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Having a loved one in a nursing home is an emotionally challenging experience. Even more challenging is monitoring the nursing care for an on-going period of weeks, months, or years. Since very few people outside the industry know what to expect, monitoring is not an easy task. However, it is vital for the welfare of the resident.

Once your loved one is admitted to a long-term care facility, the monitoring process begins. Close monitoring is the only way to assure consistently good nursing care. Regular visits to the nursing home are essential for monitoring resident care. Time your visits for different hours of the day. If you always arrive at lunch on Tuesday, for example, the staff will be aware of this and may alter the routine for your benefit. Visit on Saturday night and see what happens. There's nothing wrong with trying to keep staff on their toes. This varied visiting schedule will also allow you to get acquainted with more facility staff members, which is always helpful.

One way you can affect your loved one's care and monitor it at the same time is through involvement in the care plan process. If routine care plan meetings are held, make every effort to attend. If nothing else, your presence at the meeting shows the staff you intend to take an active role in the resident's care. Your knowledge of the person's preferences and history are valuable to the care team. Sharing this information will help the staff in preparing a thorough treatment plan. Think of it as a four-way team: resident, nursing staff, responsible family member (you), and the doctor.

Remember, though, the other team members have dozens of residents to monitor and their priorities are spread thin. You have only one resident to worry about, so be the voice, eyes, ears, and nose for your loved one.

Quality care is what you should expect for your money, but the ultimate responsibility still rests with the family. The following is a list of situations that usually indicate a good quality nursing facility.

1. Maintain weight

Weights should be taken regularly and listed in the resident's medical chart. It's generally a good sign if your loved one maintains the same weight after several months in long-term care.

2. Clean fingernails

Although this may seem like a small thing, clean and trimmed nails are an indicator of care. Nail care often gets relegated to the bottom of the list. Check often.

3. Clean, combed hair

Similar to clean fingernails, clean, combed hair is a good sign of daily, routine care. Dirty hair once, over the course of several months, is not a problem. However, if you notice dirty hair repeatedly, something is wrong. Check other residents in the facility. Do they also have dirty hair?

4. No pressure sores/bedsores

The bedridden resident is most susceptible to bedsores. Family members should observe if the resident is being turned routinely by the nursing staff. Usually a turning schedule will be set up. It is very important that this schedule be followed because prevention is the key.

5. Stable staffing

Stable staffing is a major factor in quality care. If you begin to recognize faces, that's a good sign. If you never see the same face twice, that's a bad sign.

6. Resident up and dressed for meals

If your loved one is often in bed at meal times, investigate and find out why. Unless there is an honest-to-goodness medical reason, your loved one should be up and in the dining room. All too often, the reason is not medical but inadequate staffing.

7. Tasty meals, served on time

Food is an issue that raises many complaints in long term care. If you regularly observe meals served on time (a meal schedule should be posted), then the dietary department is organized. When visiting at meal time, ask for a tray. How does the food appear? More importantly, how does it taste? If you would not eat the food, why should you expect your loved one to?

If the facility has an organized Family Council, join and attend the meetings. In this way, you can compare notes about the nursing care with other family members. If your monitoring has revealed consistent problems, chances are your loved one is not alone. A group such as this has more clout to fight against internal problems and get resolutions. The Family Council can be a monitoring group as well as a support group.

Don't be afraid to ask questions. Close monitoring will require you to speak out from time to time. Both you and your loved one have a great deal at stake, and mediocre care is just not good enough. Like any other service, if you pay for something, you should be reasonably satisfied with the results.

If the difficulties continue, consider moving your loved one to another facility. Re-examine all the health care options that meet their needs.

If you need additional assistance or advice, there are people in your community who can help. The local ombudsman acts as an intermediary if you have unresolved complaints. You could also call the State Board of Health or the local Adult Protective Services Agency.