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Advice & More March 2018

When You Have to Choose a Nursing Home (or Assisted Living)

By Teresa Ambord

The older I get, the more friends and family members I have that need the various levels of senior care, from temporary stays in rehab hospitals, to independent living, to full nursing care. And in each facility or level of care, I’ve been wowed at how good the care is.

Elder housing isn’t what it once was, and thank goodness for that. Between high school and college I’d trained to be a nurse’s aide at our tiny rural hospital, which included a few convalescent beds where the patients were treated like precious commodities. But when I moved to the city for college, I worked part-time in a real convalescent hospital, and it was a nightmare.

Walk in the front door of that nursing home and the first thing that hit you was the smell of urine. Too many patients and too few staff to adequately care for them meant the residents were miserable much of the time. It was dreadful for all concerned, but mostly for the patients who were so dependent on us.

These days, elder care has become a booming industry and senior facilities have stepped up to meet the demand, in most cases, with excellent care. The older I get, the more friends and family members I have that need the various levels of senior care, from temporary stays in rehab hospitals, to independent living, to full nursing care. And in each facility or level of care, I’ve been wowed at how good the care is.

Now, if anything the choices may be too many. If you foresee that you or a loved one will soon be needing some degree of long-term care, it might be a good idea to start looking at the options.


First: What Level of Care are You Considering?

Here’s a breakdown of the major types of facilities.

  1. Independent living. These are best for people who can live on their own, don’t have specific medical care needs, but want convenience. Independent living communities offer such
    niceties as meal preparation, housekeeping, housekeeping, security, and may have on-site beauty parlors and barbers, clubs, church services, buses to take them shopping and transportation to appointments.  Residents can make use of all or none of those things.
  2. Assisted living facilities. These are for people who need some medical care. They include everything offered by an independent living facility, but also provide help with managing
    medications when needed, and with activities of daily living such as bathing, dressing, grooming. Some assisted living homes are apartment-like settings, and others are more institutional.
  3. Nursing homes. These are homes for people who need round the clock nursing care, and other support services. If this is the level of home you are considering, it’s important to
    inquire about how emergency care is provided. How available are physicians? Are staff members certified in CPR? What are the qualifications of nurses that provide direct patient care? How does the nursing home deal with family visits? Are visits restricted? How are patients with Alzheimer’s or Parkinson’s cared for?

This information should be available from the local Area Agency on Aging. Also, ask the patient’s doctor, nurses, therapists if they would recommend a particular place. You may be able to ask your own doctor, as news of substandard care travels fast in the medical community. Doctors may be reluctant to actually criticize a facility, so you may have to judge by the doctor’s hesitation to recommend that facility. Also ask social workers and relatives and friends.


Keep the Patient Involved in the Decision-Making Process if Possible

I have a friend whose husband is inching towards what seems to be inevitable dementia. While he can still participate in the decision, the two of them are visiting a wide variety of facilities. In fact, when the time comes, they might both move into a facility where she can live with him, perhaps an assisted living home, until he needs a great deal more care.

If your – or a loved one’s – need for a care facility is still off in the future, you might consider doing the same. That is, let the future patient participate in the decision of where they will eventually live.


What to Consider

If you go “facility shopping,” here are a few points to give special attention to:

  • Cleanliness. To the extent possible, observe hygiene. It shouldn’t be hard to notice if residents are being neglected.
  • Staff. Does the number of staff seem adequate to manage the number of patients? That’s not to say that employees aren’t hopping busy, but the staff-to-patient ratio should be such that all patients get bathed and receive other personal attention they need. The same is true not just for nursing care, but also general maintenance and kitchen staff.
  • Services. What are the patient’s special needs? Be sure the facility provides for those needs. For example, a patient may require the use of a lift machine to get in and out of bed. Many will need physical therapy and/or a gym where they can go to strengthen their limbs. How are supplies paid for? If supply costs are added to the patient’s bill, are the costs reasonable? Are there regular increases in costs? Hidden charges? Obviously meals are a key service. If you’re considering a facility you should visit it during a meal time and observe if meals are served in a relaxed manner and if plenty of food is available.


Get the Unseen Story

Don’t accept any facility without first checking its financially stability, record of legal compliance, and quality of management. Facilities aren’t likely to be perfect, but significant problems in any of these areas may lead to trouble finding sufficient staff of qualified health professionals.

Find out if the facility has current valid state and local licenses, and liability and malpractice insurance.

Ask to review state inspection reports and investigate whether they have lawsuits pending.


Sidebar: What Would I Have to Pay for Long-Term Care?

Every year, Genworth Financial does a “Cost of Care Survey” that measures the average costs for most levels of care for seniors or other people who need a little help, or a lot of help. Here are the results of the 2017 survey. Costs, says Genworth, rose an average of 4.5% between 2016 and 2017. The biggest increase was seen in the cost of home health aide care.

Here are the average costs in the nation, and the percentage of increase from the prior year:

  • Home health aide services, $21.50 per hour (up 6.17%)
  • Homemaker services, $21/hour (up 4.75%)
  • Adult day health care services, $70/day (up 2.94%) 
  • Assisted living facilities, $123/day or $3,750/month (up 3.36%)
  • Semi-private room nursing home care, $235/day or $7,148/month (up 4.44%)
  • Private room nursing home care, $267/day or $8,121/month (up 5.50%).

Why do this study every year? David O’Leary, the CEO of Genworth’s US Life Division says it’s to raise awareness about the cost of aging and help start the conversation about planning for long term care.” He points out that with most people preferring to remain at home as long as possible, “the good news is that home care is still more affordable than nursing home care."

You can check the average costs in your state on this site:


Teresa Ambord is a former accountant and Enrolled Agent with the IRS. Now she writes full time from her home, mostly for business, and about family when the inspiration strikes.

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