Wednesday, August 23, 2006

A Note About Choosing Care Facilities

There is a ton of advice out there (or here, depending , I suppose, on where you are) about choosing care or assisted living facilities. There are checklists, and comparative tables and so on blah blah blah.

But there are a number of items that don't appear on lists, and certainly if they do, don't make it too high on the important factors of those lists. I talk about them a little in my book, Nursing Homes: The Family's Journey ( www.nursinghomesbook.com). But even there, they don't have the prominence they could.

One of those items is the issue of ownership of the facility and where it fits in the corporate world. Many, many of these places are owned by chains, and many are some kind of investment tools. This has a direct affect on how they provide service. For example, the ones that are investment tools have a focus on making money for their investors. That doesn't rule out their providing good care, but it does create an inherent dichotomy in where their focus is. It can be a choice between care and the bottom line, care and profits. It can dictate the salaries that they pay (or don't) and therefore the quality of people that they hire and retain. Especially in Canada. This doesn't say that they do not have good and caring people, but it does say something about how that staff is treated. Just like any caregivers, in order to provide good care, they need support from somewhere. As staff, part of that support are the wages and benefits.

Almost more important is the fact that corporate facilities and chains have to be more bureacratic, and have policies that extend across the chain. They often have a corporate image that they are trying to portray across their systems. The problem is that when they are in different "market areas" their are different and unique factors which impact on care needs. The corporate issue lowers the flexibility that the individual units can provide. It also absolves them of having to do any problem solving. More than once I have run into attitudes of "We can't do this...'" which ends up meaning that their corporate parent doesn't allow it, and they are not going to make an effort. It also is a way for them to absolve themselves of having to make efforts or be responsive to the needs of individuals in varying communities.

Individually owned and operated facilities are not constrained by the same needs of a larger organization. They may not have some of the same resources, but they also don't have the same cost. They are free to develop their own policies and procedures, and their own culture which can be specific to their facility, their area, their state or province. Of course this means that they may not have the same standards. But it means they have the opportunity create a unique environment. It also means they have more ability to respond to the social, cultural, and political environment in which they are located.

To sum it up, think about "where the buck stops" if you were to compare locally owned and operated places and chains. Then think about what that means.

So make sure you ask about ownership and governance when you look at facilities. Go to the corporate website, buy some of their stock, and think about what you are buying. O'kay?