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How to Choose a “Nursing Home” for Your Elderly Parent

Elderly hands held in younger handsAdministrator’s Note: Welcome to the Envision Home Health and Hospice Blog. This post is the first of many to come on a variety of health topics.

At some point it’s bound to happen: your elderly mother or father is no longer safe to live at home. It may be because they’ve had a long illness that has left them debilitated—or they keep falling and hurting themselves—or they just need a little help to take a shower and get dressed.

Whatever the reason, if your parents live long enough (and let’s hope they do!), it’s likely that at some point you’ll have to decide where they can safely live.

And it doesn’t help that there are many types of facilities with very specific titles and purposes—yet most people lump them together as “nursing homes.”

Yet, if you understand, 1) why you shouldn’t feel guilty about “putting Mom in a nursing home”, 2) what your parent needs, 3) the technical names for the different facilities—and what they offer, 4) how they are paid for, and 5) how to choose a good one, the task becomes a little easier.

Step 1: Don’t Feel Guilty

I’ve seen some people struggle for years with the idea of moving their elderly parent into a healthcare facility—all while their parent struggled physically or emotionally in a home that compounded all the problems.

If your mom or dad can’t participate fully in today’s busy world—they may be isolated and left alone far too often.

And “home alone” for an elderly person can mean risk of accidents and depression.

There’s a reason why modern healthcare facilities for the elderly have steered away from calling themselves “facilities” for the more friendly title of “communities”. Why? Because elderly care is much more community-oriented and home-like than what it used to be.

These days, the best “communities” are designed for a more neighborhood-like experience—including cozy rooms, more gathering places, better food, engaging activities, regular entertainment, real socializing with other seniors, etc.

So, as much as you think that your dad or mom will be happier in your home—or their own home—it’s quite possible they will be more content (and safer) in a more stimulating environment with their own age-group.

Step 2: Identify What Your Parent Needs

Healthcare facilities for the elderly are tiered in a hierarchy based on how much assistance the person needs.

Is your mom or dad generally in good health and basically independent—but wants to be around other seniors? Then an “independent living” (IL or ILF) community may be perfect.

Does your mom or dad simply need some help with bathing, dressing, and meals? Then an “assisted living” (AL or ALF) facility would fit the bill.

Maybe your parent has some complex health issues that need monitoring—or recently had a hospital stay for an illness or surgery. In that case, he or she may need a “skilled nursing facility” (SNF) with 24-hour nursing care and daily therapies.

Does your parent have serious dementia, e.g., Alzheimer’s or other dementia? And are they safest when they’re in a controlled and monitored environment? Then you probably need to choose an assisted living or skilled nursing facility with a “memory care unit” with strictly-controlled access so your mom or dad can’t wander off.

Or maybe you can see that your parent is likely to experience all of these needs—perhaps in slow, chronological order—and you don’t want them to switch facilities every time they have a greater need. Then you might consider a “continuing care retirement community” (CCRC) where all levels of care are offered.

Step 3: Know the Technical Names of Elderly Care Facilities

The term “nursing home” has become a vague, generic term used to describe any facility that provides elderly care. It’s too vague to be useful when you’re making decisions, so it’s important to know the real names.

From the lowest amount of care to the highest, here are the names that are normally used in this industry:

“Senior Community” or “Independent Living Community” is the name for a facility (or sprawling campus!) that is designed for active seniors who are in relatively good health and who don’t need assistance with anything. They are designed to enhance quality of life by grouping seniors together who may have common interests or needs for socializing. Normally, these communities feature individual apartments or townhouses, have lots of recreational and socializing activities and have a cafeteria or restaurant for meals if the residents don’t want to cook.

An “Assisted Living Facility” is designed to help those who have trouble with “activities of daily living” (ADLs). What are ADLs? Think about what you did this morning…you got yourself out of bed, bathed, groomed yourself, and got dressed. Those are ADLs. An assisted living facility has the personnel (certified nursing assistants or CNAs) to help each resident who has challenges with ADLs. Assistance can also include medication reminders, transportation, and meals.

“Skilled Nursing Facility” is the name for facilities that provide true, 24-hour healthcare for patients with fairly complex health issues. These facilities staff nurses 24 hours a day and provide rehabilitative therapies like physical, occupational, and speech therapy. They are staffed with a social worker and have a medical doctor assigned as the house physician (although you can use your own doctor if you prefer). I like to think of these facilities as one step down from a hospital—in fact, many elderly patients who have a hospital stay for an illness or surgery are discharged from the hospital directly to a skilled nursing facility to get “rehabbed” before they eventually return to their home. However, many of these facilities also have a “long-term” group of patients that will live there—receiving care—indefinitely.

A “Continuing Care Retirement Community” (CCRC) is a facility that usually includes all of the above. Within a large CCRC can be an independent living community, an assisted living facility, and a skilled nursing facility.

Be aware that most of these facilities are not exclusively for the elderly—but could include some younger patients or residents.

Step 4: Know How to Pay for the Care at Each Facility

Costs of these facilities will vary significantly by area and amenities.

Facility Provider of Funds and General Cost
Senior Community or Independent Living Community Normally private pay. Some limited Medicaid funds for low-income seniors. Often starts at $3,000 per month but could be much higher.
Assisted Living Facility Normally private pay, but sometimes covered by long-term health insurance and Medicaid. Can start at $1,500 per month but could be much higher.
Skilled Nursing Facility Medicare pays for up to 100 days of care after a qualifying hospital stay. Medicare HMOs also pay for care. Long-term care can be funded by private pay, Medicaid, or long-term care insurance. Care often costs $300 or more per day.
Continuing Care Retirement Community Different levels of care can be funded as described above—but some CCRCs require private pay only.

 Step 5: Choose a Well-Run Facility

The internet is a great resource for reviews and ratings of specific facilities. Try a search for “assisted living facility ratings [name of city]”, or search for the specific name of the facility you’re considering. For skilled nursing facilities, Medicare provides detailed statistics and ratings at their website: Nursing Home Compare. At the website look for facilities with 5-star ratings and/or high staff hours per resident.

Healthcare professionals who visit multiple facilities on a regular basis—like nurses and therapists from home health agencies—will have excellent insight about the quality of specific facilities. Consider calling a home health agency and asking to talk with one of their professionals. Doctors and hospital discharge planners are also good sources of information.

Finally, nothing beats a tour of the facility. Visit the facility with someone you trust so you get their impressions—and take Mom or Dad along if possible. A good tour will include all areas of the facility, including bedrooms, activity areas, and dining rooms. Ask about the menu, how often activities are held, and what kinds of activities are provided. Don’t be afraid to introduce yourself to some of the residents and ask their opinions of the facility—most seniors will be happy you asked and they’re not afraid to give you an honest opinion.

I’d love to hear about your own experience, so please leave a comment in the comments box.

Blog posts at this site will cover many other aspects of senior care, nursing, and therapy. I invite you to subscribe to this blog.

 

Comments

  • Sally Knotwell

    Fabulous info, Derek….I’ve bookmarked this for the future – either for my own mother or maybe to refer to my dear son for his dear mother! Thanks so much for some well-thought-out and concise information.

    June 10, 2013 21:06
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    • Derek White

      Glad it’s helpful, Sally. Thanks for reading. Let me know if you need any more information.

      June 11, 2013 16:06
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  • Cindy Newman

    This is really helpful. Great advice especially on not feeling guilty. Thank you Derek!!

    June 11, 2013 23:06
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  • Melody Newey

    This is great! I like the clarification about types of facilities. Most of us have no clue about all the options. Thanks for posting.

    June 13, 2013 08:06
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  • Kelsey

    This is great information that everyone should know. At some point in most peoples live they will have to look into find a retirement home for either them selves or someone else. My parents are looking for a retirement home and I am trying my best to help them find a nice place.

    February 6, 2015 17:02
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  • Not feeling guilty is a great tip when considering putting a loved one in a care facility! My parents felt so guilty about putting my grandma into a home that they put it off much longer than they should have! My grandma ended up getting hurt one day and she couldn’t call anyone for help. After that, they finally conceded to finding a good care facility for her. Since then, they have been very open about wanting us to put them in a home when they are no longer capable of caring for themselves. It is a good thing to talk about because now none of my siblings or I have to feel guilt about it.

    February 17, 2015 21:02
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  • Thanks for these tips for choosing a nursing home. I love that you mentioned the importance of identifying the needs of the person who is going to be living in the nursing home. Like, obviously someone with Alzheimers is going to need different services from someone who is in relatively good health. Make sure to ask about what kind of medical care the home offers. You want to make sure you can feel confident that your parents (or whoever is going to be living in the home) are well taken care of.

    March 23, 2015 08:03
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  • I really like what you said about finding what your parents need. Every nursing home is different, and excels in a different area than another. Finding a nursing home that does best where your parent needs it the most, is definitely an important thing to consider.

    August 3, 2015 12:08
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  • I like your advice about not feeling guilty about putting my parents in a nursing home. Both of my parents are getting old and I worry about them every day. I know that I will have to place them in a nursing home soon, especially if one of them passes away first. I just hope that the facility I choose will be a good fit for them.

    January 18, 2016 16:01
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  • I appreciated that you mentioned that you should look for a nursing home after you check your parents’ needs, so you could choose accordingly. My wife and I have been talking about finding a nursing home to help my parents because they are having issues with taking care of themselves, and it would be important that we could find the right nursing home for them. I will be sure to identify their needs before we choose a nursing home.

    September 12, 2019 15:09
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