Answer Man

How to stay well-informed on making nursing home decisions

Q: Nursing homes are often a necessity for senior citizens and those needing nursing care. Are there evaluations available to help seniors and their families make decisions?

Sam H., Shiloh

A: Perhaps one of the most comprehensive places to start is a service called Nursing Home Compare at www.medicare.gov/nursinghomecompare/search.html.

Compiled by CMS — the Centers for Medicare and Medicaid Services — the site, on which you can search for specific nursing homes or homes in a general area, contains quality of care and staffing information for all 15,000 nursing homes that participate in Medicare or Medicaid. (Please remember other nursing homes are not included.)

Specifically, the site offers five-star ratings of overall quality and performance on health inspections, reports on health and fire-safety inspections and information about staffing, including the number of various types of nurses, physical therapists and nursing assistants. The site also offers a set of quality measures including the percentage of residents with pressure sores, urinary incontinence, etc.

In addition, you can find information on deficiencies found in the home and dates they were corrected. For example in Belleville, last October’s report included Memorial Care Center, Midwest Rehabilitation and Respiratory, the Lincoln Home and Four Fountains Convalescent Center, among others. By studying them, you can judge how serious they are (or were) and how quick they were to respond.

With easy clicks, you can find how CMS calculates its ratings along with booklets on how to choose a nursing home, a nursing home checklist and information on long-term care options, Medicare coverage and what rights you or your family member will have as a nursing home resident. CMS, however, does stress that you should not rely solely on its rating to make a final decision. It probably should go without saying that both you and perhaps someone you know who’s knowledgeable about them should make a lengthy visit of any home under consideration.

If you want more help, Illinois offers quarterly reports of nursing home violators at http://dph.illinois.gov/topics-services/health-care-regulation/nursing-homes/violator-quarterly-reports. The most recent, July through September, shows fines being levied against homes in Aviston, Belleville, Cahokia, Granite City, Lebanon, New Athens and Swansea, although, unfortunately, the report lists only the numerical section of the code being violated rather than the specific infractions. You also can find profiles on every nursing home in the state at www.illinois.gov/sites/hfsrb/InventoriesData/FacilityProfiles/Pages/default.aspx but they seem much less helpful than the CMS information and they’re a year out of date.

Good luck.

Q: In the 1960s, Arthur Miller wrote a play called “After the Fall.” What fall? The Garden of Eden? And who is counseling Quentin, the main character, and why? However, I think the final sentence, though harsh, is a lesson for us all: “I think, Quentin, one must finally take one’s life into one’s own arms and kiss it ...”

D.S., of Trenton

A: Like so many writers before him (Hawthorne, Melville, Faulkner, etc.), yes, Miller almost certainly was referring to man’s expulsion from the Garden of Eden as a jumping-off point to explore Quentin’s personal journey through an imperfect and sometimes sordid world.

It’s a common theme in American literature for good reason. Many of the first European settlers intended to establish a kind of New World garden where all individuals would find peace and prosperity. But even those with a passing acquaintance with history know it didn’t take long for this dream to die, too, leaving those like Miller to wrestle with how to survive in a fallen world.

For Miller, “After the Fall” and Quentin’s personal torments are seen as deeply autobiographical. Just as Quentin’s first two wives play prominent roles in the play, Miller wrote the play two years after he had married his third wife — and two years after his second wife, Marilyn Monroe, had died of a drug overdose. In fact, critics largely slammed Miller for what they charged was his exploitation of Monroe’s death. Miller claimed the resemblance was merely coincidence and that he was merely ruminating over his ability to connect with women in his life. After his father died four years later, however, he would write “The Price,” in which two brothers work to accept their own father’s death.

But “After the Fall” is far more sweeping in scope. Quentin also dealt with his father’s “fall” when he went bankrupt during the Depression. And Miller also considers the “fall” of the entire world as seen when he visits a concentration camp with Holga, his new, German girlfriend. (In 1962, Miller had married the Austrian-born Inge Morath.) And don’t forget Miller was writing the play shortly after the McCarthy era in the U.S.

So who is counseling Quentin? The play never says. Maybe it’s just an inner dialogue with his conscience, much as Miller may be mulling over his own life as he writes the play. In the end, he reaches a reconciliation that, as you suggest, might be wise for most of us: We’re all imperfect and mistake-prone, but we should forgive ourselves, embrace life and strive to do better.

Today’s trivia

Who was the first woman to be placed in nomination for president by a major political party?

Answer to Sunday’s trivia: You’re likely familiar with the name Amelia Earhart, but you probably don’t know Geraldine Mock. You should. From March 17 to April 19, 1964, this 39-year-old Columbus, Ohio, mother of three became the first woman to fly solo around the world. Covering 23,103 miles, she set seven records, including first woman to fly across both the Atlantic and Pacific oceans. She later was honored by President Lyndon Johnson.

Roger Schlueter: 618-239-2465, @RogerAnswer

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