?
• Best response – "Yes. We can accommodate any individual’s lifelong pattern of bathing. Please let the admitting nurse know what his/her preference is and we will make accommodations."
• Rationale – The facility should be able to flex its staffing practices to meet individual resident preferences regarding bathing and showers.



6. What is your policy on morning routines; can my loved one be awakened in the morning according to their lifelong pattern?
• Best response – "Yes. We can accommodate any individual’s preferences."
• Rationale - The facility should be able to flex its staffing practices to meet individual resident preferences regarding their morning routine.



7. What is your policy regarding the main meal being served; do you offer alternatives if my loved one does not like the main entrée being offered?
• Best response – "Yes. Let me show you a list of the alternatives which we always have on hand if someone does not prefer the main entree being offered."
• Rationale – The facility should have alternatives available to meet any individual’s request.



8. May I see your facility’s mission statement?
• Best response – "Yes. Please let me show you our mission statement."
• Rationale – Research studies have indicated that leaders who can easily access their mission statement are leaders who are mission driven. These leaders believe in their organization’s mission to serve. They are also more likely to remind caregivers of their organization’s mission.



9. How do you measure caregiver satisfaction? Do you conduct staff satisfaction surveys? If yes; what do you do with the satisfaction survey results?
   • Best response – "Yes. We measure our caregivers’ morale by conducting staff satisfaction surveys. We analyze and act on the results. Our staff satisfaction is very important to us. We are always working to improve the quality of work life of our staff."
   • Rationale – Leaders who allow their staff an opportunity to complete staff satisfaction surveys are more likely to be committed to improving their quality of work life. Simply put, the happier the staff, the better the care the residents will receive.
   
   
   
10. What is the role here for family members? Do you have a family council and are we welcome at your facility?
• Best response – "We welcome and encourage family members to visit here any time, to volunteer here and to participate in our family council. I am happy to provide you with our family council meeting schedule."
• Rationale — Research indicates that families establish regular visiting patterns soon after a resident enters into a facility, and that support of families is a source of significant support for both the elders and the nursing home staff. Family members are keen observers of residents’ quality of life. An active and involved family council has been proven to have a positive effect on the facility.



11. What type of recreational activities are offered here?
• Best response – "We offer our residents a wide variety of activities here and encourage them to participate in those which are of interest them. Once we learn about an elder's interests, we inform them of which activities match their interests on a daily basis."
• Rationale – An individualized activities program based on an elder's interests has been shown to result in improved quality-of-life indicators.