Finding the Right Place to Live
The Agency’s Elder Rights Division is available to help assure that consumers of long-term care services make the best decisions possible based on the most complete information available. Most typically, placement decisions are made in times of family crisis, pushed forward by a fall, injury or rapid decline in health. Too often a decision is made without much forethought or planning and under pressure, such as when a patient is being discharged from an acute care hospital and decisions must be made quickly.
Though it’s often not possible to consider all factors, planning ahead will make the transition from community to facility less stressful for everyone. With that in mind, some suggestions are offered below to help you make good long-term care choices.
Least Restrictive Environment
As rights advocates, we recommend that consumers seeking admission consider all care options before decisions before irreversible decisions are made. For example, can a family member’s need to be in a safe environment during the day be met by an adult day treatment program? Is privately paying for a companion an alternative to more costly institutional care? In another example, a person who needs meal preparation, housekeeping and the safety of a congregate environment may be very adequately cared for in an assisted living setting rather than a nursing home.
Sources of Payment
The type of payment accepted by a provider of long-term care services can have a great impact on selection options. All licensed nursing facilities do not accept Medicaid, the primary payment source for low-income residents. Similarly, long-term care insurance policies typically pay for care only in facilities recognized by the insurer. Selecting a provider outside the network may require private payment or a transfer. Determining exactly how the care will be paid for is an important step that is too often based on false assumptions or expectations.
Review the Admission Contract
It is recommended that the contract be reviewed to determine the extent of available services, costs and billing process. Note that the family of an admitted resident can be held responsible for charges only if they are recognized as the Power of Attorney or are otherwise managing that resident’s funds. You might also request a copy of a resident's handbook or other information regarding the rules and policies that apply to residents.
Location
Ideally, consider a facility that is located in an area that is easy for family and friends to visit. Accessibility by public transportation may be a critical factor that allows family to regularly visit.
Similarly, the size of a facility may be important to consider. Nursing facilities average about one-hundred beds, assisted living generally have smaller capacities and adult care facilities much smaller with no more than sixteen residents.
Special Services/Programs
Many facilities offer specialized care and services for residents with special needs. The most common types of special services include segregated care units for Alzheimer's disease and other dementias. It is important to carefully consider what is really special about the care. Is additional staff consistently available? Are there enhanced services, such as activities or therapies available, or is the special area little more than a locked and secure area?
The special amenities available should be clearly defined within the contract, including entry criteria and conditions that would necessitate transfer. Keep in mind that “special care” does not automatically equate to better care.
Prior Performance
This information can be used to inquire with the facility about what changes have resulted from the citations or to consider how the facility approaches problems identified by the state or Ombudsman advocates.
- Ohio Department of Health Citation History
- Local long-term care ombudsman complaint history
Where do I get information?
- Ombudsman Verified Complaint History: Contact the Elder Rights Division by phone or e-mail
- Ohio Department of Health Survey Results: www.ltcohio.org
- Choosing a Nursing Home: Booklet available from the Area Agency on Aging
Other Sources of Information
Outlined below is a step-by-step process to help evaluate and select a long-term care facility best suited to meet individual needs.
The Initial Visit
After considering the applicable factors noted above, contact each facility to arrange your first visit. The purpose of the first visit is to get a general feel for the living environment and the individuals who are responsible for ensuring that residents receive good care. Keep in mind that you will more than likely be offered a tour by admissions staff or marketing representatives who will project their facility in the most favorable light possible.
If possible, ask to meet with the nursing home administrator, director of nursing or other department heads. Is the administrative staff courteous and helpful? Ask how the facility handles grievances or problems.
As you tour the facility, consider these questions;
- Is the general atmosphere warm and inviting?
- Is the facility clean and odor free?
- Are the hallways and common areas spacious and free from obstructions?
- Are rooms comfortable, inviting and easily accessible by residents? Where are they located in relation to the nursing station?
- If your visit occurs at a mealtime, is the meal appealing; are residents engaged and interacting during mealtime?
- Contact the prospective resident’s personal physician to determine if the physician will continue to follow their care during the nursing home stay. If the physician will not be available, the nursing home will assign a staff physician to provide medical care.
If a bed is available, you may want to put your name on the admissions list. Keep in mind that the facilities with the best customer service and best performance record will more than likely have a waiting list. In fact, in order to maximize your choices, you may want to have your name listed on more than one admission list. It is often difficult to gauge the length of wait before admission, but keep in mind that typically, female admissions often occur more quickly than male admissions, simply because there are more dual occupancy female rooms available.
If you are unsure about the facility’s ability to meet your needs, make a second appointment.
The Second Visit
We recommend that a second visit be made to the nursing homes you are considering on a weekend or evening to obtain some insight on how care is provided throughout the day. Consider speaking with other visitors, they likely can give you important insight into the care provided. During the visit observe the following:
- Do residents appear alert?
- Are a majority of the residents in physical restraints?
- Do residents appear clean and appropriately dressed?
- Does staff respond quickly to resident call lights or requests for assistance?
- Are nurses and attendants highly visible?
- Are residents treated with dignity and respect?
- Are residents involved in meaningful activities?
If you are satisfied with what you have learned, have your name placed on the waiting list. Obtain a copy of the admission contract and package so that you can become familiar with the information you will need to provide at the time of admission. It is good practice to stay in touch with the facility periodically to indicate your ongoing interest.
Prior to the day admission, you should locate the following documents or information:
- Power of attorney or guardianship documents
- Living will or other end of life decision documents
- Names and contact numbers for any insurance carriers
- Personal items to be kept at the facility
Remember, a caregiver’s role does not stop at admission. Caregivers should stay involved, be aware and be willing to act as an advocate to obtain the best possible care.
Real Story
- B had lived alone in her own home until she started becoming confused and disoriented.
B's only son was worried about her wellbeing and took her to see her medical doctor who diagnosed her with Alzheimer's and dementia. B's son was upset and concerned and asked the doctor what he should do and how he could help her. B's doctor suggested that she be placed in a nursing facility where...Read More »
