Finding the right long-term care for a loved one is one of the most emotional and high-stakes decisions a family can make. Often, this search begins in a moment of crisis—a fall, a sudden health decline, or the loss of a primary caregiver.
To help you navigate this daunting process, here is a guide on what to look for, what to ask, and how to see past the marketing.
Start with Government Ratings (But Use Caution)
For nursing homes, the federal government provides a baseline through the Medicare Care Compare tool. These facilities are rated on a one-to-five-star scale based on health inspections, staffing, and quality measures.
- Rule of Thumb: A one- or two-star rating is usually a red flag.
- The Limitation: Ratings often rely on self-reported data. As Sam Brooks of the National Consumer Voice for Quality Long-Term Care notes, “Ratings can rule out the worst options, but they don’t necessarily find the best.”
- Pro Tip: Look for non-profit facilities; they are often more robustly staffed than for-profit chains.
Note: Assisted living regulation varies by state, meaning there is no centralized federal rating system. You will need to check your specific state’s regulatory agency for inspection reports.
Look Past the Lobby
A beautiful lobby with chandeliers and fresh flowers is a marketing tool—it isn’t a medical indicator. To find the truth, you need to engage your senses during a tour:
- Listen: Is it peaceful, or are call bells ringing incessantly without being answered?
- Smell: Do you detect odors that suggest a lack of cleanliness or personal care?
- Observe Interactions: Do staffers make eye contact and speak respectfully to residents? Do they seem rushed and frantic, or calm and attentive?
- Trust Your Gut: As Jennifer Fink, founder of Fading Memories, advises: “If it’s giving you the ‘ick,’ move on.”
Staffing is the Gold Standard
Expert consensus is clear: Staffing levels are the single most important factor in care quality. A difference of just 30 minutes of care per resident per day can be the difference between a resident getting a shower or being discovered quickly after a fall.
- Ask about longevity: How long have the nurses and aides worked there? High turnover usually signals a stressful environment.
- Visit on off-hours: Visit at 7:00 PM on a Tuesday or on a Sunday afternoon. This is when staffing levels typically drop, revealing how the facility truly operates when the “A-team” isn’t on the clock.
Think Three Steps Ahead
A facility might be perfect today, but you must consider the “what ifs” of the future.
- The Medicaid Question: If your loved one’s private funds run out, does the facility accept Medicaid? If so, how many beds are allocated for Medicaid residents?
- The “Care Creep” Cost: Assisted living billing can be complex. Ask for a breakdown of how costs increase as a resident’s needs grow. Helping a resident to the bathroom or managing medication can add thousands to a monthly bill overnight.
- Discharge Policies: Ask specifically: “Under what conditions would you require a resident to transfer out?” This is vital for those with dementia, as some facilities may try to evict residents if their behaviors become challenging.
How We Can Help
Deciding on long-term care is “stressful, grief-inducing, and hard,” but you don’t have to do it alone. Utilizing resources like your local long-term care ombudsman can provide an independent perspective on resident complaints and facility history.
We hope this information is helpful to you in the important work you do as a family caregiver.
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