To select quality care, ask these questions about a facility's record

Quality isn't necessarily the first thing families look for when choosing a residential facility. Like in real estate, it's often location — being close to people who will visit is important.

But quality is at or near the top for most, and it can be elusive and difficult to evaluate. Last week, I suggested key questions to ask to determine two of its primary ingredients, staffing and flexibility.

Today I'll talk about the third ingredient: Who manages the day-to-day care provided at a residential facility and what's their track record? This means getting information on the past performance of the place you're considering, plus a few of its sister facilities (if any). That's its "brand" — what does the company stand for? Is this company in the business of taking good care of people AND making money, or just making money?

Unfortunately, you're in for a fight to find the answers. While the government collects reams of information on care providers, it offers consumers few clues with which to evaluate their histories and performance (and then makes the information hard to get). But it's not impossible, and a little information is better than none, so let's begin.

Understand that much of residential care is a real-estate business. Often, one business owns the property, while another — the one responsible for what goes on day-to-day — provides the care.

Your first question: Who operates this facility? I know of no government or commercial database that provides this information, so you have to ask the facility's staff.

Second question: Where else does it do business (get the city and state) and what is its name? With the identity of a few sister facilities, you can track the operator's performance history on a wider level. Why is this important? Because how it cares for residents in one location is likely to be similar to its care in others.

More information

Residential facility surveys: www.adsa.dshs.wa.gov/Resources/rcshelp.htm or 800-422-3263. (Ask for the DSHS Medicaid licensing office nearest the facility you're interested in.)

Complaint histories:

Long-Term Care Ombudsman's

Office, 800-422-3263. (Ask for the regional office nearest the facility you're considering.)

Washington's Department of Social and Health Services (DSHS) inspects every care facility in our state at least once a year. The exception: retirement communities that provide no hands-on assistance, because these are not licensed. But for all other choices — retirement communities that provide some care, assisted-living facilities, and adult family homes — you'll usually find their most recent inspection report in a binder at the front desk. Nursing homes must post them in the lobby. Ask to see them when you visit.

Be cautious about inspection reports. They vary greatly in accuracy because of their subjective nature, and many are complicated and difficult to understand. However, they're all we have. Comparing several gives you a feel for how to read and judge them.

Then, if you can, get the inspection reports for several of the sister facilities of the one you're considering. You can visit and ask to see their surveys (not easy if they're far away), or, if they're in our state, contact the closest DSHS Medicaid licensing office and ask to have copies sent to you (they're free up to 100 pages).

Imagine another possibility. You're considering three assisted-living facilities for your mom. You've visited each, asked a lot of questions, and read their surveys. That evening after dinner, you go online to read their surveys from the past several years. In addition, you review similar information for a few of their sister facilities. You're able to sort by location, types of care and other factors, giving you a snapshot of each company's "brand," or track record. You're now closer to a decision, but first, you have a few questions about some of the citations they've received, questions you intend to ask in person. Since your mom's care is at stake — at $4,500 a month — this careful process is essential.

Unfortunately, this scenario isn't ever likely to exist. I asked a spokesman for DSHS last year when its survey results would be available online. The answer: never — it's too costly. Other states aren't much better.

The situation is different for nursing homes, the granddaddy of eldercare. You can obtain three years of inspection results for every nursing home in the country online at www.Medicare.gov (scroll down and click "Compare Nursing Homes in Your Area"). It's presented in a strange format that's difficult to understand, and, remember, survey results can have a lot of holes. Nonetheless, it allows consumers to quickly compare the track records of individual nursing homes, as well as their sister facilities (after you provide their names and locations).

I did this when I was shopping for a nursing home for my dad. One facility was part of a large corporation whose sister facilities had huge numbers of deficiencies, the one we chose had fewer. It wasn't sure proof, but it helped steer us in a direction.

Finally, you can learn about the complaint histories of individual facilities by contacting the Long-Term Care Ombudsman's Office (a program in every state that advocates for residents' rights). Some ombudsmen are extremely helpful, others not. However, a little information is better than none, and the more you have, the better your decision-making will be.

Liz Taylor's column runs Mondays in the Northwest Life section. A specialist in aging and long-term care for 30 years, she consults with families and their elders. E-mail her at growingolder@seattletimes.com or write to P.O. Box 11601, Bainbridge Island, WA 98110. You can see all of her columns at www.seattletimes.com/growingolder/.