New apartments at St. John's United

A sign shows the planned new apartment building during demolition of an old building at St. John's United on Monday. The campus on Rimrock Road offers senior apartments, assisted living and skilled nursing care.

Montanans have more choices for long-term care than ever before, with 35 licensed assisted living facilities and six nursing homes in Billings alone, according to a state website. Yet picking the best one can be difficult, especially if the individual or family is hurrying to make a decision.

Help is available for these important decisions.

Last week, Montana newspapers reported that six nursing homes in the state (none in Billings) were on the nation's "poorest performer" list. Such listings are cause for serious concern, but don't provide information for making a good placement decision.

The Gazette asked state long-term care ombudsman Vanessa Fitchett for her advice. Fitchett, who has been an advocate for Montanans in assisted living and nursing homes for more than 13 years, lives in Plains. She supervises 17 full-time equivalent ombudsmen statewide and also makes regular visits to licensed facilities near her home in western Montana.

"We are resident driven," Fitchett said in a telephone interview. The ombudsman's job is to ensure that resident rights guaranteed by state and federal law are upheld. They make unannounced visits to licensed long-term care facilities where about 14,000 Montanans reside.

"Make plans for the future," Fitchett advised. "Don't wait till the situation is an emergency. Discuss long-term care with your family. Call your local Area Agency on Aging."

Fitchett offered these tips for checking out long-term care facilities:

  • Take a tour and note staff interactions with residents. Are the residents happy? Is the staff respectful? Are residents and staff talking or is the facility virtually silent. Did the staff greet you?
  • Use all of your senses. Does the place smell? What noises do you hear?
  • Visit at meal time and observe how residents are served. Sample the food.
  • After taking a tour, return after 5 p.m. or on a weekend to observe what's happening then.
  • Think about how the place would suit you or your relative.
  • Ask if the facility has a resident council. If it does, ask to speak with the council president. 
  • Read the state inspection reports that must be posted at the facility and also are online.

The Montana Department of Public Health and Human Services posts inspection reports for both licensed nursing homes and licensed assisted living facilities.

The federal Medicare Compare website rates each nursing home with up to five stars — five being the best. Dive into those star ratings by comparing nursing homes' staffing levels and quality measures. The website provides the ratio of work hours for nurses and certified nursing assistants per resident, as well as data on incidents of falls, pressure sores, use of psychiatric medication and physical restraints.

It's important to know what level of care an individual needs and to think about how those needs are likely to change. Some facilities offer multiple levels of care. Independent living, assisted living and skilled nursing care can be located all on one campus. Others may offer independent living and assisted living, but not skilled nursing. Nursing homes may have adjoining assisted living apartments.

Assisted living facilities may be licensed for 'A' beds for people who need help with three or fewer activities of daily living, such as dressing, bathing, toileting or mobility. Assisted living can be licensed for up to five 'B' beds for residents who need more help. 'C' beds are licensed for residents who have cognitive difficulties, such as dementia. The individual's physician should be consulted about what level of care is recommended. 

Nursing homes are much more highly regulated than assisted living facilities. For example, state and federal law requires an inspection of every licensed nursing home at least every 15 months. Assisted living facilities may go three years between inspections.

Relatives, friends and other advocates for residents need to inspect frequently to assure that their loved one's needs are being met. Check the box above for more resources on long-term care.

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