How to Pick a Nursing Home or Assisted Living Facility

Introduction

Placing a loved one in a nursing home or assisted living facility is often one of the most difficult decisions we face. As our loved one's physical and/or mental conditions decline, we are often faced with no alternative but to consider long term care placement. The reality is that many of these facilities lack the staffing necessary to meet the needs of their residents. The following is a list of guidelines which can be used in determining whether a particular nursing home or assisted living facility is appropriate for your loved one. It is not intended as, and should not be used by you as legal advice, but rather a touchstone for reflection and discussion with others about this important decision.

1. First you must assess your loved one's needs.

Do they require skilled care at a nursing home, or can they live in a semi-independent environment of an assisted living facility? Assisted living facilities cannot provide skilled care, but many of them now have special Alzheimer's units for cognitively impaired patients that provide for many of the daily needs of their residents. Ask your doctor what type of facility is best suited for your loved one. As a practical matter, any long term care facility is required to do an evaluation of the incoming patients to determine if it can meet their needs. However, this evaluation is not always reliable, and some facilities may accept patients even where they do not have the capacity to fully meet their needs.

2. Start with a list of recommended facilities in your geographic area.

A social worker at a local hospital or employees of your local Department of Aging or Ombudsman Office may be able to provide you with a listing of nursing homes or assisted living facilities in your area. Social Service offices in many states are responsible for regulating assisted living facilities and may also be able to provide you with a list of facilities. Often these professionals have personal knowledge of these facilities and can be a valuable resource. However, you should also check the yellow pages and search the Internet for additional facilities as you want to develop a comprehensive list of facilities that are in your geographic area.

When choosing facilities don't forget the all important location, location, location! It is important to try and select a facility that is close to the friends and relatives who will be visiting your loved one. The facility also needs to be accessible to those persons who will be visiting your loved one the most. Commuter friendly locations (e.g. parking, public transportation accessible if necessary, near entertainment venues for off-site trips with visitors) encourage the frequent visits that will help insure that your loved one is getting the proper care in the facility, as well as improve your loved one's mental health.

3. Make a personal visit to the facility.

This will be a prime opportunity to observe the physical characteristics of the facility (e.g. cleanliness, appropriate safety precautions, staff presence). In addition to observing the facility, much can be learned from a personal visit to the facility. Although such visits will generally be coordinated with an admissions director, you may want to consider visiting the facility at a time when your visit is not scheduled. This may give you a more realistic impression of how the facility truly operates. Consider asking the following questions:

A. Ask to speak to the people who are already in the facility. This includes residents and staff members. When talking with staff determine whether they seem friendly, open and honest. Ask them if they could change anything, what would it be? Do they have family members in long term care? Are they in this facility? If not, why? For the most candid answers speak to them when their supervisors are not present. When talking to residents, ask them what they would change about the facility. Ask how long they've been there, and if they plan on staying.

B. Ask to attend a meal, and see if you can sample the food. Often, the assistance provided by the staff to residents in the dining room is a good reflection of the staffing patterns in the facility. Does the menu look to accommodate the specific dietary and/or ethnic needs of the facility's residents? Do they have many choices on the menu? Is the food served hot?

C. Ask for a list of activities provided that week. Most long term care facilities provide various activities in an effort to keep their residents stimulated. This is important for purposes of maintaining good physical and mental health. See if they have a bulletin board with a list of activities. Do they have outside activities or field trips?

D. Ask about the staffing at the facility. What is the ratio of staff members to patients? Are there any state minimum staffing levels, and if so, how does this facility compare? What do they do when a staff member calls in sick? Do they have a procedure in place to assure that a replacement is available? Have the staff members received any specialized training for dementia or Alzheimer's care? What is the staff turnover rate? What type of rapport do you observe between the staff and the residents? How many physicians are on staff?

E. If your loved one has suffered an injury or disability that requires a physical therapy program, does the facility have a rehabilitative program in place to meet those needs? If so, does the facility have the equipment on site, or are the residents commuted to these services? How often is the rehabilitative staff at the facility, full or part-time? How often can the regular staff provide exercise activities to compliment the rehabilitation.

F. How does the state rate the facility? All long term care facilities are required to obtain and maintain their licenses to provide care. Maintaining their license requires the facility to allow state inspections. Nursing homes are inspected and surveyed annually, and if their care is found to be deficient, they are cited. By law they are required to post these deficiency citations in a public place. You may want to ask to see the surveys going back 3 to 5 years to determine if any pattern of poor care exists. You may also find these surveys online at no cost on the applicable state web-site or at the Medicare web-site. See, http://www.Medicare.gov/NHCompare/home.asp or for a flat fee at http://www.seniorcarehelp.com/.

Assisted living facilities are also regulated and inspected, but not as stringently or as often as nursing homes. With assisted living facilities, there is much variation among the states and they are typically not required to post their survey results. Under either scenario, the inspections should not be the exclusive source of information about the facility. You should still ask the admissions director to see the surveys, and you can contact your local Social Services Department or the State Department of Health to obtain the information under the Freedom of Information Act. However, there will be a cost associated with copying and producing the survey documents.

G. Is it a for-profit or a non-profit facility? Generally, a non-profit facility will have less incentive to sacrifice patient care for added corporate profit. This doesn't mean that there are not excellent long term care facilities that are profit based, or horrendous facilities that are non-profit. But as a general rule, you may be better off with a non-profit facility because they don't have a margin of profit to conflict with the expense of providing adequate care.

4. Do Your Homework - Run a Search on the Internet

If your facility is one of the larger chains, they may have an Internet site. Expect the site to reveal only good things about the facility. However, check out the local newspaper, or try using the facility name when running a search using search engines like http://www.yahoo.com,/ http://www.google.com/ or http://www.infoseek.com/. You may be surprised (pleasantly or otherwise) at what you learn.

5. Make Inquiries About Financing

Ask about the financing of your loved one's stay. Will they be entitled to receive Medicare? Most nursing homes accept Medicare if they meet the eligibility requirements, however some nursing homes do not. Assisted living facilities will not accept Medicare. Under limited circumstances they may accept Medicaid, under a process called Medicaid waivers.

In most situations Medicare will only pay for nursing homes for the first 100 days of a stay. Thereafter, you will have to arrange for alternative funding. If your loved one has assets of any kind, they may have to "spend down" to show that they meet the eligibility requirements for Medicaid. These requirements may differ from state to state.

6. Take a close look at the Admission Agreement or Contract

This agreement or contract will control your loved one's legal rights while in the facility. In a nursing home your admission agreement usually references the patient's bill of rights, which can also be found under the federal regulations, 42 C.F.R. § 483.10. Because those regulations do not apply to assisted living facilities, your contract is even more important because it specifically determines the level of care your loved one is entitled to receive, without the federally required catchalls to which nursing homes are subject. Be sure to inquire into any additional costs not explicitly stated in the contract and identify those amenities that you feel your loved one needs for a comfortable living environment. Many facilities include provisions requiring the arbitration of all claims, and waiving your right to a jury trial. You should insist that any arbitration clause waiving your legal rights be taken out of the agreement.

Conclusion

Nobody can guarantee that your loved one will receive the proper care he/she deserves in a nursing home or assisted living facility. However, doing your homework in researching the proper facility will certainly improve your odds. Remember, once your loved one enters the facility you will need to visit as frequently as possible to assure that good care is being provided. Those visits and a good relationship with the staff in the facility will create a support system that helps insure your loved one's well-being is a top priority of the facility. Above all, don't be afraid to move your loved one if the care is not satisfactory. Not every facility is compatible with every resident, and there may be another one which better meets the needs of your loved one.

Good luck.