A blog post

Choosing a Long-Term-Care Facility for a Loved One

Posted on the 30 May, 2013 at 12:55 pm Written by in Personal & Family

Deciding to move a loved one to a long-term-care facility is never easy. Finding the right facility may be even harder.

You may spend months wrestling with the decision to move your loved one to a facility providing 24-hour care.  The time you take in researching facilities is well worth it because you will find the right facility

 

A loved one with Alzheimer’s, dementia or other disability may someday need to move into a long-term-care facility. Many Americans needing care receive are fortunate to receive home care from family or friends while those with Alzheimer’s are more likely to receive care in a nursing home. A2012 Alzheimer’s Association states 75% of people diagnosed with the disease will be admitted to a nursing home by age 80 versus 4% of the general population. Knowing how to choose the right care facility for an Alzheimer’s patient is essential in providing proper care for an Alzheimer’s patient.

 

1: Determine Needs

 

Understanding the sort of care an individual with Alzheimer’s requires comes before selecting a care facility for that individual.  Facilities typically provide several levels of care:

 

 

 

Assisted living for those requiring support with one or two daily living activities such as dressing or bathing.

 

Skilled nursing for those requiring the attention of a nurse every day including those bedridden or exhibiting more complicated behavior issues.

 

Memory care for those demonstrating dementia or Alzheimer’s disease.

 

 

 

A facility may provide varying levels of care under one roof offering the option of first moving to a senior-care residence then moving on to another level of care as the need arises.

 

Matching a facility’s location to a loved one’s desired location is important. Will an urban or suburban setting be the right choice? Will the city of current residence or somewhere else nearer the family be the right choice? Will the facility allow pets and accommodate special dietary needs? These are the sort of considerations to take into account before starting a long term care facility search.

 

2: Assess Ability to Pay

 

Financial considerations such as the lack of long term care insurance may limit options. Assisted living on average costs about $3,600 a month and memory care on average about $4,700 a month. Skilled nursing facilities cost an average more than $6,700 a month with some costing as much as $10,000 a month.

 

Health insurance and Medicare do not cover this level of care.  Veterans may qualify for assistance for long term care through the Department of Veterans Affairs.  Be aware Medicaid rules vary by state.  Generally, the government programs pay for long-term-care services such as nursing home care.  Remember that assets must first be exhausted before becoming Medicaid eligible.  Medicaid covers assisted living in more than half of the states if the cost is less expensive than a nursing home.  The Medicaid waiting list for assisted living is long.

 

3: Start the Search

 

After determining the sort of facility and services needed, the search begins.  Professionals, doctors, friends and family are all good information resources.  Other resources such as the U.S. Administration on Aging’s Eldercare Locator provide invaluable help.

The nation’s largest senior-care adviser service is A Place for Mom and has a directory listing 19,000 senior care facilities including those specializing in dementia care.  The service’s advisers provide free assistance in finding care options.  A senior care facility listed in A Place for Mom pays the service a referral fee when a senior chooses that facility. The fee is a percentage of the first month’s rent and all facilities pay the same percentage.  Another resource, Medicare.gov’s Nursing Home Compare tool, compares skilled nursing facilities based on the quality of care each provides.

 

 

 

The National Association of Professional Geriatric Care Managers’ member directory provides links care managers in a given area. Professional geriatric care managers help families evaluate care options in selecting a senior care residence. Professional geriatric care managers charge on average$100 an hour.

 

Assess the needs and level of care services needed then create a list of facilities best meeting those needs and services.  Make sure each facility is properly licensed by checking your state’s health and human services department or Medicare.gov.  Use the Eldercare Locator site to contact information your local long-term-care ombudsman.  Ask the ombudsman if a given facility may have received any citations.  No facility is perfect.  Be alert to citations for significant lapses in patient care such as serious injury, neglect or error in medication management. Ask whether the properties have recently changed ownership or management.  A facility in transition is not a good choice.

 

 

 

4: Visit Facilities

 

Sound long term care facility research means personally visiting at least three facilities.  Be proactive: go in, walk around, meet residents, have a meal.   Schedule appointments to tour facilities and speak with the staff during the week.  An impromptu weekend visit is also a good idea.  How does the facility operate when the admin staff isn’t present?

 

What to look for:

 

Be aware of overall cleanliness.  Is ‘clean’ really clean?

 

Trust the senses.  Are there strong, offensive odors in common areas or emanating from residents’ rooms?

 

Observe the residents.  Are they in common areas and are they active?  If not, where are they are and what are they doing?

 

Watch employees. Do they smile and say hello?  Do they clearly enjoy their jobs?  Do they encourage residents to participate in activities by command or social invitation?  Are nurses behind their stations or are they engaged with residents?

 

Observe an activity. The facility should post a list of daily programs.  Make sure programs and activities actually take place.

 

Look at the physical setup. Does it look like a residence and not a hospital?   To create a more home-like setting, residents should be able to bring their own furniture and belongings.  Resident safety is of the greatest importance: confirm the facility is secure.   Memory care facilities require a simple floor plan, typically one with a single hallway encircling a common area.  Active decorative elements encourage positive attitudes:  Aquariums, caged birds, potted plants and gardens give residents a reason to smile.

 

 

Important Questions:

 

Is a particular care facility able to meet the needs required?   What are those specific needs?  Be open and honest in discussing the needs required.

 

What are basic monthly costs?  Are there added costs should a resident require extra help with medications or incontinence?  Levels of care vary and additional help may bring additional costs.  Some facilities may charge a community fee or one-time payment covering the administrative cost of moving someone into the facility and making a room ready for that person.  Is that refundable should the resident not to stay?

 

What kinds of activities are provided?

Are there on-site or off-site religious services?

 

What is the caregiver-to-resident ratio? Ideally, the ratio is not less than 1 to 15 for assisted living and 1 to 8 for memory care.

 

What conditions necessitate a resident’s moving to another level of care?

 

Are doctors regularly visiting the residence?

 

Is the staff regularly trained in Alzheimer’s and dementia care?

 

Is the facility licensed to provide dementia care?  Is there a dedicated dementia care unit with a dementia daily routine?

 

Are residents happy living there? Ask visiting friends or family who might be visiting their thoughts about the facility. First and always: trust your instincts. If something doesn’t feel right, it probably isn’t right. 

Happy Hunting!