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How do I choose a long-term (skilled nursing) facility?

Choosing the right facility doesn’t have to be overwhelming

Long-term care refers to a wide range of medical, nursing and social services provided over a pro­longed period.

Forget the cliché of old folks homes in the past. While one in five of those aged 85 or older are in nursing homes, the need for long-term care can result from chronic illness, dis­abil­i­ty or from a sudden ac­ci­dent or stroke in someone at any age.

Long-term care doesn’t take place only in a nursing home, but also is provided in the home, a community fa­cil­i­ty or a retirement community. Care providers may be licensed nurses, family members, neigh­bors, or those working with community services that help a person with activities of daily living. However, if an individual does not have these support systems or their need for skilled nursing or rehabilitative care continues to grow, a nursing home or retirement community may become the best alternative.

Location, location, location

Location is the starting point, and the most important consideration.

  • Is it easily accessible to the prospective resident’s family and friends?
  • Is a hospital offering emergency services reasonably close?
  • Most important, is it agreeable to the person who will be living there?

After you’ve compiled a list of nursing homes within a specific area, check with your physician, social worker or minister to see which ones they might recommend.

Narrow the list by phone

It is not necessary to visit all the communities in person. You can eliminate some of them by simply calling and asking several key questions:

  • Does the home provide the type of care needed?
  • Are special services and therapy the physician considers necessary provided?
  • Does it participate in the Medicare or Medicaid program?
  • What are the home's admission criteria?
  • Is an opening available? If not, how long is the average waiting period?

Armed with your shortened list, visit with friends and neighbors to see if anyone is familiar with any of the facilities. Many times people who have placed a loved one in a nursing community are able to offer valuable advice.

Personal visits are vital when choosing a long-term care community.

Prepare in advance for your visits

It's important to visit each of the communities in person before making your final choice.

You've decided it’s time for a long-term care community, so you made a list of possibilities and called them to ask pertinent questions. Then you shared your shortened list with professionals and personal acquaintances having some experience with such places. What’s next?

Go see for yourself.

You must make a personal visit to each facility you’re considering before you decide. There is no better way to gather information for comparing communities on your list.

Start at the top.

  • Meet with the administrator and, if possible, the director of nursing services and the director of social services. Spend enough time with all three to get a feeling for staff members’ at­ti­tudes about their work — and toward the residents.
  • Visit with the director of marketing or admissions co­or­di­na­tor about admission procedures and standards, up-front processing or holding fees, and lifestyle options.
  • Ask what criteria the community uses in selecting roommates. 
  • Find out who owns the community and whether it is for-profit or not-for-profit.
  • Ask to see the state licenses and a copy of the community's latest state survey. Find out how any deficiencies listed in the survey were resolved. 
  • Check to see if the community is certified for participation in Medicare and Medicaid programs. 
  • Ask to see the statement of residents’ rights.

Tour the community in the company of a staff member.

  • Feel free to ask questions about anything you do not understand. 
  • Evaluate whether the community has a pleasant, home-like atmosphere and is reasonably free of odors. 
  • Be sure to visit some of the resident rooms. Ask if you can bring in fur­ni­ture, pictures or other special possessions to help personalize the room. 
  • Make sure there is a call button for the nursing staff at each bed and in each bathroom.

Visit with the nursing staff. 

  • Find out if there is flexibility in daily care schedules, and if residents are allowed a preference on bath times. 
  • Ask how often the physician visits and how often residents' medical records are reviewed. 
  • Ask about the care plan process for each resident.
  • Make sure you see an activity schedule. 
  • See how often therapy sessions are scheduled and ask about the types of services provided.

Learn all you can about meals — important events in every resident's day. 

  • Be sure to see a copy of the menus and, if possible, stay for a meal. 
  • Make sure hot food is served hot and cold food is served cold.
  • Check to see that the dining room is clean and attractive and food is served in a pleasant atmosphere.
  • Ask how special dietary requests are handled. 

Get specific about costs.

  • Make certain any long-term care community spells out the specifics of available services and their costs.
  • Basic health care charges usually cover nursing care, room and meals, housekeeping, laundry, recreation and per­son­al care, medical records services. 
  • Extra charges are usually made for phy­si­cian services, drugs and med­i­ca­tions, physical therapy, diagnostic services such as lab work, X-rays and elec­tro­car­dio­grams, and personal services such as telephone calls, beauticians and barbers. Ask about ar­range­ments for phar­ma­ceu­ti­cal services.

Placing a loved one in a long-term care community can be a difficult decision. But understanding the selection process and knowing what to look for can help you make that decision more confidently.