• Determine what type of facility the person needs. You can read my definitions to learn the differences between nursing homes, skilled nursing units, assisted living facilities, continuing care retirement communities and adult day care centers. In general, most people hope to retain as much independence as possible. (An increasingly popular option is in-home care. I’ll write more about a great home care company located in Central Florida in one of my next blogs.)
• Decide what part of the state of Florida your loved one is interested or willing to live. I’ve divided my database into the following regions: Panhandle, North Florida, Central Florida, Central Gulf Coast, Southeast Coast, Southwest Gulf Coast, South Central Florida. You can also look at my map to understand where those regions are.
• Conduct a search of the Florida Senior Living Advisor database, based on your answers to the above two questions. If a facility has a website, I provide a direct link to it from the database. So look at the facility’s website to get more information. Of course, keep in mind that some of these Florida senior living facilities provide very detailed information on their websites, others do not. If a facility you are interested in does not have a website, you will need to call to get more information.
• Look at Florida Senior Living Advisor’s “Evaluating Facilities” page for a list of the questions that I asked – and some I wish I had asked – as I was researching facilities for my elderly father. The answers you receive can help you start to narrow down your list of options.
• Of course a big deciding factor is cost. This will vary greatly from facility to facility.

And don’t forget good, old-fashioned word-of-mouth. Talk to friends and neighbors. This is what lead me to help my father find the perfect facility – a casual conversation at a social event with an acquaintance I had not seen in several months. When she asked, “What’s new?” I proceeded to explain how I was immersed  in helping my father select a Florida senior living facility. She responded by telling me about a facility she had just visited with her elderly mother. And the rest, as they say, is history.

One more idea: if you feel like you need more help, someone to walk you through the process, consider hiring a senior care management company. I  recently met a wonderful woman named Patrice Antony who owns and operates Elder Advocates, Inc. in the Orlando area. Patrice is a Physical Therapist and Geriatric Clinical Specialist with more than 27 years of experience in working with the handicapped and the elderly. Patrice and her staff will do as much or as little as you need – from helping you research and select a senior facility, to consulting with medical staff on a client’s behalf, and negotiating with insurance companies. For more information, visit the Elder Advocates website.

I’d love to hear back from anyone currently going through this search process for an elderly family member. Comment on this blog or send  me an email at mitra@flseniorlivingadvisor.com.

In Volusia, officers from the state’s Medicaid Fraud Control Unit arrested Marjorie Nelson, owner and operator of Helping Hands Manor I and II in Edgewater. According to the Attorney General’s office, Nelson told investigators she had not licensed the second location because upgrading the septic system and fire suppression systems would cost too much. Those upgrades were necessary to qualify for a license. Nelson is charged with operating an unlicensed assisted living facility, a third-degree felony. If convicted, she faces up to five years in prison and a $5,000 fine.

In Duval County, officers arrested Tommy Teague and Roberto Gallegos on charges of operating an unlicensed facility at 2198 Mossbrook Court in Jacksonville. Teague and Gallegos face third-degree felony charges and could each face up to five years in prison if convicted.

At the third facility, Medicaid fraud investigators determined through a routine spot-check that Torina Brooks had exceeded the capacity of her licensed facility, Pauline’s House in Jacksonville. Brooks placed the extra clients in an unlicensed facility across the street and requested Medicaid reimbursement for their care. She faces one count of operating and/or maintaining an assisted living facility without a license, one count of Medicaid fraud and one count of grand theft, all third-degree felonies, and could face up to 15 years if convicted of all charges.

To legally and properly operate an assisted living facility in the state of Florida, there are various administrative and operational requirements which must be met. These include licensing procedures, staffing requirements, compliance with county health and local fire authority regulations and the safe management of medication by trained staff personnel.

For a searchable database of licensed assisted living facilities throughout Florida, visit Florida Senior Living Advisor. Licensing status can change, so be sure to ask for proof of licensure when visiting a facility. For more information on the Florida’s licensing process for senior living facilities, visit the Florida Agency for Health Care Administration (AHCA).

Last fall my father had to spend several weeks in the nursing home that is part of his Florida continuing care retirement community. He had fallen in his apartment, received treatment at a local hospital and then was discharged to the nursing home for rehabilitation and physical therapy. To be blunt, initially it was a terrible experience. When we arrived at the nursing home, they assigned my father to a room and then left us to fend for ourselves for what felt like an eternity. How wonderful it would have been to have someone – a nurse, an administrator, anyone -  take a few minutes to welcome him, explain his daily schedule, meal options, etc. Yes, I understand that he was just one of many patients they had to deal with. But a little warmth and time spent in his admission would have gone so far in starting things off on the right track. Instead I left the nursing home that afternoon with a knot in my stomach, with no confidence in the care he would receive. It certainly did not feel like a “homelike environment.”

One of the other points in Friday’s CMS report is that nursing homes should start to pay “close attention to resident’s preference for his or her own daily schedule.” I know this will be a difficult task, but how wonderful it will be for the residents in nursing homes that can fulfill this suggestion. My father prefers to eat his dinner later in the evening, 6:30 at the earliest. While he was in the nursing home, he had to eat at 5pm. That may seem like a minor issue, but to anyone who has dealt with a family member in this situation, you know that it has a big impact on their attitude and sense of dignity. One of the things that upset my father the most while he was in the nursing home was that he was dependent on the nurses and CNAs just to use the bathroom. He would have to ring the call bell and then wait, and wait, and wait, for someone to come into his room to help him up to the bathroom. As you can imagine, at 84-years-old, this was often an urgent issue for him.  But most of the nursing staff seemed to exhibit total disregard for this.

I believe that part of the problem initially was that my father was placed on a floor where most of the other residents were much more incapacitated that he was. So I think the staff was a bit slack – it is tempting to not be “resident-centered” if the resident doesn’t know the difference, and can’t even articulate any frustration. He was also placed in a corner room at the end of the hall, a bit of the “out of site, out of mind” phenomena. After my sister and I raised a fuss, he was transferred to a different floor and that’s when things turned around. He was surrounded  by more active residents, and more engaged staff members. I recall the dining supervisor found out that he had been asking for honey to go with his hot tea (which was usually served lukewarm, by the way). Just when he had given up on ever getting honey, she arrived with several small packets  delivered personally to his room. A small gesture that made a big impression.

I’m sure there are nursing homes in Florida and the rest of the country that already focus on “resident-centered care” and “homelike environments.” But there are far too many that don’t. This won’t happen overnight. But I have hope that these new survey guidelines will at least get these important issues on the table and create greater accountability for nursing homes. If you’d like to learn more about the CMS guidelines, visit http://www.cms.hhs.gov/transmittals/downloads/R48SOMA.pdf

For a searchable database of nursing home in Florida, visit Florida Senior Living Advisor.

This is the federal government’s Medicare website. One of the most useful tools they provide is their Nursing Home Compare database. This tool has a Five-Star Quality Rating System about every Medicare and Medicaid-certified nursing home in Florida and throughout the country. There are 677 Florida nursing homes in the database.

Here is a description of the rating system for nursing homes from the website:
The Five-Star Quality Rating System helps consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions.

The Nursing Home Compare Web site now features a quality rating system that gives each nursing home a rating of between 1 and 5 stars.  Nursing homes with 5 stars are considered to have much above average quality and nursing homes with 1 star are considered to have quality much below average.  There is one Overall 5-star rating for each nursing home, and a separate rating for each of the following three sources of information:

Health Inspections – The health inspection rating contains information from the last 3 years of onsite inspections, including both standard surveys and any complaint surveys.  This information is gathered by individuals who go onsite to the nursing home and follow a specific process to determine the extent to which a nursing home has met Medicare’s minimum quality requirements.  The most recent survey findings are weighted more than the prior two years.  More than 200,000 onsite reviews are used in the health inspection scoring nationally.

Staffing – The staffing rating has information about the number of hours of care on average provided to each resident each day by nursing staff.  This rating considers differences in the level of need of care of residents in different nursing homes.  For example, a nursing home with residents who had more severe needs would be expected to have more nursing staff than a nursing home where the resident needs were not as high.

Quality Measures (QMs) – The quality measure rating has information on 10 different physical and clinical measures for nursing home residents – for example, the prevalence of pressure sores or changes to resident’s mobility.  This information is collected by the nursing home for all residents.  The QMs offer information about how well nursing homes are caring for their residents’ physical and clinical needs.  More than 12 million assessments of the conditions of nursing home residents are used in the Five-Star rating system.

On the Web site people will be able to arrange the order of the nursing homes according to any of the three aspects above, as well as an overall quality rating based on those three sources of information.