Getting a Sense of the Inside Out of Nursing Homes – Part II


IMG_2071Choosing a nursing home for a family member is one of the most difficult decisions in life. It is a stressful time and a consuming task that’s often made worse by the fact that your loved one has suffered a medical crisis or long-term illness. The period of time is generally very short for locating and choosing a nursing home — which only adds to the decision pressure. Social workers often make suggestions. That is not, however, a substitute for in-person hands-on assessments. My mother has suffered three falls with three major breaks, separated by a year of thriving and traveling despite Alzheimer’s. The choice we made as a family the first time she needed nursing home/rehabilitative care wasn’t the same as the 2nd or 3rd choices we made. We had, albeit painfully, become more attune to looking at nursing homes from the inside out.

While it’s true that there’s no place like home — the outline below provides a sense of how families can perhaps meet part-way there. The creator of the world’s quietest room on earth,  Steve Orfield, says, “what you and your loved one see, hear, smell, touch and taste will have an impact on your lives … it’s about the user experience.” The last post (Part I) highlighted Steve’s ambition to improve senior living spaces. I recommend you listen to our informative podcast with Steve Orfield.  Now, let’s continue with the outline for a greater sense of choosing nursing homes — also known as Healthcare and Rehabilitation Centers.


  •  Is the nurses station centrally located so that residents can be monitored? At one facility that meant being parked there like cars in a traffic jam. At the place we chose that means within view of the day room, where residents interact with staff and visitors and watch television (if not engaged in activities elsewhere in the building).
  • Who’s on duty? At one facility that meant asking the nurse, looking at name tags, and memorizing faces. At the place we chose it means checking a name tag, the assignment board or the wipe-off board affixed to each resident’s bathroom door where shift nurses and CNA are noted.
  • Is there outdoor space? At one facility that meant a small gazebo tucked in the corner of the parking lot. At the place we chose it means an outside courtyard that’s tucked into the center of the building; it’s accessible, spacious and safe. There’s also the option of a quiet stroll down adjacent sidewalks, beneath the trees — an opportune spot for bird-watching.
  • Where are the residents? Are they lying in bed or are they dressed and sitting where daytime activities take place? At one facility, residents were given the option of staying in bed .. and by the looks of it, most chose to do so. At the place we chose, residents are up and dressed (even if wheelchair or geri-chair bound) to absorb the day … with transitions back to bed for nap-times.



  • Are there spaces to visit other than in your loved one’s room? Do any of those afford low-noise for near-private conversation? At one facility, we would’ve had two options: resident’s room or the dayroom which also functioned as the diningroom. At the place we chose, there are multiple day-rooms, a chapel, two dining rooms, and the outside courtyard, in addition to the “bedroom.”
  • What do you hear when you sit back and listen? At one facility, there was an incessant alarm going off … the one alerting CNAs that a resident needs assistance. It resonated throughout the hallway more times than we could count. At the place we chose, the alarm is discreet at the nurses station and connected to an indicator light for each hallway.
  • Who’s talking? At one facility, the staff-patient ratio was 25:1. Nearly every moment was consumed by the tasks at hand, so there was little to no time to talk with residents while (swiftly) meeting their needs. At the facility we chose, the ratio is 10:1 or less. CNAs can be seen and heard sitting next to residents engaged in casual conversation, and that even occurs in the bathroom. I’ll never forget the time I arrived to overhear Mom’s CNA chatting with her about how many children and grandchildren she has … while brushing her hair near the bathroom sink.
  • Is there night noise? It’s something to think about when transitioning a loved-one to a long-term care setting. Steve Orfield pointed out that “visual noise can become very prominent.” My sister and I took turns staying overnight during the early part of our mother’s transition. That led to effective talks with staff about night lighting and ways to minimize hallway traffic and noise.


  • Take a stroll on a regular basis with your loved one. Walking through a hallway at one facility actually made me nauseous when I inhaled the odors.  Occasional foul odors are one thing, but it certainly shouldn’t be the norm.
  • Dwell outside for a bit in the “fresh air.”  A nearby sewer treatment plant or outlet to a busy highway will quickly interfere with time you hope to spend outdoors.
  • Personal hygiene tops the list of priorities and it doesn’t stop at your loved one’s body.  Make a habit of smelling the bed linens and wheel chair padding — cleanliness should apply in every area where your loved one resides.



  • Can you order guest meals from the kitchen? Get to know which meals served are your loved ones favorite by spending time eating together — meal time visits are a wonderful opportunity for family time.
  • Supplement with a variety of brought-in favorites or drive-thru’s together for ice coffee, ice cream or another perk. The care center we chose has a patient pantry where refrigerated and frozen items can be labeled, stored, and readily available.
  • Mid-late stages of Alzheimer’s inhibits one’s ability to dress independently. Maintain their sense of dignity by providing options. A loved one’s fashion taste (preferences) apply here too. Encourage staff to give choices: “do you want to wear this one or that one?” Small decisions can have a big impact — a smile is worth a thousand words!


  • Touch is a profound blessing, from being tucked into bed to receiving a hug or pat on the back. Sometimes, I’ll just sit beside my mother as she sleeps and hold her hand or stroke her hair. What you do is often more important than what you say, especially in loving someone through Alzheimer’s.
  • Deliver small things that touch the mind and body: scented soaps and body powders, cotton pajamas, a plush pillow, etc.
  • Room decor that touches your loved one’s heart will inevitably touch others too. I’ve made a point of labeling pictures so conversations can develop, noting favorite colors for dressing preferences, and posting inspirational messages for Mom and all those who interact with her.
  • Movement can be as simple as tossing a ball to physical therapy exercises. It’s one of the greatest gifts for helping individuals with Alzheimer’s stay in touch with the here and now.


There’s no place like home … but as Steve Orfield is building a bridge between design and perception, so can families build a bridge between home and care centers … thereby making a positive difference from the inside out.

Even in choosing the “best” of care options, there will be shortfalls and concerns that have to be addressed from time to time. What aspects of care are you grateful for? What would you add to this list? We can all learn from one another. Send your comments and nursing home care insights to me at

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