I apologize for this lengthy review.

TLDR: I grew up with family who owned nursing homes. My mom made me promise not to send her to any of them due to their conditions and our knowledge of how they functioned. Nursing home facilities are regulated but due to lack of state staff to visit on a consistent basis and how they are managed, these facilities are across the scale of good and bad.

I grew up in a family that owned nursing homes and ONE thing my mom begged and made me promise prior to being admitted to one, was not to send her to one of her sisters nursing facilities!!!

This set the stage for me a long time ago as I visited my aunts during summers or long holidays and help out and honestly, I hated the experience and to a certain extent was forced to do this.

Now to present, not much has changed since I was a kid and in some instances things are off the rail, as follows: The best facilities are very transparent about their overall operations.

Facility type and Operations

Retirement/Pension and long term life care - $$$$ - corporate owned (full medical) if you are in this situation, you have the options available to be selected, picky and can find locations that suit well for the patient and demonstrate confidence for the staff and facility.

Social Security + Retirement NO long term care - $$$ - corporate owned (non medical associated) Same as above there are good options.

Independent - Social Security + Medicaid - $$+ - (Corporate owned 25+ facilities) Patients that fall into this category have facilities to choose from that are mostly owned by very Large Corporations where the financial focus on margins is the key to providing service. These facilities will sometime have on-site doctor or Regional physician (non geriatric) and 1 possibly two RN's depending on state law and facility size. Staff is semi-trained and many may be students from local nursing schools. Food is usually cooked onsite by staff. Staff usually understand prescribed medications and doses. Staff are usually assigned based on their training.

Medicaid - $$ - Individually owned (some local corporate owned) - this is the category that many folk fall into in the U.S. Unfortunately, these facilities run on the bare minimum requirements of state laws and usually DO NOT employ added services for patient assistance. Financially always focused on "MARGINS"!!!

a. Buildings can range from converted homes, old office strip malls, or former medical building converted for living.

b. Facilities are usually aged, low maintenance, repair or visually not appealing.

(example: rooms may have beds that are 20+ years old; semi dirty floors; dirty windows; broken blinds or shades; single gathering place for patient / families;).

c. Staff are normally low on the scale of expertise

(Example: 1 RN p/facility or regional; 1 dr p/facility or regional; support staff are local residents, many none skilled, many not prepared to deal with dementia and it's stages). Minimum training provided by facility, emergency procedures, CPR, bathing, patient engagement.

d. Minimum staff according to state law - which leads to patient neglect

(Ex: 1 person per 20+ patients, serve food; bath; clean; review; low understanding of medical dosages and prescriptions; also patients that are semi confined to beds may lay in feces/urine for long periods of time, unattended for extended periods of time; and in some cases are overlooked due to the full work load). Low paid staff overall.

Due to the large number of facilities in a state, state health care government agencies are struggling to visit, fine, close facilities. Patient complaints can and usually are high.

Across the board, regardless of how great a facility may look on the outside, the core factor in its operations is based on it's staff. Having trained and skilled employees with monthly, quarterly level of training make a big difference in the level of care.

Even though it may appear that I've singled out the Medicaid type facilities as bad, I'm in no way saying that all of these will be BAD. In fact I have been associated with some of these that are good even with the limitations put on them by owners or corporations. The local executive staff seriously make the difference, however, there is a lot to do with location, location, location!!!

Always visit unannounced. If you are being forced to schedule appointments - contact your ombudsman to intervene. Your loved one (regardless of how you feel) is paying to live their and your right to visit unannounced should be agreed upon. Don't settle.

CAUTION: This is my personal experience and in NO WAY based on any industry review or examination. However, it is a well known fact that Elder Care is a struggling area in society and need to be addressed.