How to Help Your Loved One Choose a Long-Term Care Facility

More than two out of every five Americans will need long-term care at some point in their lives. If a person lives to past 65 years old, there’s a 69 percent chance he/she will need some kind of long-term care. Maybe your loved one is getting to the point where you can no longer give them the care that they need. Don’t beat yourself up. People in old age often require around the clock monitoring that’s impossible for one person to do alone, much less someone juggling multiple jobs, social and familial roles, and outside obligations.

If you’re feeling like a long-term facility might be the best option for your loved one, first do some research on your own and then sit down with them to compassionately discuss the issue. Even though you’ll no longer be performing the day-to-day tasks for your loved one once they’ve moved to a care facility, you’ll still have plenty of responsibilities. You’ll serve as a visitor, advisor and advocate. You’ll likely help pay the bills, arrange medical appointments, talk to doctors, and ensure proper follow-up care. You’ll make sure that your loved one is eating the proper diet and receiving the right medications. And of course, you’ll keep track of your loved one’s happiness and engagement in the community. It’s a different role than the one you’ve gotten used to, but it’s equally vital.

It’s easy to get overwhelmed with choices as you poke around for care homes online. Figuring out and choosing the right match for your loved one can seem nearly impossible. However, by the end of this article, you’ll know all the qualities to consider and the steps to take in finding the perfect facility.

The first thing to think about is what kind of facility would best suit your loved one’s needs.  There are many different settings for long-term elderly care, each suited to different types of residents, including:

Skilled nursing facilities (SNF)
  • Licensed healthcare residencies for residents who require 24/7 care and monitoring
Assisted living facilities (ALF)
  • Residents retain some independence while typically requiring custodial care
  • Some include separate wings for dementia care, Alzheimer’s disease, or memory impairments
Intermediate care facilities
  • Optional Medicaid benefit that provides individualized health care and rehabilitation services to promote elderly independence
Residential care facilities (RCF)
  • Similar to assisted living, but smaller with live-in care providers
Subsidized senior housing for elders with low to moderate incomes
  • Some programs offer additional programs
Continuing Care Retirement Communities
  • May include: individual homes or apartments, an assisted living facility, and a nursing home
  • Residents can move from one level to another based on their needs
Sub-acute Care facilities
  • Serves patients needing complex care or rehabilitation
Community Services
  • Adult day services, care coordination and case management, meal programs, senior centers, and friendly visitor programs)
Home Care
  • Accessory dwelling units, a.k.a. in-law apartments

Facilities also offer a range of different services to their elderly populations:

Medical assistance performed by skilled caregivers:
  • Administering medication
  • Ambulation assistance
  • Performing rehabilitation therapy
Daily activities performed by custodial caregivers:
  • Personal hygiene
  • Dressing
  • Bathing
  • Meal preparation
  • Feeding
  • Transport to medical services
  • Supervision (protecting a person from wandering away or accidentally injuring themselves or others)

The following steps will help ensure that you and your loved one find the best facility to meet their needs.

#1: Plan ahead

Advanced planning helps to ensure that you have control over choosing the right facility to meet your loved one’s needs. Before visiting care homes with your loved one, sit down and discuss their options and opinions of an ideal environment. Take notes as you ask them questions, and then prepare a list of your own questions to ask when you visit each care facility. The most important thing to consider in preparing these questions is your loved one’s specific needs. Maybe their medical condition requires that an RN be on-site at all times, maybe there are certain activities that they need in their daily routine, maybe they require special dietary restrictions. You should consider both your loved one’s short-term needs and long-term needs. Even if questions don’t arise from reflecting on your loved one’s characteristics, jot down your observations as they might prompt questions or further assessment as you tour each facility.

Here are some categories to help you brainstorm some questions:

  • Pets: allowed/not allowed
  • Smoking: indoors/outdoors/not at all
  • Transportation: to outside activities/to medical appointments
  • Health: management, assistance, doctors
  • Money: pocket money, management, access
  • Security: perimeter, grounds, visitors
  • Meals: options, taste, dietary needs
  • Finances: monthly rate including fees, Medicaid/out-of-pocket, billing specifics, for-profit/not-for-profit
  • Activities: participation, encouragement, range, religious
  • Privacy: amount, space, situation, and attitude
  • Staff: consistent, rotating, live-in, ratio
  • Therapy: mental health, physical health, availability

A quick note on health insurance coverage. Medicare covers short-term nursing home stays following hospitalization, but generally doesn’t cover long-term care. Medicaid may cover long-term care to a variety of groups, including people with disabilities or mental illness. Make sure to fully understand your loved one’s benefits before they decide on a home. It’s crucial to determine whether and how your loved one or your family can pay for a facility at the onset of the decision-making process to prevent future disasters. To find out more about how to finance long-term care, visit the U.S. Department of Health and Human Services’ resource: LongTermCare.gov.

#2: Research facilities online

Visit this website to discover the residential care homes near you. You can learn about each facility’s cost, services, and ambiance. The site also features resident and caregiver reviews that will give you a better understanding of it’s qualities and atmosphere. You can also locate nursing homes through Medicare’s Nursing Home Compare to find out about the quality of every Medicare- and Medicaid-certified nursing home in the country. Plan to visit at least 5 or 6 facilities to compare a range of different features and to help your loved one understand what they might enjoy most. If you’d prefer to talk to someone on the phone, you can call the Eldercare Locator, open weekdays from 9:0 a.m. to 8:00 p.m., EST at 1-800-677-1116.

#3: Schedule an appointment with the owner, house manager, administrator, or to tour each potential facility

Ideally, your loved one can accompany you on these visits, but if conditions prevent them from doing so, make sure to bring any of their questions to ask on their behalf. Print out Medicare’s “Nursing Home Checklist” bring it on your visit. Request a tour of the entire building and grounds so that you get a full picture of the kind of lifestyle it affords to its residents. If you can, talk to the residents and their families and request a look at a resident’s living arrangements. Once you get home, write down any remaining questions for the staff or residents.

#4: Call your state health department or state licensing agency and request a copy of each facility’s license and latest inspection report

You can also call the Better Business Bureau to determine whether any complaints have been lodged against a facility and whether those issues have  been resolved. Small care homes aren’t subjected to any federal standards, so access as many reviews and reports as possible to verify their legitimacy.

#5: Once you’ve narrowed it down to your top picks, visit each facility as many times as possible

Visit the facilities both with and without your loved one, at different times of the day. Make sure to scope out the mealtimes, activity periods, evenings, and weekends.

#6: Focus on convenience for you and your family

Try to find a facility that’s closest to those who will visit your loved one the most.

#7: Contact your local Long-Term Care Ombudsman for more information about the facilities you’re considering

This person serves as an advocate for residents of long-term care facilities. They try to resolve residents’ issues and motivate change at the local, state, and national levels to improve the residents’ quality of care and of life. Try to connect with anyone who might be familiar with the facility to hear his/her opinions.

#8: Inquire and observe

Pay attention to how the residents are treated by staff. As you know from being a caretaker, the care that your loved one receives will be the most important determinant of their well-being.  Conduct longer interviews with willing residents. Listen to their answers and take note of their reactions.

Even though it’s easy to judge a place on its aesthetics, try to focus less on your initial visual reactions and instead focus on the quality and quantity of the care being received by the residents. Do the residents seem happy? Do the caregivers seem stressed out or in control? Does there seem to be an adequate staff-to-resident ratio? Are the residents socializing or engaging in isolated activities? Ultimately, the interactions between your loved one and the staff and fellow residents will have the greatest impact on your loved one’s quality of life.

Be particularly watchful for signs of elder abuse. There are many different types of elder abuse that will be difficult to catch, but physical, verbal, and emotional abuse can be spotted with enough vigilance. In addition, remain on the lookout for these signs in your loved one once they’ve relocated to a long-term care facility.

Signs of physical abuse in long-term care facilities are:

  • Dysfunctional or absent call light
  • Excessive weight loss
  • Pressure sores
  • Scratches, bruises, skin tears, cuts, or welts: (watch out for bruises in distinctive patterns, such as a bruise that wraps around the arm or a bruise shaped like an object; also look for patterns of injuries from visit to visit)
  • Signs of excessive drugging
  • Lack of physical hygiene

You should also be concerned if your loved one exhibits the following behaviors:

  • Poorly explained injuries
  • Withdrawal
  • Confusion or extreme forgetfulness
  • Depression
  • Anger
  • Helplessness
  • Hesitance to engage in an open conversation
  • Fear
  • Secrecy
  • Distrust

#9: Scrutinize the contract and the guaranteed rights and protections

It’s best to discuss the terms of the contract with a lawyer. Changes can be made to the terms of the contract if your loved one and a facility representative initial each change. Skilled nursing facilities are required to provide a list of their residents’ rights and protections under federal and state law. Your loved one will receive a copy of these rights upon admission to a facility. You should read this document yourself and go over each right with your loved one to ensure that they understand how to protect themselves from mistreatment and get the care and services they need.

Make sure that your loved one’s rights include:

  • Freedom from verbal, sexual, physical, and mental abuse
  • Freedom from non-treatment-related physical or chemical restraints
  • Receive necessary care to ensure personal safety and hygiene
  • Freedom from unnecessary transfer or discharge from the facility
  • Voice complaints and suggestions without discrimination or punishment
  • Remain fully informed about their medical condition and treatment plan
  • Be treated with consideration, respect, and dignity
  • Retain reasonable privacy
  • Get proper living arrangements
  • Manage their money
  • Spend time with visitors
  • Participate in activities

Keep your loved one as involved in the process of choosing a long-term care facility as possible. All of the information you’ve learned should be weighed alongside their gut feelings, reactions, and preferences.

Once your loved one moves into a long-term care facility, it’s still important to assess their opinions. If they dislike their situation, find out more information. If they’re being mistreated, confront the staff immediately to try to resolve the issue and consider moving them to a new facility. If they simply aren’t happy, consider a number of factors. It can take time to adjust to a new living situation, meet new people, and mentally come to terms with massive living changes. Sometimes, it just takes some time to settle down, but if your loved one continues to complain or their physical or mental state rapidly deteriorates, try to find an available bed in another home.

If you want to learn more about choosing the right long-term facility, check out this comprehensive guide produced by the Department of Health and Human Services.