The needs and challenges of older adults in assisted living, independent living and memory care settings can be numerous and hard to navigate for caregivers. Dr. Sandra Petersen, DNP, APRN, FNP-BC, GNP-BC, PMHNP-BE, FAANP, holds certifications in family practice, geriatric medicine and psychiatric-mental health and has been in active practice since 1993, addressing the questions of seniors and their caregivers to ensure older adults live fuller, happier lives.
Question: I’m going to start touring nursing homes to find somewhere for my mom. What should I be looking for on these tours? Anything about the facility I should look for, or are there specific questions I should ask the staff?
Answer: Deciding on nursing home or skilled nursing facility placement for a loved one isn’t easy. As with most decisions of this sort, it really is “buyer beware.” Thinking through the person’s needs and long-term prognosis play an important role in the decision-making process. Here are some questions that will help guide you when choosing a long-term care facility. Ask these questions of yourself and your loved one first: What are your expectations/preferences; then, when you begin interacting with personnel in different facilities, ask the same questions of the facilities.
Consider how well the facility answers match yours, and choose the top “candidates.” Then plan visits at different times of day to look at staff coverage, meal service and appearance of residents at different times of the day. Starting with an empirical process such as this will help you “score” the top candidates, assist you in deciding which features are most important for you and your loved one, and make the decision-making a bit less daunting.
Here are some questions to consider:
- How soon do I need to place my loved one? (Ask the facility how soon a room is available, or if there’s a waiting list.)
- How convenient is the location for my family and me to visit? What is the visitation policy? Are you and your family able to visit at times that fit your work and family schedules, or are there limitations?
- What improvements have been made to the facility? Are some planned? Is there a generator if the power goes out? Are there handrails in bathrooms and hallways? What safety features have been added? Do the residents wear call pendants to summon assistance?
- How are emergencies handled? What if there’s a fire? An evacuation? If evacuated, where are residents taken?
- What activities are offered? Religious services? (Does this match up with your loved one’s needs?)
- Is the facility Medicare- or Medicaid-certified?
- How does billing work? Monthly paper bills? Electronic draft payments allowed?
- Are services tiered or à la carte? How much do services cost? How is the facility staffed on each shift?
- Who determines what services the resident needs?
- Are there doctors who “round” in the community? How often do they come, if so? Or, is the resident expected to use an outside doctor?
- Is there a house pharmacy? (Check to see if it’s on your loved one’s insurance plan.) Are outside pharmacies/mail order pharmacies allowed? If so, is there a charge?
- Does the facility provide transportation to outside appointments?
- Under what circumstances or conditions might my loved one be asked to move (like for certain illnesses, cognitive impairment, etc.)? Is there a secure (fenced) outdoor space for residents to walk?
- How often are housekeeping and laundry services provided? Is there an extra charge?
- Are residents allowed to set their own “schedule” (i.e., get up when they want to, eat meals within an extended window of time, etc.), or is the schedule the same for everyone? How does this match with your loved one’s preferences?
Undoubtedly, the above questions are only the tip of the iceberg when it comes to this important choice but will, at least, get you started. Choosing a long-term care community for a loved one is a “journey” not undertaken lightly as your loved one’s well-being and happiness are at stake. A methodical, comprehensive approach is the best way to ensure a good fit for you and your loved one.