How to Choose a Long-Term-Care Facility for a Loved One

Making the decision to move a loved one to a long-term-care facility is never easy. Finding the right facility is even tougher. I know because I made the decision recently to place my mother, who has been diagnosed with Alzheimer's, in a memory-care residence that specializes in caring for people with the disease.

After spending months agonizing over whether it was the right time to move her to a facility where she could receive 24-hour care, I spent just as long trying to find a residence that would best suit her needs. I believe, though, that all the time it took me to research and visit facilities was worth it because I did find the right place for my mom.

If you have a loved one with Alzheimer's, dementia or other disability, that person might someday need to move into a long-term-care facility. Although the majority of Americans who need care receive it at home from family or friends, those with Alzheimer's are much more likely to receive care in a nursing home. According to a 2012 report by the Alzheimer's Association, 75% of people diagnosed with the disease will be admitted to a nursing home by age 80, compared with 4% of the general population. That's why it's important to know how to choose a long-term-care facility if the need arises for someone you love. The steps below will help.

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Step 1: Determine your needs

Before you can select a long-term-care facility for a loved one, you must know what sort of care he or she needs. There are several levels of care that senior-care properties provide:

Assisted living for those who need help in one or two activities of daily living, such as dressing or bathing.

Skilled nursing for those who need the attention of a nurse every day, who are bedridden or have more complicated behavior issues.

Memory care for those with dementia or Alzheimer's disease.

Some properties provide varying levels of care under one roof. That can be a good option for people who want to move to a senior-care residence when they're just starting to require help, then stay in place (by simply moving to another wing or floor) as their needs progress, says Sean Kell, CEO of A Place for Mom, a senior-care adviser service.

Kell says that, in addition to considering the level of care, people need to think about where their loved ones would want to be. That is, would they prefer living downtown or in the suburbs? In the same city where they currently live or closer to family in another city? Do they need a place that allows pets or accommodates special dietary needs, such as a kosher diet? These questions need to be addressed before you start your search in earnest.

Step 2: Assess your ability to pay

Your options may be limited if your loved one does not have long-term-care insurance or other financial resources to pay for care. Assisted living costs $3,600 a month on average, Kell says, and memory care runs about $4,700 a month on average. Skilled-nursing facilities cost an average of more than $6,700 a month and can reach as high as $10,000, Kell says.

Health insurance and Medicare do not cover this sort of long-term care. If you're a veteran, you might be able to get help paying for long-term care from the Department of Veterans Affairs. Medicaid rules vary by state, but in general the government program does pay for long-term-care services (primarily nursing-home care). However, your loved one basically has to deplete his or her assets to become eligible. Medicaid does cover assisted living in more than half of the states if the cost is less expensive than a nursing home, says Byron Cordes, president of the National Association of Professional Geriatric Care Managers. But the waiting list to get Medicaid coverage for assisted living is long, he says.

Step 3: Start your search

Once you know what type of facility would be the best match for your loved one, you can start your search. Ask doctors, as well as friends and family, for recommendations. There also are several resources to help you develop a list of senior-care properties that might fit the bill.

Eldercare Locator is a service of the U.S. Administration on Aging. It provides links to Area Agencies on Aging, which can provide a list of facilities and information about long-term-care options in your area.

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A Place for Mom is the nation's largest senior-care adviser service. It has a directory of about 19,000 senior-care properties, including facilities specializing in dementia care, and its advisers provide free assistance in finding care options. (The senior-care properties in its network pay A Place for Mom a referral fee when a senior moves in. The fee is a percentage of the first month's rent, and all properties pay the same percentage.)

Medicare.gov's Nursing Home Compare tool lets you compare skilled-nursing facilities based on the quality of care they provide, find out what special services they offer, and see results of health and safety inspections.

The National Association of Professional Geriatric Care Managers' member directory can help you find a care manager in your area. Professional geriatric care managers can help families evaluate care options and select a senior-care residence. They charge $100 an hour, on average.

Create a list of properties that best meet your loved one's needs and wants. Make sure each is licensed by checking with your state's health and human services department or Medicare.gov. Use the Eldercare Locator site to get contact information for your local long-term-care ombudsman, then ask him or her if there have been any citations at those properties, says Linda Fodrini-Johnson, executive director of Eldercare Services in San Francisco. Nothing will ever be perfect, but you don't want to see significant lapses in patient care, such as serious injuries because of neglect or errors in medication management. Also ask whether the properties have recently had a change of ownership or management turnover. Fodrini-Johnson says that you can mark off such properties from your list because a “facility in transition is not the place you want to go.”

Step 4: Visit prospective facilities

Internet and phone research can only get you so far. To know whether a facility is right for your loved one, you need to visit it. Try to inspect at least three. "You have to get in there and look at it, walk around, meet the residents, have a meal," A Place for Mom's Kell says. Fodrini-Johnson recommends making an appointment to tour the residences during the week and speak with administrators. Then you should plan to make an impromptu visit to each on a weekend to see how the facility operates when the administrator isn't there.

What to look for:

Pay attention to overall cleanliness. Does it meet your expectations of what "clean" should be?

Follow your nose. Are there strong, offensive odors in common areas or emanating from residents' rooms?

Watch the residents. Make sure they are in common areas and are active. If not, ask where they are and what they're doing.

Watch employees. Do they smile and say hello? Do they look like they enjoy their jobs? How do they get residents to participate in activities -- by command or social invitation? Are nurses behind their stations, or are they engaged with residents (which is where they should be)?

Observe an activity. The residence should have a list of daily programs posted. Make sure those programs are actually occurring.

Look at the physical setup. It should look like a residence, not a hospital. That means it should allow residents to bring their own furniture or other belongings to make their rooms or apartments feel more like home. And make sure that the property is secure so that residents can't wander off. If it's a memory-care facility, the layout should be simple -- such as a single hallway that encircles a common area -- so that residents don't get confused or lost.

Look for life, such as fish tanks, caged birds, potted plants and a garden -- something to give residents a reason to smile.

What to ask:

Can my loved one's needs be met? Be explicit about what the person requires. Don't hold anything back.

What is the basic monthly cost? What are the added costs if a family member needs extra help with medications or incontinence? There are often several levels of care, and even little things have additional costs.

Is there a community fee (a one-time payment that covers the administrative cost of moving someone into the facility and refurbishing a room for that person)? If so, is it refundable if your loved one doesn't want to stay?

What kinds of activities are provided?

Are religious services held at the facility, or are residents taken to services off-site?

What is the ratio of caregivers to residents? It should be no less than 1 to 15 for assisted living and 1 to 8 for memory care.

What conditions would cause a resident to need to move to another level of care?

Does a doctor make regular visits to the residence?

Specific to Alzheimer's and dementia, what sort of training does staff receive for dementia?

Is the facility licensed to provide dementia care, and is there a special unit for people with dementia?

Is there a daily routine for people with dementia? (The answer should be yes.)

Finally, ask residents if they like living there, and ask any of their friends or family who might be visiting what they think about the facility. Most important, trust your instincts. If something doesn't feel right, it probably isn't.