Monitoring care quality after the move — staying involved
This article is for informational purposes only and does not constitute medical, legal, or financial advice. Please consult appropriate professionals for guidance specific to your situation.
Three months in, the crisis mode is over. Your parent has adjusted to some degree. The emergency that prompted placement has been managed. Life settles into a rhythm. You visit on weekends. You get occasional updates from the facility. Things seem fine. And then you miss a week of visits. And then you miss two weeks. The urgency is gone. The demands of your own life reassert themselves. Months go by with minimal contact. Your parent has adapted and seems reasonably content. The intensity of involvement that was necessary in the first days and weeks no longer feels necessary.
This is where quality of care problems often develop. Not because of malice, but because of human nature. When families are present and attentive, facilities tend to function better. Staff members who know a family member will see their parent today are more likely to make sure your parent's appearance is neat, their medications are on time, any problems are attended to. When families are absent, the attention can drift. Your parent becomes one of thirty residents. Their individual needs matter less because there's no one watching to make sure they're addressed.
This doesn't mean you have to visit every day. Reasonable ongoing involvement can be much less frequent than the early involvement phase. But it needs to be consistent and present. Your parent is in a facility for months, possibly years. They need to know you're still there, still advocating, still paying attention. The facility needs to know they're accountable.
How to Evaluate Quality of Care
Nursing home quality varies wildly. Some are genuinely good. Some are mediocre. Some are terrible. The difference between a good facility and a bad one isn't always visible to families who don't know what to look for. A facility can look clean and run smoothly and still be providing inadequate care. A facility can look a little chaotic and still be excellent with individual residents.
Infection rates are one real indicator of care quality. Ask your facility directly: what's your infection rate? Specifically, what's your urinary tract infection rate? What's your pneumonia rate? What's your rate of methicillin-resistant Staphylococcus aureus (MRSA) infection? Good facilities know these numbers and can share them with families. They also compare their rates to other facilities. If your facility's infection rate is significantly higher than state averages, that's a problem.
Infection rates matter because infections are preventable through good hygiene, good wound care, and prompt treatment. A high infection rate suggests corners are being cut or attention is lacking. Urinary tract infections are particularly common in facilities because catheter care requires diligence. MRSA infection suggests inadequate infection control practices. Pneumonia in a facility population isn't unusual, but very high rates suggest inadequate attention to swallowing issues or aspirations that should be prevented.
Family complaints and regulatory violations are another measure. Your state's Department of Health probably has inspection records for nursing facilities available online. Look at recent inspections. What violations were cited? Most facilities have some violations. But look for patterns. Are there repeated violations around the same issues? Are there any violations around abuse, neglect, or quality of care? Are there violations that suggest poor staffing or inadequate training? Some violations are minor. Some are serious. Learn to distinguish.
Also ask about staff expertise. Who is the medical director? What are their qualifications? Who is the nursing supervisor? How long have they worked there? If there's very high turnover in key positions, that's a concern. Staff who know your parent and know the facility's systems provide better care than staff who are new and don't have continuity. Ask about training. How often is staff training provided? Are staff trained specifically on things your parent needs, like dementia care or wound care or specific medical conditions?
Red Flags in Nursing Care
Some warning signs should prompt immediate action. Pressure sores (also called bedsores or decubitus ulcers) are a red flag. A pressure sore means your parent has been left in one position too long or their skin hasn't been properly protected. Good facilities prevent pressure sores through positioning changes, special mattresses, and skin care. A pressure sore developing in a facility is a sign of neglect.
Similarly, injuries from falls are concerning. Occasional falls happen. But if your parent has had multiple falls, or if a fall resulted in serious injury, the facility should have been monitoring your parent more closely or taking precautions to prevent falls. Ask what happened after each fall. What changes did the facility make to prevent the next one? If the answer is "nothing specific," that's a problem.
Medication errors are serious. Did your parent miss doses of medication? Did they receive someone else's medication? Did they receive an incorrect dose? These shouldn't happen. If they do, it suggests poor pharmacy processes or inadequate nursing oversight. One medication error is a problem. Multiple suggest systemic issues.
Poor hygiene is visible and concerning. Does your parent look clean? Are their clothes clean? Do they smell of urine? Do their nails look cared for? Do they have bad breath that suggests dental care is lacking? These things might seem minor but they indicate whether the facility is attending to your parent's basic needs and dignity. Someone isn't making sure your parent showers. Someone isn't brushing your parent's teeth. Someone isn't changing clothes if they're soiled. This is not accidental. It's a choice about whether to do the work.
Weight loss without explanation is also concerning. Is your parent eating? Are they getting enough nutrition? Is food being adapted if your parent has swallowing difficulties? Unexplained weight loss can indicate your parent isn't eating enough or isn't able to eat properly. It can also indicate they're developing a medical condition. Either way, it should prompt investigation.
What to Monitor Continuously
Beyond these specific red flags, pay attention to your parent's overall health trajectory and emotional state. Is your parent declining more rapidly than you'd expect? Is your parent increasingly confused or withdrawn? Is your parent in pain? Is your parent developing new medical problems frequently?
Some decline is expected. Your parent is aging. But rapid decline or decline beyond what makes sense for their condition can indicate something is wrong. Ask questions. What's changed? Is the facility aware of the decline? What are they doing about it?
Pain management is important. Your parent might minimize pain to avoid being a burden. Or your parent might not communicate pain clearly if they have cognitive impairment. Watch for signs of pain: grimacing, guarding (protecting an area that hurts), agitation, behavior changes. Ask your parent directly about pain. Ask the staff whether they're monitoring for pain. Ask whether pain medications are being given appropriately. Uncontrolled pain isn't just cruel. It interferes with recovery, with nutrition, with sleep, with everything.
Also monitor dignity and autonomy. Is your parent being treated with respect? Are they being included in decisions about their care? Are they able to maintain their own preferences and personality? Some facilities treat residents like objects to be managed rather than people with preferences. Your parent might wear clothes chosen by staff rather than clothes they prefer. Your parent might eat at times set by the facility rather than when they're hungry. Your parent might be told when to sleep and when to wake. Some of this is necessary for facility operations. But facilities can do this while still preserving dignity. If your parent feels like they have no say in anything about their own life, that's a problem.
Also pay attention to whether your parent is socially isolated or engaged. Is your parent participating in activities? Visiting with other residents? Getting outside? Seeing visitors? Isolation contributes to depression and decline. A good facility works to keep residents engaged and connected, even when that requires effort.
How To Help Your Elders provides educational content for family caregivers. This is not a substitute for professional medical, legal, or financial advice. Every family situation is different; what works for one may not work for another.