Elder Law

Choosing Long-Term Care

Choosing a long-term care facility for yourself or a loved one can be confusing and stressful. Learning about the various options and considerations ahead of time can help you stay positive about the experience.

Factors to Consider

There are many types of long-term care. What's appropriate for you or your loved one will depend on the answers to these questions:

  • Is long-term care insurance available?
  • Can the person needing care walk unassisted and feed him or herself?
  • Is constant medical supervision necessary?
  • Is special assistance, such as physical therapy or Alzheimer's help, needed?
  • What resources - such as Medicaid, Medicare and private insurance and other funds - are available to pay for the care?

Types of Facilities

There's a big range of care available to residents of long-term care facilities. From least restrictive to most restrictive, they include:

  • Independent living residences with separate living quarters and no special living or medical assistance
  • Assisted living facilities with small private living quarters and some help with daily tasks such as eating, dressing and monitoring of health needs when needed
  • Nursing home or rest home facilities, which offer full-time assistance with daily living tasks and health monitoring, but no extensive medical care
  • Intermediate care facilities or skilled nursing care facilities with intensive medical care for the chronically and seriously ill
  • Extended care facilities, which are usually hospital-affiliated and offer short-term care for seriously ill patients

Resources for Long-Term Care Facility Referrals

There are many people who can give you ideas on which long-term care facilities to consider, including:

  • Your family physician
  • Hospital discharge planners, social workers and home health care nurses
  • Friends and neighbors who have been through similar experiences
  • Your church pastor
  • Geriatric screening programs through a local hospital or community center
  • Government agencies such as the federal Area Agencies on Aging or local social services or family services groups

Touring the Facility

When you have your choices narrowed down, it's best to tour the facilities during business hours without an appointment. You can meet with the staff, see everything, and take a meal if there are dining facilities. It's best to go back for a second look in the evening or on a weekend to see if there are differences in staffing at "off" hours.

Things to think about when touring a facility include:

  • How long did you have to wait to see a staff member?
  • Does the facility look and smell clean?
  • How does the staff interact with the residents?
  • Are residents interacting socially with each other?

Necessary Information

Some questions to ask while at a facility include:

  • Who responds to emergency calls for help and how soon?
  • What is the ratio of staff care providers to residents?
  • How are immobile residents cared for?
  • What is the cost of care? Are there additional charges for "extra" services?
  • Is the care covered by Medicare or Medicaid? (Aside from practical financial considerations, eligibility for these programs means the facility has met minimum government standards for safety and cleanliness)
  • Does the facility maintain liability and malpractice insurance?
  • Are health licenses and state inspections up to date?
  • Is there a physician on staff or on call? Is a licensed nurse on duty at all times?
  • Are all staff members trained in first aid and CPR, with emergency equipment easily accessible?
  • Are medications and other potentially dangerous items locked up so that someone who is disoriented can't access them?
  • Is there an emergency exit plan in place, with easy exit access?
  • Can family members visit? Can you visit any time or just at specific times and places?

You can also investigate on your own by:

  • Checking with the local courts to see if there are any pending lawsuits for malpractice or unpaid debts
  • Checking with state and local agencies and boards to find out what certifications the facility has and how well it rated in recent surveys of state facilities
  • Checking with local fire marshals to see if safety standards are met

If you or your loved one has an Alzheimer's diagnosis, you'll want to ask about staff members' familiarity with the disorder, and ask specific questions about:

  • Special physical precautions, such as extra locked cabinets and supply areas
  • Alarms on exits
  • Staff familiarity with recent Alzheimer's developments and treatments
  • Increased staffing ratios for Alzheimer's patients

The hard work and effort that go into your search pay off with the peace of mind you gain knowing you have done everything you can to find the right care option for your loved one.

Questions for Your Attorney

  • My mother owns a home but now needs constant nursing care. Is she required to sell her home in order to obtain Medicaid to pay nursing home costs?
  • Is a reverse mortgage a good way for me to pay for long-term care?
  • Can I sign a contract with an assisted living facility on behalf of my elderly mother? What do I need to look for when signing the contract?
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