Feel very fortunate that you were able to put your mother in a nursing facility as you did, because, not everyone is as lucky as you are.
The families, do indeed do their homework, before, placing their loved one in the nursing home of their choice, but, the staff member doing these tours, will tell you anything to sell the place. They would tell the family, that they have cooking classes, but yet, they didn't even have a kitchen or access to any cooking faculties. The families were told, they go on day trips, which never happened. However, they would occasionally take the residents' to restaurants. When they came back, you would hear horror stories from the residents', because, they would go understaffed, not to mention without a nurse, or, the fact, that the bus driver was not qualified. There were residents' that were not properly restrained in their wheelchairs, and would roll around in the back of the bus. The staff would take these residents' without their dentures, not to mention, making sure that some of the residents' would have their proper diet, such as some, that would have a puree diet, because, they have problems swallowing. When a staff member expressed concern, because, the person in charge allowed a man with alzheimer's to go to the bathroom by himself, she was accused of stepping on her toes.
I think it is very important for the residents' to live as much of a normal life, as if they were home. You tell me, where is the quality of life for these resident's in some of these homes ?

Skilled nursing? Quality staff? A homelike environment? Let's stop the retirement community B.S. and get down to some of the issues already expressed.

Having worked in one the the mentioned facilities for over 5 years, I have seen many cases of what has been mentioned. Yes, the state has made numerous trips to investigate but it usually comes down to a "one-on-one" situation unless by some stroke of luck there is a witness. The facility always wins the one-on-ones.

The issues that I observed start with the Director of Nursing. This individual sets the tone of what is to be expected or tolerated. Most do not have the guts to do what is necessary since they will alienate staff and create shortages causing staff to leave. They are captive to their own world and come and go like Depends on a bottom. The inmates (staff) run the asylum and do what they want at will. There are some compassionate staff but they are in the minority. Most CNA's have seen an opportunity to make a few bucks more than when they worked at a convenience store and chose this career for the money reason. They are the work horses of these facilities but are the biggest group that lacks social skills and education. Their supervisors do not supervise as they should since they in turn are not supervised by their D.O.N. Most of your administrators have little to no healthcare backgrounds and are castoffs from corporate America bringing in their baggage of dysfunctional leadership. This just further entrenches the management issues of the healthcare facility. We always used to joke at to who we thought was steering the ship for the day since most kept hitting waves or icebergs. This is endemic of the healthcare system but no one wants to roll their sleeves up and clean house. My guess is that most are affiliated with a religious denomination and we shan't embarrass God or our contributors.

State inspections? Most facilities know in advance that inspectors are coming and are diligent in getting charts up to date and the facility cleaned. After they leave, it is business as usual. I watched this many times and it is almost comical to see the flurry of activity and then everyone goes out for a smoke and sits on their arse. Only the facilities that are the worst of the worst have any repercussions from the state. Most inspectors find insignificant things to nit-pick since they must justify their positions.

Speaking of a religious affiliation, this has become the touted marketing tool to bring them in as they say. If members truly knew what was going on in the name of their denomination, many would choose elsewhere. There are facilities with a religious affiliation that run a good ship. You can tell this by where all your good employees end up at. My hats off to those facilities since you have figured out what is needed and can effectively manage your facility. You have quality people at the top and seek that throughout your ranks. The rest of your contemporaries just fill in the blanks with who ever they can hire and it shows.

Retirement facilities are beneficial for some people who need this care and living arrangement (widows, widowers). Fear plays a big factor in marketing this lifestyle and it is easy for an older person to succumb to it and make a hasty decision to move into a facility. It is a financial drain and is set up to deplete assets with entrances fees, yearly fee increases and other expenses. It has become an area that this business has seen the opportunity to absorb the financial assets of seniors who have spent a life time acquiring. We called it the Senior Cash Cow syndrome of the retirement community business. They are all the same no matter what they say since they are all set up the same way. Some may be better at hiding that fact than others.

Making the choice to move to this type of facility requires a lot of research by family if this truly is what your mom or dad want to do. Know that their assets will be depleted unless they are well healed and the family will see no assets that could have been passed on. Visit the healthcare facility in the evening, on weekends or holidays. You will see what we all see then since it is play time in the asylum. You will hear call bells ringing, smell the smells of those who couldn't wait any longer and hear those calling for help. This is reality and you need to see it. Families are afraid to speak out for fear their loved one may be the target of neglect or abuse when they are not there. I have heard this many times from families so make sure you are their advocate.

So stop, look and listen when making the choice of your retirement home. Your golden years are just that for those looking to tap your bank account.

State Surveys are independent evaluations of nursing facility performance. Annual surveys are conducted by state survey agencies, usually the state's department of health, using protocols, procedures, and forms developed by the Centers for Medicare & Medicaid Services (CMS).

A consumer concern about surveys is the repeated finding by the Government Accountability Office (GAO), in a series of reports issued since 1998, that surveys understate deficiencies and cite deficiencies as less serious than they actually are.

The survey component of CMS's proposed ranking system provides a more positive statement about quality than justified. States are increasingly using their state enforcement systems, instead of the federal system, to sanction facilities for noncompliance with standards of care. State enforcement actions do not appear on Nursing Home Compare.

The National Senior Citizens Law Center recommends that consumers use the new rating system with caution, and only as an aid while also pursuing other information and strategies. Consumers need to understand that the five-star system is a beginning, not an end.

A nursing home's quality can shift from month to month, so you have to be savvy in asking the right questions. Existing residents and their family members should be asked for their opinions.

Inspection data is mostly based on a once-a-year survey and may not accurately reflect the nursing home's performance today. Staffing information and quality measures are "self-reported" data by the nursing homes themselves. Self-reported data makes nursing home quality "appear" to be better than it actually is. It cannot easily be reduced to a star rating.

A recent GAO study found that nursing homes over-report staffing levels compared with staffing reported on audited Medicaid cost reports. Over-reporting of nursing coverage is associated with for-profit ownership of nursing homes.

Researchers recommend more careful scrutiny of staffing levels in for-profit facilties during the survey process and that improvements be made to the process of public reporting of staffing levels.

CMS should provide more and better information on Nursing Home Compare, including links to the actual survey forms and information about staff turnover. Also, CMS should use payroll data to report staffing information.

Anything to do with "quality indicators" is bogus. When de-regulation failed under the previous administration, they wanted, among other things, the "quality indicator" process to eventually replace traditional annual surverys because it relies upon self-reported, unaudited data supplied by the facilities themselves and is without consequences for failures. But it still relies upon self-reported, unaudited data supplied by the facilities themselves.

It leaves you with that warm-n-fuzzy "we'll-help-them-fix-their-problems," even though 99% of their failures are failures of practices they should already be experienced in before they are granted a license. It is part of the "kid-gloves," don't be-so-hard-on-the-poor-poor-nursing-homes" from the previous administration.

Sometimes there are no alternatives to skilled care. In these cases, it is extremely important that the family visit often, and pay attention to what is going on. I have found that if you constantly monitor your loved one's situation, the care they receive is greatly improved. Sad, but a reality.