If you were to hire someone to care for you at home, you would choose someone who has the necessary skills and is also caring. Not so easy to find. If you find someone good don't let them go.
Going to a facility is culture shock. Institutional care is exactly the opposite of what you would look for at home. This is best demonstrated by the bathing process. Basically you are pulled out of a warm bed at the facility's convenience, not yours, and thrown into a hard plastic chair. You are stripped naked and hosed down like a car in your back yard. The water temperature depends on the mood of your aide. Maybe she thinks you need to wake up a little so the water will be colder. You are now cold, wet, and most likely combative. An alternate way is to use a bed bath system that employs lotions, massage, and moist warm towels proven to be hygienically equal or better that the traditional bath. So why doesn't the facility use this system.
Toileting is another issue. It is done on a schedule so you better be on the same timeline. If you have visitors and it's the "wrong time to go", you may have to suffer the indignity of sitting in your urine and or stool for a while. Imaging what your aide must be thinking. Probably that job at Walmart that doesn't look so bad any more.
After being involved with nursing homes as medical director for 25 years, I've come understand the problem. Facilities and their staffs are under great financial and regulatory pressure. Everyone seems to have a distorted reality. This includes administrators, staff, government, and families. The truth is nursing homes at the present configuration will not work.
When you visit the nursing home as a prospective client, don't be misled by the new carpet or the fancy conference room. The approach should be the same as if you were at home. Who is the person who will be caring for you directly. Are they well paid.? Do they have enough help? Are they well trained and how is that ensured? What is the philosophy on dignity, independence and meeting client preferences? The further you move away from the client caretaker relationship the less important it becomes.
The government underpays and over-regulates . Their oversight is well intentioned but misguided and self serving. Facility administrators spend most of their time at meetings talking about their financial hardships. Facility Boards are great people who are leaders in their own fields but easily misled by bells and whistles played by management. The dollar pyramid is inverted and ready to topple. Most money is spend at the top ; far away from the client-caretaker relationship.
There is much talk about culture change and moving toward a more homelike environment. But that's all it is- talk.... and I've heard it for many years. Facilities should de-institutionalize and spend their resources on the points of contact. When they realized that the need to reconfigure their thinking and not their physical plant, they will win the battle. Congress needs to realize that home care dollars spent will save them from extended hospital and nursing home stays. We seem to be heading in the wrong direction.