Skilled Nursing Care Evaluation Checklist

Nursing Home Name: _______________________________________________ Contact Name: _____________________________________________________ Address: _________________________________________________________ Telephone: _____________________ Email: _____________________________ Date Visited: ___________ Circle: First Visit Second VisitThird Visit

Day of the Week: _________ Circle: Morning Afternoon Evening

Floor Plans and Safety Accommodations

Is the floor plan logical and easy to follow? What types of rooms are offered? Private or semi-private? Do the hallways have handrails? Do rooms/bathrooms have grab bars and call buttons? Are there safety locks on the doors and windows? Are there security/fire safety systems? Is there an emergency generator or alternate power source? Circle the in-room amenities that are available. Is there an extra cost? Phone TV Cable Internet Other

Healthcare Services

Is specialized memory care available for individuals with dementia or Alzheimer’s? If memory care is offered, is it provided in a separate unit with additional security and specially trained staff? Is transportation available for visits to the resident’s personal physician or special medical services such as dialysis? Is there an extra cost? Are there any restrictions? Is physical therapy available for as long as the resident needs it? Does the facility provide EMSA/TotalCare ambulance services membership? Is there an extra cost?

Quality of Care and Life

What is the facility’s philosophy of care? Do they focus on person-centered care? Are care planning meetings held at times convenient for residents/family to attend? Does the skilled nursing facility have an active family council? Do residents have the same caregivers on a daily basis? Does the staff knock before entering a resident’s room? Are the doors shut when a resident is being dressed or bathed? Are there any onsite amenities? (e.g., beauty salon, chapel, library, etc.)

Are residents offered choices of food? Is the food tasty and nutritious? Are snacks offered throughout the day? Is there fresh water available in the rooms? Do residents receive assistance eating or drinking as needed? Does the nursing facility meet cultural, religious, and/or language needs? Are residents you observe participating in activities and exercise? What is the visitation policy? Is the location convenient for family visits? Are transportation services provided? Is there an extra cost or any restrictions? Does the community have outdoor areas for residents and staff?

Licensing, Staffing and History

Is the skilled nursing facility Medicaid certified? Is the nursing facility locally owned? Is it a nonprofit or for-profit organization? Has the facility’s license ever been revoked? If so, when and why? Are background checks conducted on all staff members? What is the staff turnover rate? Does the skilled nursing facility have its own doctor(s) on staff? Can you use your own primary care physician? How many licensed nurses are on duty at each shift? RNs: LPNs: What is the resident-to-staff ratio? Resident-to-nurse? Resident-to-aide?

Things to Pay Attention to During Your Visit

Is the facility clean? Does it smell clean? Is the patient’s bill of rights posted? Is there a resident notification area? Is there an up-to-date activity and meals calendar posted? If so, do the activities and meals sound appealing? Do residents appear well-groomed and happy? How do staff and residents greet each other and interact?

Ask residents and their families for their opinions about the facility and staff.

Financial Obligations and Processes

Is the nursing facility accepting new residents? If not, is there a waiting list for admission? Is a contract available that details all fees, services, and admission and discharge policies? Is the contract easy to read? Do you understand it? What levels of care are addressed in the contract? Does the facility accept payment through Medicare or Medicaid? Are deposits required? Are any refundable? How are rate increases and late payments handled? Under what conditions would a resident be asked to leave the facility? How much notice is given?