It's frustrating to discover that the care Mom is receiving in her new nursing home falls short of expectations—yours and hers. It's frightening to think that it might be bad.
But how would you know?
"There are literally dozens of warning signs," says Dan Sewell, director of the senior behavioral health unit at the UC San Diego Medical Center. Here are what he and other experts consider especially serious red flags:
1. Marked emotional or physical changes. Look first to your loved one. You should be concerned if she is less able to function as usual, has stopped taking part in activities, or has become withdrawn and uncommunicative. If Mom is experiencing emotional abuse—such as being ignored or talked down to—she may be agitated and withdrawn, fearful, or experience loss of weight or appetite and sudden changes in mood or sleep pattern. Physical abuse or neglect may be a concern if Dad has unexplained bruises, pressure ulcers, or skin tears, particularly in areas that are not regularly visible, like the upper back, hips, and thighs.
Careful, though: These are potential clues, not proof, of bad care. "The problem is that some of these changes represent the inevitability of the underlying disease, and not poor care," says Josh Uy, assistant professor of geriatric medicine at the University of Pennsylvania's Perelman School of Medicine. Mom might think a staff member was condescending when he was just using a term of endearment. Bumping the nightstand can cause an alarming bruise on an elderly person using a blood thinner like Coumadin. You'll need to observe the staff with Dad, stop by unexpectedly on various days and at different times, and ask staff to explain anything you find worrisome.
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2. Unanswered or deflected questions. "I don't know, but I will find out" is an acceptable response—but not regularly, and you shouldn't get the feeling there's something to hide. "If staff are evasive with your questions, unable to answer your questions, or refuse to discuss your loved one's care with you, this is a big red flag that care may be suboptimal," says Amy Jo Haavisto Kind, an assistant professor in geriatrics at the University of Wisconsin School of Medicine and Public Health.
Some questions, such as, "My mom is losing weight, what is the plan?" should always have a ready answer. "If all a person gets is blank stares or a dismissal—'Old people just do this, don't worry about it'—then that is concerning," says Uy.
What's the ultimate wrong answer? "I get more concerned when someone says, 'This is how we do things here,' and has no desire to help," says Jatin Dave, a physician at the Brigham and Women's Hospital's Center for Older Adult Health.
3. Frantic, discordant, or inadequate staff. A busy, thin-stretched staff may be unavoidable at times, experts say. But does it always feel chaotic when you visit? Are staff working well together, or do they seem to have bad attitudes? At meals, do they talk only among themselves or do they mingle with residents? Does important information get lost between shift changes?
Don't overlook the leadership. Is the director nowhere to be found and unknown to residents? "I have never seen a place with strong, involved leadership that had bad care," says Barbara Bowers, associate dean for research at the University of Wisconsin-Madison's School of Nursing, who researches long-term care delivery.
4. High staff turnover. "Some regular staff turnover is an unfortunate reality at most nursing homes," says Kind. "However, if you notice that your loved one's nursing home constantly is training new staff to the point that no one on the staff knows your loved one—well, it is time to look for a new nursing home." Consistent staff-resident pairing is important in the quality of care Mom gets.
5. "I don't want so-and-so to care for me." Your loved one should never feel distressed or uncomfortable around any staff member, experts say. Even if Dad suffers from cognitive problems, "take these statements seriously and investigate them thoroughly with the nursing home leadership," says Kind. "They may be signs of mistreatment or neglect."