How to Select a Long Term Care Facility for Your Loved One

iNancy askes you to join her in looking at the dynamics of making the decision to admit a loved one into a Long Term Care Facility. Learn about the resourc…

iNancy Elder Care with Nancy Karen Culp RN.  As a Registered Nurse with almost 38 years of nursing experience in Long Term Care, I bring to you a series of articles & guides to help navigate thru the process of placing and sustaining a loved one in that setting. Overseeing the care of my own mother who was diagnosed with Alzheimer’s type dementia has brought with it understanding of what it is like to walk in your shoes. This information is presented to give you support and advice. Here is my unique perspective for your benefit.

Either you are on the doorstep of making the decision to permanently place your elder or disabled adult in a Long Term Care (LTC) facility or perhaps you have already made the decision and need to know what to do next. Your loved one may be at home, in an alternate level of care like an assisted living facility that can no longer meet their care giving needs, adult home or senior housing or recently admitted to the hospital following a medical crisis such as a stroke or a fall.

If coming from home or a lower level of care, the factors that need to be taken under consideration for placement in a LTC facility may include some of the following:

  • Difficulty managing incontinence (loss of bladder or bowel function) which is cited by some studies as the number one reason for LTC admissions.
  • Increased need for assistance with activities of daily living assistance like walking, transferring from one surface to another like in and out of bed; difficulty feeding, bathing, toileting, grooming or dressing.
  • Behavior management resulting from a decline in mental faculties that result in memory loss, wandering, angry outbursts etc.
  • Medical or physical conditions that require skilled nursing care like management of advanced disease processes related to unstable cardiac or respiratory illnesses or wound treatments.
  • Primary caregiver no longer able to meet the physical or emotional demands of caring for a loved one at home.  Spouses often feel so responsible that they go beyond what they are capable of until they get to a point of physical exhaustion or emotional distress.

No matter the precipitating factors, once the decision has been made and things will happen rather rapidly especially if coming from a hospital setting.  In a matter of weeks, days or sometimes hours, you will be faced with a whole new set of questions, decisions and responsibilities.

Note that the facility admission may only be temporary as in the case of rehabilitation following surgery or a stroke and there is full expectation that your loved one will be going home barring any untoward change in physical or mental condition.  Or perhaps the admission will be to provide temporary respite so you can take a much needed break, vacation or have a medical condition that needs to be taken care of yourself.  In these cases, you still need to do your investigation into facility services and their history of care giving outcomes.

The Facility Selection Process – Tap all available resources:

You will need to choose one or two LTC facilities.  If you have not yet chosen a facility or know of one you prefer, you will need to take time to complete the selection process. Word of mouth or personal experience is a reliable resource but even in that case, doing some investigation into facility services and history of operation in recommended. No matter what, you need to include an on-line search at M (Once at the site, click on “Facilities & Doctors” then on “Compare Nursing Homes” and follow directions from there.)

This governmental on-line resource will give you the following information about the facilities you are considering for potential admission.  You can look at facilities on an individual basis or select up to 3 facilities for comparison.  This is the M web site information that will be available to you:

  • Overview: Contact information, facility characteristics like number of beds and special services.
  • Inspections: Department of Health survey results.  There are potentially 160 regulations that are evaluated during the annual survey process and results from the last 3 surveys are available for your review. Also note that by regulation the facility must have a copy of the most recent survey accessible in the facility for your review so ask to see it if you have not previously done so on ling.
  • Staffing: This resource converts the staffing hours reported by the nursing home into a measure that shows the number of staff hours per resident per day.
  • Quality: Information comes from data that the nursing homes regularly report on all residents. It includes aspects of residents’ health, physical functioning, mental status and general well being.
  • Fire Safety Inspections:  Lists the fire safety requirements that the nursing home failed to meet. Fire safety results are not included in the nursing home’s Overall Rating.
  • Penalties and Denials of Payment Against the Nursing Home: Lists the civil monetary penalties and payment denials that the nursing home received in the last 3 years.
  • Complaints and Incidents: Lists the deficiencies from incidents reported by the nursing home in the last 3 years as well as complaints.
  • Five Star Quality Rating:  This rating is a combination of Survey results, Staffing levels and Quality Measures.

Speaking from the perspective of the facility operators, some of the information on-line may not be fully reflective of the facility reputation and excellence of care being given.  Some of the data may not give you an accurate reflection and further explanation may be needed.  For example, a facility may show a high incidence of pressure ulcers on-line which could be and indicator of poor quality care but perhaps the facility specializes in wound care which is a logical explanation for the results being skewed.  So when in doubt, be a diligent consumer and ask the facility representative for an explanation.

If the decision has to be made immediately as in a hospital setting, the hospital Case Manager will provide you with a list of local nursing homes now commonly referred to as LTC facilities.  Either you will be visited in the hospital by the facility representatives (sometimes called a screener) or you will call the facility(s) and ask to speak to the person who oversees the admission process (sometimes called an admissions coordinator).  You will be asked a series of questions to overview your situation and specify what your loved ones need is. If a bed is available within the time frame you need, an appointment for a meeting with the admissions coordinator (which is sometimes a Social Worker or other designee) and arrangements for a tour of the facility will be made.

If coming from a hospital setting, the facilities will promptly then send a screener to see their potential admission and meet with you.  The screener is a representative of the facility who is assigned the responsibility to get necessary information to see if the facility can care for your loved one.  If your loved one is in another level of care such as an assisted living or adult home, this meeting will take place with-in a few days or if they are in senior housing or you are caring for them in at home, an appointment will be made for a visit. The information gathering process may happen via phone if the facility is at a distance from where you live.

The hospital process is by far the one that moves the quickest because discharge may be as short as in a day or two.  Depending on the circumstances, you may meet with a number of screeners from various facilities who will provide you with basic information, brochures and answer your questions about their facility. The screener records a profile of your loved ones physical and behavioral care needs, medical condition, financial, insurance status and medications in order to evaluate if the facility can provide the care that is needed.  If your loved one is on a state Medicaid program, you may not have a choice for placement and will have to take any bed offered even if at a distance from your location.

In addition to gathering the more obvious information like facility location, size and services available, the next step is making an appointment to tour the facility and talk further with admissions.  You may want to ask the following questions and make these objective observations at the time of your facility tour:

  • Make note of how the facility and the staff present themselves.  First impressions are important.  Listen to what your gut is telling you…
  • Is the facility well maintained?
  • Do the residents look cared for and generally happy or content?
  • What personal belongings other than clothes can you bring such as furniture and wall hangings?
  • Ask to see an activities calendar and inquire about availability of crafts or events that may be of interest to your loved one.
  • What type of medical and consultant services are provided. By regulation the facility must provide dental services but you will want to inquire about beautician, podiatry, optician or other consultant services.
  • Ask to see the last Department of Health survey results if you have not already reviewed it on-line at M .  Give the facility representative an opportunity to clarify any of the findings you may question.  Truth be told, sometimes a deficiency results from only one mistake or oversight compared to the many other times the facility did things right. 

Making the Decision – May not be easy but determination needs to be made in the best interest of all concerned:

The optimal position to be in as a care giving family is to realize that admission into a long term care facility may one day be a necessity and discussion and planning have already been in process. This may include purchase of long term care insurance or completing advanced directive or power of attorney paperwork.  Unfortunately, this sort of preparation is not as common as expected and the decision point may need to be made in desperation or crisis mode as in the case of following a hospital stay.  To complicate matters, most elders have no idea what the term “long-term-care” means but rather “nursing home” care which may bring with it undesirable visions and feelings.  Perhaps they have been cared for in the comfort of a home like setting in which they wish to remain but it’s no longer possible.

Given the generational culture of the average nursing home elder, many of them assume someone else will make the decisions about their care such as family members, hospitals or their physician.  If they are cognitively alert and aware, of course it is very important that they be included in the decision.  They are used to being independent in the comfort and privacy of a home or their own room of an assisted living or adult community.  They may not be cognizant of the need for placement as the progress of their disabilities may have been slow and they have adjusted to them with time and your support.  It may seem like a failure of sorts to them.  It is important that you state your own needs as part of this discussion so they understand things from your perspective if they haven’t already figured that out themselves.

Bottom line, the decision to place a loved one in a nursing home may be accompanied by feelings of sadness, anger, grief, guilt, relief (and then you may feel guilty about being relieved….) fear and uncertainty.  The best way to deal with these feelings is head on.  Realize you are not the only one who has ever felt this was and reach out for support to help you work thru those feelings and uncertainties. Like with any significant life changing experience, realize that those strong feelings will fade over time one day you will be able to see the benefits for all concerned.

If all goes well you will be notified of acceptance of your application and a bed is offered to you by the LTC facility.  Arrangements will be made for transfer into the facility.  You will be asked to come to the facility to review and sign what is called an Admission Agreement.  This is usually done on the day of admission but if you have schedule conflicts, you can make arrangements to sign all the necessary paperwork prior to admission. At that time a deposit may also be required in anticipation of care being rendered.  The size of this agreement can be overwhelming and covers all services, financial and legal obligations as well as a plethora of regulatory requirements such as privacy laws and facility and resident responsibilities.  You will be given a copy for your records.

So the moral of the story is to be as prepared as possible ahead of time.  Have ongoing family discussions and plans in place for who will be responsible for what.  Don’t be hesitant to reach out and accept assistance along the way.  This is after all one of the biggest life changing events you will face and a challenge for all concerned.

Be nice to your kids, they will choose your Nursing Home” Author Unknown