How to Protect a Loved One When Choosing a Nursing Home or Assisted Living Facility
The decision to move a loved one into a nursing home or assisted living facility often arises abruptly, triggered by events such as a fall, a medical emergency, or the loss of a primary caregiver. This sudden need can initiate a daunting and stressful search process, something many families hope to avoid. However, understanding what to look for and which questions to ask can significantly impact the quality of care and safety for your loved one.
Start with Government Ratings and Research
Regulation of assisted living facilities varies widely across states, resulting in a lack of centralized standards or information sources. In contrast, nursing homes are monitored by the federal government. The Centers for Medicare and Medicaid Services maintains detailed records on nursing homes, including ownership details, staffing levels, and violation histories. Each facility is assigned a star rating from one to five, though experts caution about its reliability due to reliance on self-reported data.
Sam Brooks, director of public policy for the National Consumer Voice for Quality Long-Term Care, notes that while star ratings can be unreliable, they offer initial clues. "One or two stars, expect it to be bad," Brooks advises. Ratings are useful for eliminating poor options but may not identify the best. Brooks recommends focusing on four- and five-star facilities and considering ownership, as nonprofit homes often have better staffing. Additionally, review inspection reports and online feedback, then compile a list of potential candidates for in-person visits. "The data only goes so far," Brooks emphasizes.
Look Beyond the Lobby During Visits
When touring facilities, resist being overly influenced by decorative elements like elegant furniture, chandeliers, or floral arrangements designed to impress. Mark Sanchez, CEO of United Hebrew in New Rochelle, New York, suggests using your senses: listen for noise levels and unanswered call bells, check for odors, observe resident interactions with staff, and note if employees are rushed or respectful.
"Culture shows up in small moments, and it matters," Sanchez says. Seeking insights from current residents' families or consulting local long-term care ombudsmen—federally funded advocates in every state—can provide valuable perspectives. Amidst data overload, trust your instincts. Jennifer Fink of Auburn, California, relied on gut feelings when choosing a memory care community for her mother, advising, "Trust your gut. Keep top of mind that the salesperson wants your loved one's money. If it's giving you the 'ick,' then move on."
Prioritize Staffing Quality and Levels
Experts unanimously stress that staffing is the most critical factor in long-term care. Evaluate both the quality of care observed during visits and average staffing levels from reported data. Small differences, such as an extra half-hour of daily nursing care per resident, can significantly impact personal attention, including assistance with showers, meals, or fall detection.
During visits, monitor how quickly call bells are answered and whether residents are engaged in activities. Inquire about staff tenure, as facilities with long-term employees often offer better continuity of care. Evan Farr, an elder law attorney in Lorton, Virginia, recommends visiting during off-hours. "These are the times when staffing is reduced and the true operation of the facility becomes apparent," Farr explains. "It is entirely possible to have a five-star rated facility that is woefully under-staffed from 5 p.m. Friday until 8 a.m. Monday morning."
Adopt a Long-Range Financial and Care Perspective
In urgent situations, it's easy to overlook long-term considerations, but planning ahead is essential. Initially, many residents can afford care costs, but what happens if funds deplete? For nursing homes accepting Medicaid, ask about bed allocations for such residents and availability. Assisted living facilities may have complex billing structures; inquire about cost increases as care needs escalate, as some add charges for tasks like bathroom assistance.
Geoff Hoatson, founder of Family First Firm in Winter Park, Florida, warns, "Four-thousand dollars a month can become $8,000 overnight." Additionally, facilities sometimes seek to discharge residents due to financial or health changes, with dementia patients often targeted. Hoatson advises, "Ask specifically what conditions would require transfer." By combining thorough research, sensory observations, and forward-thinking planning, families can make informed decisions to protect their loved ones in care settings.
