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���������������� ������ ���������������� ������ ���������������� ���������� CARE ���� ���� ���� ���� ���� �� Do patients look to be clean and properly groomed? (Hair combed, shaven, nails trimmed and manicured, etc) ���� ���� ���� ���� ���� �� Are patients appropriately dressed for time of day, activity or weather? ���� ���� ���� ���� ���� �� Does the facility conduct a preliminary evaluation of the resident’s needs? (A care plan) ���� ���� ���� ���� ���� �� Can patient and family members be present during this evaluation? ____ ____ ____ How often is this care plan evaluation updated? ���� ���� ���� ���� ���� �� Does the home have an Alzheimer’s program? ���� ���� ���� ���� ���� �� Does the facility report periodically in writing to the personal physician? ���� ���� ���� ���� ���� �� Is there a therapy program available to meet patient’s needs? ���� ���� ���� ���� ���� �� Is the therapy program on site or off premises? DINING & FOOD ���� ���� ���� ���� ���� �� Is the kitchen area clean including the food storage area? ���� ���� ���� ���� ���� �� Is the dining area well lit and attractive? ���� ���� ���� ���� ���� �� Are personal likes and dislikes taken into consideration? ���� ���� ���� ���� ���� �� Does the dietitian plan a variety of menus for patients on special diets? �� ���� ���� ���� ���� ���� �� Are snacks available? �� ���� ���� ���� ���� ���� �� Are foods served at the appropriate temperatures? �� ���� ���� ���� ���� ���� �� Is food tasty and attractively served? �� ���� ���� ���� ���� ���� �� Is there enough staff to assist patients who need help with eating? SOCIAL SERVICES / ACTIVITIES PROGRAM ���� ���� ���� ���� ���� �� Are rooms available for patient activities? ���� ���� ���� ���� ���� �� Is equipment (such as games, easels, yarn, cards, etc.) available? ���� ���� ���� ���� ���� �� Are residents using such equipment? ���� ���� ���� ���� ���� �� Are patient preferences observed? ���� ���� ���� ���� ���� �� Are group & individual activities available? Participation encouraged? ���� ���� ���� ���� ���� �� Are outside trips planned? ���� ���� ���� ���� ���� �� Are arrangements made for patients to worship as they please? ���� ���� ���� ���� ���� �� Is a social worker available to assist residents and families? LICENSOR / COSTS ���� ���� ���� ���� ���� �� Does the home have a current license? If no, do not use home. ���� ���� ���� ���� ���� �� Does the administrator have a current license? If no, do not use. ���� ���� ���� ���� ���� �� Is the home Medicare and/or Medicaid Certified? ���� ���� ���� ���� ���� �� Are all services covered in the basic daily charge? ���� ���� ���� ���� ���� �� Does the facility have a written description of its services & fees? ���� ���� ���� ���� ���� �� Are advanced payments returned if the patient leaves the home? MORE INFO ONLINE: POLKELDERCARE.COM More on Nursing Homes: • Need to Find a Facility? • Printable “Questions to Ask” Worksheet Related Issues: • Legal & Financial Issues 36 www.PolkElderCare.com


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