No fewer than one in five Marylanders over 60 will live an average of almost three years in half a room in a building filled with sick or confused people. The stay won't come cheap: The basic rate, without any extras, normally runs at least $100 a day.
It's a stay few plan or even think about until they have to. Most choosing a nursing home -- often children, spouses or other relatives of the elderly -- must decide on one quickly, out of necessity, amid an emotionally wrenching crisis.
But it's vital to set aside time to take a hard look at nursing homes -- to visit, ask lots of questions, keep detailed notes, inspect records -- to ensure good care in a pleasant environment.
* What type of care is needed? "Skilled care" is intensive care under the supervision of doctors and nurses or rehabilitation such as physical or speech therapy. "Intermediate care" means limited nursing care as well as help in taking medication, bathing, dressing and getting around. Getting a bed can depend on what kind of care is needed.
* Can you find a nursing home near your home? Few things are more important to a patient than frequent visits from relatives and friends.
* Is the nursing home approved for Medicare and Medicaid programs? Most nursing home residents exhaust their assets in less than a year and then must rely on Medicaid to foot most or all of the nursing home tab.
Medicare, the federal medical and hospital insurance system for those over 65, pays only in rare cases, accounting for less than 2 percent of nursing home care in Maryland.
* What extra charges are likely? Basic rates normally covers room, meals, housekeeping, linen, general nursing care, recreation and personal care. Many homes charge separate fees for physician visits, drugs, tests and services such as phone calls and haircuts.
* Can you visit the home? Call the administrator and arrange for a meeting, a tour and time to poke around, observe and chat with residents and staff. Meet the directors of nursing and social services. Be observant and keep detailed notes.
* Is the home clean, brightly lighted and free of strong chemical and deodorant odors often used to cover up smells because linens and clothes haven't been changed promptly?
* Are patients dressed, groomed and talking? Do they appear comfortable and cared for and participate in regularly scheduled recreation and activities? If most appear docile, it could mean they're sedated with drugs.
* Can residents walk outside in good weather?
* Are many patients wearing restraints? If so, ask why. Such restraints should be used only with a doctor's written order.
* What kinds of care are provided to meet the patient's specific needs, such as Alzheimer's disease, other illnesses or physical disabilities?
* Are rooms bright and decorated with pictures on walls? Is there adequate space for personal belongings, clothing, a television and radio?
Are phones provided? Is theft a problem?
* Are bathrooms spotless and accessible to handicapped residents? Does each bed have a curtain or screen for privacy? Does each resident have a call button within reach? Do staff members respond to calls promptly?
* Do employees show respect for residents or treat them condescendingly or harshly? Are enough nurses on duty? Maryland law requires nursing homes to have a registered nurse on duty during the day seven days a week and a licensed nurse at all times. What is the ratio of nursing staff to residents? The more RNs, the better the care may be. What is the staff turnover rate?
* Are the dining room and kitchen clean and pleasant? Do residents appear to enjoy the food? Do those who need help eating get it? How many meals a day are served? Are snacks available? Will the home provide for special diets such as low-cholesterol, diabetic or low-salt? Nursing home residents complain more about the food than anything else.
* Are emergency exit doors well-marked, unobstructed, unlocked and accessible to handicapped residents? Are fire, evacuation and disaster plans posted?
* Does a resident council meet regularly? Request a copy of the residents' rights policy.
* What physician services are available? Does the home keep records of contacts with the attending physician or the patient's doctor? Is a staff physician readily available at all times? The law requires either the patient's physician or one from the nursing home to visit at least once a month during the first 90 days to evaluate the patient's condition and review medications. Thereafter, a doctor must visit every other month. The nursing home must have a doctor available by phone or on-hand 24 hours a day.
* Does the home have arrangements with a nearby pharmacy to deliver medications and with a nearby hospital to transfer residents in emergencies?