Having worked as a consultant in the field of physical medicine and rehabilitation, I often have friends say, “I am looking for a nursing home for a relative. Do you have any suggestions?” I can’t make personal recommendations, but I have addressed this issue enough to offer many insights.

The Challenges

Often, the need to select a residential care program comes at an already stressful time. A family member has experienced a stroke, heart attack, fall, or other injury or illness and is hospitalized. The family is simultaneously addressing the patient’s current condition while trying to understand what will come next. During this emotional time, many daunting questions arise.

What level of care does my loved one need?
While most physicians or discharge planners can provide the standard answer to this question, other considerations may change what is appropriate for a specific person. For example, a location closer to home may be a better choice than a newer facility across town.

Which facility is best?
Physicians and discharge planners often recommend specific programs, but before you decide, ask an important question: What is the relationship between you and this facility? Some physicians refer patients to facilities at which they are the medical director and receive a monthly stipend for each patient seen. Many families have found their loved ones in understaffed or inappropriate facilities based on a physician recommendation that serves the doctor, not the resident.

How will we pay for this?
Between Medicare, Medicaid, Medicare supplemental insurance, and private insurance, payment issues are confusing. Unfortunately, part of the answer depends on which program the patient needs and the underlying licensing of that facility. In addition, some facilities have different types of designated/licensed beds. Good facilities will help answer financial questions and provide you with the forms you need, but be careful. Some facilities will announce that they are moving the patient from one room to another, forgetting to mention that the care which had been covered by Medicare is now private pay. Anytime a room change is announced, check to see if the payment structure changes as well.

Hospital discharge staff and geriatric care physicians can provide immense support in selecting the appropriate level of care for a loved one as well as viable options. Still, it is important to be your own advocate, making sure that the recommendations made are the best fit for you and your loved one.

If Only We’d Known

As a consultant, I have heard this many times in the context of selecting a residential care program. Here are some of the key issues:

Unprepared for Legal and Financial Issues
Do not wait until a loved one has experienced a stroke or other debilitating condition before executing medical, legal, and financial powers of attorney. Without these documents, the loved one must approve all decisions and may not be able to do so. The family must now go through the courts to become legal trustees of the person and his or her assets. In the meantime, decisions are made that might not be in the patient’s best interests, but what is legally possible until these matters are resolved.

Confused About Out-of-Pocket Costs
Don’t be shocked by unexpected bills. Who pays what can be a complicated question, and while staff members may help guide you, it's best to educate yourself prior to admission. One useful site to help understand these issues is Paying For Senior Care.

Hurried Admission Without Facility Tour
The number one regret I’ve heard is that family members wished they had visited a facility before placing a family member there. What seemed perfect based on a glossy brochure or website turned out to be a program that failed to meet the resident’s needs or the family’s expectations. Although it takes time and effort, doing this one thing will avoid many future problems.

Be proactive and avoid these problems, making the transition into residential care less stressful for you and your loved one.

My Three-Point Inspection

I have toured hundreds of residential facilities, and before I look at a single record, chart, or report, I already know the quality of care provided by looking at three things:

1.) How does it smell? The facility should smell clean but not strongly of disinfectant.

2.) How is the staff dressed? All employees should be dressed neatly and professionally, with clean clothes that are free of stains or dirt.

3.) How are the residents dressed, and where are they in the building? Residents should be dressed in neat, clean, comfortable clothing, and most should be out of their rooms, socializing or participating in activities.

If a facility passes these tests, there are more questions to ask, but at least you know you’re on the right track.