Are you currently considering a nursing home stay for either yourself or a loved one? In either case, you would expect to receive the best care, especially for the very expensive prices nowadays, wouldn't you? Unfortunately, locating a facility that provides genuine quality care may be tantamount to finding the proverbial needle in the haystack. Know the truth about nursing home or assisted living facilities before you decide.

I have been involved with health care for more than 15 years as a Combat Medic in the United States Army, a Certified Nurse Assistant, Physical Rehab Aide and Occupational Rehab Aide in California and the suburbs of Illinois. My wife is a Registered Nurse with more than 11 years of experience, and like myself, the majority of the experience is in nursing home or assisted living centers.

1989 was the year I became employed in my first nursing home. One of the many duties of a CNA, or certified nurse assistant, is to help the residents of the nursing home with their morning routine. While assisting a certain resident, I noticed the sliding doors of her closet were broke and one of them wouldn't open without forceful tugging. After getting her clothes together, I opened a drawer for some socks and a few roaches crawled out from the haphazardly bundled clothing. I later discovered most of the rooms in this particular facility were in the same appalling condition.

Mysterious injuries to some of the mentally handicapped residents also created rumors of abuse. Yet, no one seemed to know anything about it. Through the Medicare and Medicaid programs, the federal government is suppose to conduct on-site inspections of nursing homes participating in Medicare and Medicaid and to recommend sanctions against those homes that are violating health and safety rules. Yet, this particular facility, on several occasions, somehow received a Five Star rating after "inspections".

I assumed I made a bad employment choice and the next nursing center would be better. I was wrong. Within three months of employment at a different facility, a couple of senior residents confided that a certain nursing assistant was handling them roughly. Being the young newbie to the status quo, I hesitated to act. I was aware the elderly could be quite fragile, so perhaps the manhandling they described was a misunderstanding. Then I witnessed this same assistant "person" placing a soiled diaper onto the face of a resident several times in a teasing manner. I had seen enough, I brought this to the Director of Nursing (D.O.N).

I was not aware at the time however, that both the nurse of that shift and the D.O.N were both friends of the abusive assistant. Therefore, when a meeting was finally convened on the matter about a month later, you can probably imagine what the outcome was. My heated defense of the residents fell on deaf, dumb and blind, ears. The so-called nurse defended the abuser and the D.O.N merely pointed a finger at this assistant and said, "You were wrong." and absolutely nothing else followed, not even a written reprimand. However, I became known as the "trouble-maker" shortly after the meeting.

Fortunately, there was some poetic justice; the abusive assistant was later fired for getting into a "fist-fight" in an elevator with another assistant. This was a "Holy" facility in the suburbs of Illinois.

A large man with documented psychological problems abused other residents at the last facility in which I was employed. Although there were several staff complaints and he choked a female caregiver at one point, his transfer to a more appropriate facility was continually delayed to maintain the profits of his stay. It therefore seemed unconscionable to hear the, oddly high-strung, administrator of this same facility was rumored to be embezzling holiday funds that were meant for the caregivers.

When I learned a new policy required completely untrained caregivers to pass medication to the residents, I began to update my resume, and when I learned that there wouldn't be a nurse at all for the night shift, I turned in my two weeks notice. It was an obvious attempt to save money by limiting or eliminating professional care. These facilities never mention to visiting family members that when the patient or resident census is low, the nursing assistance is often cut to save money. This practice can lead to neglect, which tends to create new issues, such as bedsores for the bedridden residents.

There was a certain focus prevalent among the many facilities in which both my wife and I were employed and apparently, nothing has changed. They all claimed the well-being of the resident is the primary concern; some even placed impressively framed statements or plaques on the walls with their creeds of care. There was no fine print however, that stated the true primary concern above all else was Money. Making money and saving money. A single resident brings in five to eight thousand dollars a month and in "special care units" such as an Alzheimer's unit, it can be $10,000 a month. Thus, everything, and I do mean EVERYTHING else, is of lesser importance. What makes this statement all the more outrageous is that it may actually sound naïve to some, in today's corporate controlled world. "Of course it's about money, what else could it be about?"

It should be mentioned the examples given above are extreme and may not necessarily occur in all nursing centers. However, the Centers for Medicare and Medicaid Services (CMS) on February 5, 2008 named 4,037 nursing homes whose pressure sore and/or physical restraint rates it says have targeted them for "improvement". Thus, anyone who is considering a nursing home or assisted living facility stay, for either a loved one or themselves, should consider and understand the reality of these facilities and the possible measures that can be taken to promote better care.

So, what can you do if you believe extended assisted living or nursing care is needed for you or a loved one? Here are some suggestions and options you might want to consider.

- If distance is not a major concern, you may be able to locate a decent facility via the Senior Housing Net.com site. After choosing a place, if you have the means, research the facility. Find out what you can about it before you visit it. Perhaps you can check for recent complaints, or any history of lawsuits, with the Better Business Bureau online. If this is not an option, arrange a visit and ask the residents about the care, their rooms, the food, etc.

- Notice if you can detect urine when you enter the facility. If there is no one in the immediate area and the odor is very noticeable, we suggest that you turn around and leave. It is a telltale sign of poor sanitation and or possible neglect of bedridden patients.

Most assisted living centers are modeled impressively to give a beautiful "Home-like" appearance and most new residents agree it is much better than the sterile-looking hospital appearance of many nursing homes. However, do keep in mind; it is not necessarily an assurance of superior care. In other words, appearances can be deceiving.

- Ask about the training background of the CNAs (certified nursing assistants) or caregivers, they will be assisting you or handling your loved one the majority of the time. Many assisted living centers do not require their caregivers to be certified assistants, choosing to hire untrained or inexperienced caregivers who are then asked to attend an in-service or two.

- How many caregivers or CNAs are assigned to each unit? How many nurses are there to a unit? Is the ratio to patients or residents adequate for dependable care?

If you must stay at a facility of questionable quality, try to arrange any of the following:

- If possible, have a lawyer present when filling out the admission forms. Some may say it is an unnecessary waste of money, however, nursing facilities abhor any possible legal action against them and a lawyer intimidates much like a wooden cross does when held up to vampires.

- Arrange periodic unannounced visits from family or friends. This serves more than one purpose. First, it provides witnesses to any neglect or problems. Second, it helps keep the staff on their toes regarding your care. Should any incidence of abuse occur, a quick internet search provides a long list of nursing home abuse lawyers.

- If you are a visiting family member and your loved one is in bed most of the time, check for any bedsores on the heels, hips, buttocks, back or elbows. It is your Right to thoroughly question any injuries and be certain they have been properly documented and the doctor has been informed.

- If it is within your budget, you may choose to hire a reliable private sitter to provide one-on-one assistance or care within the facility. Many families prefer this option as it provides not only constant personal attention but companionship as well. Facility staff appreciates it for the relief it can bring during a high census. As an experienced private sitter, I can attest that it is much more preferable to care for one patient than to juggle ten or twelve.

- Another option that may save you money is to hire a private home sitter. Many patients obviously prefer this because it allows them to stay in their home with a caregiver to assist them. A nurse will often be required to make periodic visits as well for any medication that must be administered. There are many agencies to assist you with this.

Although there are many negative stories about nursing facility care, it does not mean you, or a family member, will have the same negative experiences. Believe it or not, there are plenty of satisfied residents, or patients, who do not regret their move into an assisted living or nursing home and who have made new friends.

So, now that you have been given some worst-case scenarios, here's hoping you are prepared for the worst but experience the best.