by Anne Bogardus, Founder (and former caregiver to Bob and Kit)
(Note: this article is written from the perspective of a caregiver whose parents are unable to participate in some or all of the process. If your parent is able, obviously they should be included in making this important decision.)
Choosing the best nursing home for an elderly parent can be a daunting task. Finding an affordably-priced, high-quality care home takes time and resources.
And after all the work involved, it can still be hard to have answers to crucial questions:
- Is the nursing home safe?
- What about the quality of the nursing home staff?
- Are employees screened in a way that ensures they provide a high level of care to patients?
- How does a concerned adult child conduct the best possible due diligence to ensure their parent is safe, well-cared for, and content in this new home?
- How will we pay for it?
Just thinking about it can give you a headache. If nursing home care is the next step for your family, here are five steps you can take when comparing nursing homes that can help you evaluate available options and choose a facility that provides the best care possible:
- Clarify the type of care needed
- Identify financial resources available
- Gather a list of possible facilities
- Visit each facility that meets your criteria–and ask the right questions
- Select the facility that best meets the care needs of your parent
Clarify the Type of Care Needed
The first step in selecting the best nursing home is to know exactly what kind of care your parent needs. Do they have physical limitations that require assistance for basic activities of daily living? Are they suffering from a traumatic brain injury or stroke? Are they suffering from cancer or another severe illness? Do they have some form of dementia, such as Alzheimer’s, Vascular, Fronto-temporal, or Lewy Body? The specific medical and physical needs of your parent will clarify the type of care needed and provide you with a list of criteria to use in evaluating different facilities.
If both parents need care, this can become more complex, especially if care needs differ—for example if one parent needs assistance due to a stroke, the criteria will be different for another parent suffering from dementia who needs the care available in a memory care facility. There are facilities that can accommodate both types of care, and the criteria you establish here can help you weed out any facilities that don’t provide what is needed.
In addition to care criteria, consider location. If your parent lives far from you, do you want to have them to be in a facility closer to you? Or is it important to your parent to stay in their own community so friends can visit?
Identify Financial Resources Available
After clarifying the type of care needed, another crucial analysis must be done: how much money is available to pay for care? According to Genworth, in 2015, average nursing home care costs were in the range of $6,667 to $7,500 per month, although the cost varies widely from state to state, from $4,250 in Texas to more than $23,000 in Alaska. Clearly, this is beyond the reach of many families, so the question becomes how to pay for care that is needed. There are three basic sources of funds to pay for care: personal resources, government assistance, and long-term care insurance.
To begin, you’ll need to make a list of the income and investments your parents have, including pensions, trusts, IRAs and 401(k) plans, real estate (including their home), insurance or annuity income, and stocks or bonds.
Once any personal assets are exhausted, the federal/state Medicaid program will provide funds for long-term care to the elderly who are medically and financially qualified. The program rules vary in each state–and be aware that not all nursing homes accept Medicaid payments. If you anticipate that Medicaid will be needed, be aware that it can take up to six months for an application to be processed and approved, so don’t wait to begin the application process. A certified elder law attorney familiar with the rules in your state can help you navigate the process since it can be complicated.
Another program, available only to qualified veterans and their spouses, is the Aid and Attendance and Housebound benefit. To qualify, a veteran must have served at least 90 days including one day served during wartime.
Long-Term Care Insurance
For fore-sighted elders who purchased long-term care insurance in their 50s or early 60s, payments for nursing home care can be covered up to certain limits (depending on the policy) and are subject to deductibles based on the policy requirements.
Gather a List of Possible Facilities
When you know what care is needed and how it will be paid for, you can start your search for the best facility for your parent. A good place to start is to ask friends, co-workers, extended family, or church members for recommendations. These recommendations may or may not meet your specific criteria, but they provide the benefit of experience with someone you know.
As with many other aspects of life in the internet age, search engines, such as Google, Bing, and Yahoo!, make it easy to find nursing homes in your local area. In addition, you can gather information on the facilities you find from their websites, and weed out any that clearly don’t provide the services needed for your parent. It’s important to not rely only on what a facility says in its marketing material, though, and the internet also makes it possible (and easy) to review impartial information. US News & World Report in particular has assembled and ranked a list of the best nursing homes in each state. The listing provides information on how many beds the facility has, whether Medicare or Medicaid payments are accepted, the type of ownership (public/private/part of a chain) and whether continuing care is available. Each facility is ranked for health inspection ratings, nursing staff ratios, quality measures, such as incontinence, weight loss, major injuries due to falls, depression and a comprehensive list of other criteria. The rankings also include how well the facility meets fire safety standards, and tells you if the nursing home has been fined for any reason during the previous three years.
There are other sites that rate nursing homes as well, such as the Better Business Bureau where you can read what other people say about institutions you are considering—these are most often negative experiences.
USA Today also provides nursing home ratings—although the site is not as intuitive to use as others. (Select your state, then type a letter in the search box to get a list of facilities in the state.) This site provides the number of beds in the facility and the ratings established by the federal Centers for Medicare and Medicaid Services(CMS) for inspection results, quality of care, and staffing.
To learn what the rankings mean, you can read the CMS explanation of the 2015 5-Star Quality Rating System.
Visit Each Facility That Meets Your Criteria
Armed with knowledge of the care needed by your parent, their financial resources, and the independent evaluations from your research, you can begin touring different facilities. With the information you have gathered, come up with a list of questions specific to your parents’ care needs and have them with you during the tour. Here are some important questions to include on your list:
- What is the staff to patient ratio during the day?
- What is the staff to patient ratio in the evening?
- What is the nurse to patient ratio? (day and evening)
- What is the staff turnover rate?
- If memory care is one of your criteria, ask how many instances of residents wandering have occurred, did the resident leave the premises, and if so, how long were they gone.
- What protocol do they follow for medical emergencies?
In addition to your questions, during your tour take notice of the cleanliness of resident rooms, the dining room, and activities area, in addition to the entrance and public rooms. More important than the appearance of the public areas of the facility is the overall cleanliness and comfort for residents. Is there a strong smell of urine? Are the walls and floors clean? Are the rooms tidy and welcoming or excessively cluttered? Are residents engaged in activities or in conversation with each other or staff? Do the residents seem comfortable and happy with the staff members? Do staff members use the residents’ first names or take time to stop and talk with individuals?
Once you find a nursing home that can provide the type of care your parent needs and accepts the form of payment available to you; one that is welcoming and clean, rated highly, with an adequate staff-to-patient ratio; you can begin planning the transition for your parent. Keep in mind that this may start with placing your parents’ name on a waiting list until an opening becomes available.