Q: How do I know if my relative is in the best nursing home? My mother went from the hospital to a rehab setting. I did not have a choice in facilities because there were not too many openings. Now my mother needs to stay long term and I do not know if I should keep her there or if I should move her.

A: It is important to look beyond the size of the room, color of the walls, and space within a facility. What is important when comparing facilities is to watch the staff as they interact with residents. Does the staff smile, are they courteous, are they rushing people, are they being disrespectful etc. The way the staff interacts with the residents is how your mother will be treated. Talk to families in the parking lot and ask them their opinion, ask them when a problem has arisen does the staff apologize and try to resolve a problem or do they never get back to you and minimize a situation? Look at how long the key staff/team have worked together. A team that is together for a long time tends to have happier employees which filters down to the residents. Also, there are established systems in place that are working.

Q: My mother is not taking her medications properly. At least that is what I think. I asked my mother for her medications and she could only name two. She told me she takes them from the bottles. When I asked her for a current medication list she had a list from 2014 and another list from 2015. I found over the counter vitamins in the kitchen and dining room. My mother said sometimes she takes these medications. She picks and chooses her over the counter meds and I wonder if they are beneficial or if they are contraindicated with her prescriptions. What ideas do you have for me to make sure my mother is taking her meds?

A: First call the primary care physician for an appointment and if your mother will allow, go to the visit with her. Before the appointment go through the house and write down all the prescribed medications and the over the counter medications. Review them all with the physician. At the end of the appointment ask for a medication list. Keep one copy with you and post one on the refrigerator. EMT’s are trained to go to the refrigerator and look for a med list to take to the hospital. Then go the pharmacy and have them print out a medication list. Check that all meds are on both lists. When a medication has been stopped the doctor’s office should call the pharmacy to tell them the medication has been stopped. Without that order the pharmacy med list can have meds that are no longer taken. This can be confusing for everyone. Next consider filling a weekly pill box for your mother and checking on it often to see if she is taking her medications on time. There are also medication dispensing machines that will announce when it is time to take medications. Your mother would need to push a button and the medications would come down a shoot for her to take. All the9 AM meds would be in together and this would again occur at the next time she is scheduled to take her meds. A family member or nurse can fill this machine. Some pharmacies deliver medications to the house in special bubble wrapped cards. Your mother would need to push out the 9 AM pills from the card. In this situation the pharmacy would be responsible for filling the bubble wrap card. There would be another card for the next time your mother takes her medications. Your mother would need to remember when it is time to take her meds. With the machine that talks, if your mother forgets a dosage, you can be called that your mother missed a dose. Lastly, if your mother is having forgetfulness you can consider hiring a companion or home health aide into the house to help your mother and this person can remind your mother to take her medications.

Debbie Gitner, LCSW, C-SWCM, is vice president of the New England Chapter of Geriatric Care Managers. Linda Sullivan, R.N., C.M.C., is a registered nurse and certified care manager. Together they are owners of ElderCare Resource Services in Marlborough, helping families navigate resources for seniors. Contact them at 508-879-7008; toll free at 866-280-2308 or visit eldercareresourceservices.com.