Residential Care Options: Choosing the Right Place

By Family Caregiver Alliance

What should you think about and do as you explore different residential care options? First, keep your own needs in mind as well as the needs of your loved one. Before visiting facilities, see the FCA Tip Sheet, Residential Care Options: The Right Time. Be sure you are ready for this decision—it will make it easier for you to look at all options with an open mind. There are many checklists and guides to help you evaluate care facilities. A few are listed at the end of this Tip Sheet.

Steps to Take

Determine what level of care your loved one needs (see FCA’s Tip Sheet Residential Care Options: Housing Options).
Be honest about the care needs of your loved one and communicate them clearly to facility staff. The right placement is important. Will it be appropriate for both the physical and/or cognitive impairments of my loved one?
- Think not just about present needs, but also future needs. Will this facility be right when the illness or frailness progresses and dependent care needs increase?
Can residents move from one level of care to another in the same facility? Who decides about higher levels of care—the facility, the resident, and/or the family?
Be clear about finances. Unless you’ve chosen to pay for this care yourself, or as a family, only the resident’s funds should be used for payment. Then, if funds run out, there will be clear responsibility for payment. This may affect eventual eligibility for Medicaid. Become familiar with Medicaid rules in your state so you can pre-plan appropriately.
- Clarify how much it will cost now and how much if care needs increase. Is there an automatic yearly fee increase? Is it limited to a certain percentage?
Small facility or larger facility? This depends not only on what your loved one’s care needs are but also on how social they tend to be. Do they do best in a quiet, calm atmosphere or better in a more active environment? Does your loved one need more privacy or more social engagement?
Geography. The closer your loved one is to where you live, the more often you will be able to visit. It will be easier to drop in for a short period of time. (See the FCA Tip Sheets, Residential Care Options: Visiting Someone in Dementia Care, and Residential Care Options: Caregiving Doesn’t End When Your Loved One Moves) Proximity will also help you to coordinate doctor appointments, dentists, hair dressers, podiatrists, and shopping—all of which will be easier in your own neighborhood. Sometimes it is better to choose a less ideal place for a closer one. There is an old adage which has some truth: The more often you visit, the better care your loved one will receive. You will begin to know the staff and they will begin to know you. If you are a long-distance caregiver and your loved one is going to stay in his or her own community, then, again, you want a facility as close as possible to family, friends, or neighbors who will visit.
Visit the facility. Have a meal. Talk with current residents and their families. Watch how staff interacts with residents. Do residents seem happy, respected, and well cared for?
Use your senses to evaluate. Look at the setting from the point of view of your loved one, not yourself. What does it look like, what sounds do you hear, what are the smells? What is your gut reaction to this environment? What would your loved one think is important?
Observe social activities—would they be of interest to your loved one, are events well attended and engaging to those present?
- Check the activity schedule. Are there organized outings? Are there religious services at the facility? Will these services be pleasing or offensive to your loved one? Are there accommodations for cultural differences? What holidays are celebrated and in what manner? Will staff help get your loved one to these activities?
What kind of special diets can be accommodated? Is the food nutritious and appealing? If your loved one has dietary restrictions, will that be a problem? Are only certain foods served in the residence due to religious practices? If your loved one needs assistance feeding him- or herself, is staff available to help? Will someone make sure he/she gets to the dining room on time and has someone to sit with?
What can and can’t be brought with you? Will you be able to decorate with furniture, familiar objects, and special mementos? Are pets allowed to live there? Visit? Is there a garden? What is the outdoor area like and how is it accessed? Can residents go in and out on their own? At any time? What are the other amenities, like beauty shop, podiatrist visits, shopping trips, Wi-Fi, telephone, cable TV? If your family member smokes or drinks how is that accommodated?
Ask about training. Is the staff trained in dementia care? Do the caregivers get continuing education?
Is there a doctor who primarily sees patients at this facility? Should you use this doctor or keep your loved one’s current primary care physician? Is there a pharmacy that is used or do you need to be responsible for picking up medications? Is this pharmacy covered by your loved one’s insurance? Is the facility the liaison with the primary care physician or will you be coordinating care?
Be clear about the contract. Read it. If you don’t understand anything in the contract ask for clarification by email so that you have it in writing. What are the policies and procedures for admission, discharge, and retention, as well as transfers or room changes within the facility, refund policy, trial periods, or just coming for a respite break?
- There may be a clause about utilizing binding arbitration instead of going to court if a serious disagreement arises. You have an option to sign this or not. A federal ruling no longer permits this type of clause in a nursing home contract.
Ask about the grievance procedures. Find the name/number of the ombudsman for the facility. Is there a resident council or a family council? Family support group meetings?

If you are comfortable with the facility, your loved one will be more comfortable and their adjustment will be easier. Remember, there is no such thing as a “perfect” placement, but you can make a decision that meets as many of your priorities as possible within your budget.

Resources

Family Caregiver Alliance
National Center on Caregiving
(415) 434-3388 | (800) 445-8106
Website: www.caregiver.org
Email: info@caregiver.org
FCA CareNav: https://fca.cacrc.org/login
Services by State: https://www.caregiver.org/connecting-caregivers/services-by-state/

Family Caregiver Alliance (FCA) seeks to improve the quality of life for caregivers through education, services, research, and advocacy. Through its National Center on Caregiving, FCA offers information on current social, public policy, and caregiving issues and provides assistance in the development of public and private programs for caregivers. For residents of the greater San Francisco Bay Area, FCA provides direct support services for caregivers of those with Alzheimerʼs disease, stroke, traumatic brain injury, Parkinsonʼs, and other debilitating disorders that strike adults.

Residential Care Options: Five Tip Sheets

1. The Right Time
2. Housing Options
3. Choosing the Right Place
4. Caregiving Doesn’t End When Your Loved One Moves
5. Visiting Someone in Dementia Care

FCA Fact and Tip Sheets

A listing of all facts and tips is available online at www.caregiver.org/fact-sheets.

Checklists

The National Consumer Voice for Quality Long Term Care (previously National Citizens Coalition for Nursing Home Reform)
Choosing a Nursing Home

California Advocates for Nursing Home Reform (CANHR)
Dementia Care Checklist

Medicare: Nursing Home Compare
www.medicare.gov/nursinghomecompare