How to Choose a Healthcare Provider or Facility

Choosing a healthcare facility for your loved is one of the toughest decisions you can make, but it is your choice! At first appearance, through web sites and printed brochures, all facilities can put their best foot forward. However, often the quality facilities can be separated from the rest with one visit. Here are some things to look for:

• Is the facility clean and well maintained?
• Is there good food cooking?
• Is there a foul odor when you initially walk into the facility?
• Are you greeted and made welcome upon arrival?
• Are the employees courteous, friendly and professional looking?
• Are the residents busy in meaningful activities?

Once you meet with the professional team, you can ask these questions to explore their commitment to quality:

• Has the facility, owners or senior management team ever been sued or had to settle claims against it involving patient care or any negligence?
• Have abuse and/or neglect complaints ever been filed against the facility? Were these found to be substantiated by the facility's licensing authority?
• Can you have a printed copy of the company's policy for reviewing critical incidents and major adverse events?
• What are the outcome measures used to determine overall effectiveness of the program?
• Are any of the members on the ownership involved in volunteer work or disability advocacy?
• What is the turnover rate of the direct care personnel and the therapists? How does the facility attempt to maintain a low turnover rate?
• Does the facility welcome unannounced “drop-in's” by family members or family participation in therapies?
• Can you get a copy of the most recent facility licensing inspection report?
• Can the professional staff readily describe their continuous process improvement for improving the quality of care?
• What would the daily schedule look like for your loved one?
• What different ways have been used in the past with other residents to increase their quality of life?
• What is the staff to resident ratio during the awake hours and on the overnight? Do these ratios meet or exceed the minimum standards required by licensing?
• What is the caseload for the case managers and professional staff (psychologist, therapists, physicians)? Does this seem like a reasonable caseload?
• How much training do the direct care personnel have before directly working with the residents?
• How do the facility fees rank against other providers of the same services?

Of course the person you speak with may be new to the company or may be a marketing person unfamiliar with company history, so it would be in your best interest to ask for a signed letter from the owners of the company responding to any of the above questions. The willingness of ownership to foster responsive and open communication can show much about the management style of the company. Upon your first visit, also make a note of the toll free number posted to make complaints against the facility. Licensing standards require that these numbers be posted in public view.

After the first facility visit, try a simple Internet search for news articles and web sites related to a facility, its programs, ownership and senior management. The world wide web contains a tremendous amount of information about individuals and companies.

After admission, here are things to look for:

• Look for on-time and complete clinical reports from the professional staff.
• Look for timely and consistent feedback from the clinical team.
• Look for a case manger or other staff members to be your designated contact person.
• Look for a number of ways to get in touch with your case manager or contact person: phone, email, fax, mail.
• Look for regular updates on happenings at the facility.
• Look to pay less for services as your loved one requires less therapy or can live more independently.

Most importantly though, ask your loved one how things are going. Ask him or her to describe their schedule or tell you about the people they live with, the therapists, the direct care staff. Ask about the food and the upkeep of the facility. Ask what they have been doing with their free time, in therapy or in the community. Many times a resident may have some adjustment issues following admission and complains about a new placement. This can be normal, but unsettling for the family to hear. So ask probing questions of your loved and follow-up with the management team to tease out the adjustment issues from genuine complaints about the quality of care.

If you have continued concerns, consider an unannounced visit. Drop in unannounced to the facility on the weekend, early morning or later in the evening if you suspect something amiss. If they have never met you before, the staff on duty should ask you for identification and ask you to wait while they verify that you have authorization to visit. This should not take long and often the resident will see you as you arrive.

Trust your instincts. A facility should work hard to earn your trust. No one program can have perfect performance 100% of the time so when small problems arise make sure the staff respond this way:

• respond in a timely way,
• admit to their mistake,
• offer to make things right,
• ask you how to make things right,
• offer a corrective action plan to prevent the mistake from happening again, and
• follow-up with you once the corrective action plan is in place.

If mistakes are continuous or if you suspect abuse or neglect, call the toll free number for complaints against the facility. You can make this an anonymous call if you choose. And remember, the choice is yours. There are many quality providers in Texas and across the nation. Get informed and advocate for your loved one.

Other Provider & Red Flags (or what evidence juries weigh in their decisions against providers):

• “Rubber stamping” of clinical treatment reviews by the clinical or program director
• Little change from treatment review to treatment review
• Incomplete or missing clinical documentation (There is a saying in the healthcare industry “if it wasn't documented, it didn't happen”)
• Late notification of problems
• Higher than industry average turnover rates
• Poor state inspection results from year-to-year, most states like Texas post these inspections on-line for public viewing
• Facility hazards that are not addressed in timely ways
• Lack of consistency to follow their own stated policies and procedures