How to protect a loved one when choosing a nursing home or assisted living facility

Finding the Right Long-Term Care: A Guide for Families Facing Difficult Decisions

The need for long-term care often arrives without warning. A sudden fall resulting in a broken hip, developing memory issues that create safety concerns, or the loss of a caregiving spouse can thrust families into an urgent search for suitable care facilities. While this transition is rarely welcomed, understanding what to look for can make the daunting process more manageable.

For many families, the search begins with government ratings. While regulations for assisted living facilities vary significantly across states with no uniform standards, nursing homes fall under federal oversight. The Centers for Medicare and Medicaid Services (CMS) maintains comprehensive data on nursing homes, including ownership details, staffing levels, and violation records, assigning facilities ratings from one to five stars.

“One or two stars, expect it to be bad,” advises Sam Brooks, director of public policy for the National Consumer Voice for Quality Long-Term Care. However, Brooks cautions that the star ratings have limitations due to their reliance on self-reported data. These ratings can help eliminate poor options but shouldn’t be the sole determinant of quality.

Ownership structure often provides valuable insights. Nonprofit nursing homes typically maintain better staffing levels than their for-profit counterparts. Inspection reports and online reviews offer additional perspectives, though they ultimately serve as just one component of a thorough evaluation process.

Industry experts emphasize that in-person visits are irreplaceable for assessing potential facilities. When touring, visitors should look beyond decorative elements designed to create positive first impressions.

Mark Sanchez, CEO of United Hebrew, a nursing home in New Rochelle, New York, shares his approach: “When I tour a building, I listen first. Is it loud? Are call bells ringing nonstop?” He recommends using multiple senses during visits, noting telltale signs like lingering odors, residents clustered around nurses’ stations seeking assistance, or how staff members interact with residents.

“Culture shows up in small moments,” Sanchez says, “and it matters.”

Local long-term care ombudsmen, who investigate complaints in senior living facilities, can provide valuable, unbiased perspectives. These federally funded advocates exist in every state and can share insights about specific facilities.

Jennifer Fink of Auburn, California, who faced the “stressful, grief-inducing, hard and scary” decision of finding a memory care community for her mother, ultimately relied on her intuition. “Trust your gut. Keep top of mind that the salesperson wants your loved one’s money,” she says. “If it’s giving you the ‘ick,’ then move on.”

Across the board, experts identify staffing as the single most crucial factor in quality care. The difference between a facility providing three hours of nursing care per resident daily versus three-and-a-half hours might seem minimal on paper, but those additional minutes can dramatically affect quality of life—determining whether residents receive regular showers, assistance at mealtimes, or prompt help after a fall.

Evan Farr, an elder law attorney in Lorton, Virginia, and author of “The Nursing Home Survival Guide,” recommends visiting facilities during off-peak times. “Visiting a facility at night or on the weekend can be particularly revealing,” Farr explains. “These are the times when staffing is reduced and the true operation of the facility becomes apparent.”

Financial considerations require long-term planning. Initially, many residents can cover their costs out-of-pocket, but families should understand what happens if funds are depleted. For nursing homes, inquire about the number of Medicaid beds available. For assisted living facilities, determine whether they accept Medicaid at all.

Assisted living billing structures can be particularly complex. Geoff Hoatson, founder of Family First Firm, an elder law practice in Winter Park, Florida, warns, “Four-thousand dollars a month can become $8,000 overnight,” as facilities often add separate charges for assistance with basic activities like toileting.

Families should also inquire about conditions that might trigger a transfer request. Care facilities sometimes seek to discharge residents whose financial circumstances change or whose health needs become more complex, particularly those with dementia exhibiting challenging behaviors.

By considering these factors and asking the right questions, families can navigate this difficult transition with greater confidence and clarity.