If you or a loved one are considering long-term care facilities, there’s a lot to know; things to look at when selecting one.

There’s a lot to consider when choosing long-term care (LTC) providers, whether it’s for you or for a loved one. Even if it’s not immediately necessary, as, with a massive stroke or other grave illness, the question looms as we age and our health begins to degrade.

Triggering events for long-term care are often centered around the activities of daily living (ADL). Those include bathing and dressing, eating, ambulatory ability, and incontinence or toileting issues. When your loved one’s ability to negotiate their ADLs diminishes, it may be time to consider long-term care. Here’s what to ask.

What kind of long-term care do you need?

There are a number of long-term care levels. The first step is to decide the kind of care needed.

Assisted living is a catch-all term for facilities that provide a mix of housing, personal, and health services. Such facilities may be completely independent communities or offer personal and health services. Typically, an assisted living resident has retained her ability to make daily life decisions around housing, personal care services, and health. As the ability to make decisions declines, some facilities offer fuller assisted living programs.

Elderly and disabled people may require a skilled nursing facility (SNF). Usually, people go into an SNF when they are ready to leave the hospital setting but need rehabilitative care before going home. An SNF is distinguished from other long-term care facilities by the level of skilled nursing, as opposed to a facility that is more supportive of daily living.

A person who can’t remain at home because he needs 24-hour care or monitoring is a candidate for a long-term care facility, often called a nursing home or convalescent home. Sometimes known as custodial care, staff provide clinical care and offer programs to engage residents in social activities.

Although some elders are proactive in considering long-term care, most often, it’s adult children thinking about their parents’ well-being. Many seniors who want to take charge of their care as they age consider in-home help or an assisted living facility. Families are frequently involved in the decision-making process when there is a major medical concern that triggers the decision.

If choosing an LTC facility, how does it look at first glance?

In the first instance, trust your initial impressions when you visit a facility.

• Does it smell good?
• Does it look clean and organized?
• Is the ambiance quiet or noisy?
• Do the residents seem content?
• Are you allowed to talk to residents to get their feelings about the home?

Try to get a feel for the place as you walk around, in the common areas.  If any of the answers to these questions leave you feeling cold, take it as a red flag about the facility.

What about the LTC staff?

Although a pleasant atmosphere and high level of cleanliness make for an excellent first impression, it’s important to look into the people who run the facility. Ask about the management’s and staff’s qualifications and experience. Also, find out how long the staff stays at the facility. High management or medical staff turnover could signal a problem; similarly, check how long, on average, do aides and support staff stay.

You’ll also want to consider the resident to staff ratio. Medicare and Medicaid standards require at least one RN to be on duty 8 consecutive hours every day. There should also be an RN and an LVN or LPN on the remaining shifts. Other federal standards apply to medical directors, social, therapeutic, dietary, pharmacy, and housekeeping. Individual state or local standards may differ.

As important as qualifications and resident to staff ratios are, staff attitudes are even more important. Grouchy or disgruntled staff members can be a sign of hidden problems. Check for pleasant demeanors and greetings to you and to residents. Do staff seem to like their jobs, or do you get the feeling that it’s just a paycheck?

What about resident activities and programs?

Often, one of the facility’s selling points is resident activities. No doubt you’ll receive a list of activities and social programs available to residents. Ask to join or observe an activity. Do they seem appropriate for the residents’ abilities; are they designed for varied interests?

How about meals; what’s included?

Mealtimes are a prime social opportunity for residents. Ask to see the menu for the current week. Time your visit so that you can try one of the meals. Also, ask if guests can eat with their loved ones from time-to-time. You may also need to know how the kitchen accommodates dietary restrictions and residents’ preferences. Does the facility offer mid-morning or afternoon snacks?

What are the payment terms and conditions?

Long-term care isn’t cheap, and the cost is always a consideration. Ask about fees and what they include. Some facilities provide personal services, such as haircuts or personal shopping, for a fee; ask what those are. Are medications covered in the monthly payment, or are they a separate charge?

Skilled nursing facilities typically will accept Medicare or Medicaid if the resident’s stay qualifies. Some don’t, and some have a mix of patient payment methods. Check payment plans and whether or not you’re required to set up automatic bank payments.

Does the facility have references from previous patients and their families?

Don’t be put off with prepared testimonials. Ask for a list of references that you can contact independently. While HIPAA (Health Insurance Portability and Accountability Act) regulations protect privacy, you can probably assume that a facility will have asked former residents or their families for permission to use them as references.

You can also investigate facilities via the internet. You may have to dig deeper than the facility’s website, such as checking with a regulatory agency’s website. Or, you can simply enter search phrases (XYZ facility complaints) and see what comes up.

Nearly half of those 65 and over will develop a disability that results in a stay at a long-term care provider. Most stay 2 years or less, but some patients may be in care for more than 5 years. The number one question to ask a long-term care provider is: Will Mom be happy here?