Making the decision to move a loved one out of their home, away from their family and friends and into an unfamiliar building full of unfamiliar people, to spend what is usually the rest of their days, is difficult and traumatic enough on its own. Knowing how to identify the best facility that will provide the best quality of life and care can be even more intimidating, especially when new facilities are popping up by the dozens, dazzling in flashy colors and fancy décor to distract you from what’s really important: Quality of Care for mom and dad.
But finding the right place for mom or dad can be pretty easy if you can answer these 5 simple questions during your tour.
1. Is there an active Residents Counsel?
Many people often overlook the most powerful and effective player when it comes to making major changes in facility operations and controlling the standard of quality and care of the residents of the community: The residents, themselves.
In communities where quality of care is superior to all others in the area, you’ll almost always find a Residents Counsel made up of concerned and outspoken residents in the facility. Look at is as something of an HOA where the residents hold the facility and their staff (including their leadership) accountable for everything.
Whether or not there is an active Residents Counsel should be the first thing you ask – and verify! – on your tour. If the answer is Yes, you’re already off to a good start.
2. Is their Visiting Physician an actual Doctor?
When it comes to the care received by mom and dad, it’s almost always going to begin with a doctor who regularly visits the facility, meets with residents, diagnosis any issues and makes decisions for care moving forward. This added value to facilities is great for your loved ones who won’t have to leave the facility for their doctor visits, but there’s a dirty little secret most facilities don’t want you to know: A lot of times, that physician isn’t even a real doctor!
In many facilities, the person seeing your mother or father is an APRN (basically a nurse). Having a nurse visit your relative isn’t inherently a bad thing. The entire industry of Home Healthcare is built around that very practice. It is, however, dishonest and unethical for someone to represent themselves as something they’re not. If the visiting not-actually-a-physician is lying to your family about who they are, what else are they lying about?
We can tell you: Your right to choose.
While these faking clinicians don’t work for the facilities directly, they are generally in a business partnership with them, specifically introduced by a Home Healthcare Agency to act as a gate-keeper for any other care providers.
How this nefarious practice works is pretty simple: The Home Healthcare Agency introduces their not-a-doctor stooge to be the
“preferred” [exclusive] “physician” [not actually] of the facility. The lying clinician then has a monopoly on the visiting physician duties of the residents (which is bad enough because now the residents are being robbed of actual physician care) and then passes all nursing business to the Home Healthcare agency who brought them in, establishing a total monopoly of care and a total violation of patients’ right to choose their healthcare provider.
So why is this allowed? What does the facility get out of this deal? Usually nothing good. If a healthcare company abandons all notions of morality, you can imagine what their notions are on the actual quality of the care they’re supposed to provide. Bad care only reflects poorly on the facility and generally the facility loses business in the long run, but by then it’s almost always too late for their leadership to do anything about it.
Almost always, this arrangement isn’t made an owner-operator level. The owners of facilities are generally large corporations who leave the day-to-day operations to the local directors of those facilities. Almost always, those directors are being bribed under the table by the devious Home Healthcare agencies with expensive dinners, exotic vacations and other personal perks.
How is this legal? It isn’t. But reporting them is almost impossible, so it’s best to simply just avoid them altogether.
During your tour, ask who the preferred visiting physician is. The facility will have their marketing material on hand. Whip out your phone and check out their website. Look at their staff. Their founder/owner should be an MD. Most of their staff should be MDs. If they’re mostly APRNs, you already know who you’re dealing with.
3. Are their in-house Physical Therapists actually Therapists?
Physical Therapy (PT) is a huge industry, especially in Assisted Living Facilities where the majority of care needs in facilities are PT related. Much like “visiting
physician” scandal mentioned above, there’s another sneaky tactic opportunistic and dishonest Home Healthcare Agencies have done, involving 3rd party in-house physical therapists.
A lot of facilities have a room dedicated as a PT/Wellness clinic. Usually, this room is staffed by a separate company. This allows facilities to provide in-house PT services to their residents while potentially collecting rent on the room. It’s a great business model and there’s nothing inherently wrong with it. So, of course dishonest Home Healthcare agencies found a way to poison it to fill their pockets.
What they do is partner with a PT group who will rent the space and then refer all other nursing duties to that Home Healthcare Agency, again effectively blocking all other care providers and robbing residents of their right to choose.
It’s a dishonest practice that requires a dishonest PT company. So what dishonest practice does this dishonest PT company do to benefit from the deal? Because they now have the monopoly on the PT services in the facility and they can charge residents or bill to Medicare or insurance whatever they want, they generally staff the rooms (assuming they’re staffed at all) with Physical Therapy Assistants (PTA) instead of actual Physical Therapists. They then charge standard rates for Physical Therapists for the care provided at the PTA level. Once again, the HHAs and their crooked partners are presenting themselves and charging residents and Medicare as something they’re not.
Again, if your facility has an in-house PT/Wellness clinic, ask for the marketing material and do your due diligence, researching the PT group running the clinic. Check their staff and licensures. If they’re mostly PTAs, that’s who will be seeing your family, but you can rest assured they’ll be billing and collecting on much more than that.
Not all Home Healthcare Agencies are created equal. A few Home Healthcare Agencies like Welcome Homecare staff their own Physical Therapists who are licensed PTs. If they aren’t the active preferred provider in the facility, it’s possible to request them or have the Residents Counsel petition to have them made the preferred provider or operator of the clinics to ensure all residents receive qualified PT care.
4. Is their primary Home Healthcare Agency actually 5-Star?
As stated above, these questionable relationships almost always originate at the Home Healthcare level. When touring the facility, the Home Healthcare Agency with the most nurses (you’ll see their logos on their clothes or badges) is generally the preferred agency. And again, the facility should have their marketing material on hand.
Dishonest agencies will represent themselves as something they’re not. They’ll claim to be five star and usually accompany that with “quality of care.” This is a metric they actually rate entirely themselves and rely on no outside input. Believe it or not, that’s an industry standard. But there is a rating they can’t fake or rate themselves: Patient Satisfaction. And they can’t hide it either.
You can find the HHA’s patient satisfaction star rating (along with a lot of other great information) on Medicare’s website by typing in the HHA’s name or zip code you’re in. You can also see how many patient surveys were collected to reach their star rating. Remember that any rating according to less than 100 surveys is not statistically valid.
Unless there are no 5-Star agencies in the area (highly unlikely) there is absolutely no reason for a facility to not prefer a 5-Star patient satisfied agency. If the preferred HHA of the facility isn’t the highest rated in patient satisfaction, you should ask the Executive Director why they should receive your business if they’re not committed to providing your relative with the best care in the area.
And then you should leave, because any answer they give you won’t be the honest one.
5. Is the Facility actually Local?
Assisted Living is a booming business. Over 100 facilities have popped up in North Florida alone and there is no sign of that climb stopping any time soon.
Many of these facilities are owned by national corporations. There’s something to be said of that success, but it could also mean the people who actually care about future of their business are not directly involved with the future of your family members.
Usually, these large corporations leave the facilities under the management of management companies and local staff and they only meet every once in a while over the phone to get reports. Often times they aren’t getting an accurate read on the situation because the local staff don’t want to be honest with their personal benefits from nefarious dealings that will ultimately have long-term negative effects on the facility long after they’ve moved on to other jobs in other companies.
You can tell how a facility is owned by looking at their website and seeing what locations they have. If their corporate offices aren’t in your area, that’s a pretty sure sign they aren’t locally owned.
If their facility checks off the previous 4 questions with good results, that may not be a problem. But if the last 4 questions leave you wanting, you might have better luck choosing a locally owned and operated facility where your concerns will have a better chance reaching the eyes and ears of the people who can make a difference.
You can see why choosing the right place for mom and dad can be tough. But it doesn’t have to be impossible and you don’t have to do it alone. Companies like Welcome Homecare have done a lot of the vetting for you and have partnered with only the most honest and upstanding facilities and transitionary agencies in the area dedicated to residents’ choice.
If you are concerned about making the best decision for mom and dad, we’re here to help. Contact us any time.