The need for long-term care assistance continues to grow. Roughly 5.8 million people in the United States used paid long-term care services in 2020, with about 1.9 million of those residing in long-term care facilities, according to the Congressional Budget Office. Seven out of ten people will require some form of assisted living care during their lifetimes.
Moving a loved one into a long-term care facility can be a costly proposition, but there's more to consider than just the price tag. Here's some helpful guidance if a relative—say, a parent, grandparent or sibling—may soon need extended nursing care.
Four Main Types of Facilities
For starters, it's important to understand the differences in options for long-term care facilities. Here are four common options.
Nursing homes. For years, people often referred to all long-term care facilities collectively as "nursing homes," but that was misleading. Nursing homes provide a wider range of health care and personal services than what's normally available at an assisted living facility (ALF). Nursing home services typically include round-the-clock nursing care and supervision, three meals a day, and assistance with everyday life activities. Other services—such as rehabilitation services and speech therapy—may also be available.
In some cases, an individual will stay at a nursing home for a short period following a hospital stint. Once they recover, they go home. However, many residents remain for the long haul due to continuing physical and/or mental conditions that require extended care.
ALFs. An ALF may be suitable for someone who needs assistance with daily care but not 24-hour skilled nursing care. Fees are generally based on different levels of care afforded to the resident.
Usually, residents live in separate apartments (or a couple may share an apartment). They also may have access to common areas, such as dining rooms, game rooms and lounges. Services typically include assistance with personal care and medications, meals, housekeeping, laundry and security. Recreational and social activities are often an important aspect of this living arrangement.
Continuing care retirement communities (CCRCs). The third option is completely different. With a CCRC, residents can take advantage of varying levels of care within a single community. Generally, individuals live in separate houses or apartments and rely on services provided there. Recreational and social activities are also prominent.
This alternative allows residents to dial up or scale back their service level based on their health care needs. As the need for care increases, an individual can be transferred to an ALF or nursing home on the campus or move to an outside facility. In-home care is also available so residents aren't necessarily forced out of their living quarters.
Board and care homes. This is the least common of the four options listed. Board and care homes tend to be smaller facilities than nursing homes and ALFs and usually are comprised of 20 or fewer residents. Rooms within the facility may be private or shared with others.
Because these facilities are relatively small, residents may receive more individual attention. They offer residents three meals a day and 24/7 personal care. When nursing services are required, however, residents are generally transferred off-site.
Tips to Help Pick a Facility
Quality of service is a top concern when selecting a long-term care facility for your loved one. To help guide the public, the Centers for Medicare & Medicaid Services (CMS) has identified facilities with documented issues. This can help in determining the choice for a family member.
The CMS has created a search tool that provides quality-of-care information for every nursing home that participates in Medicare and/or Medicaid. You can look up nursing homes by city, country, state or zip code. Or you can search for a specific facility by name. In general, facilities receive ratings ranging from one star for the worst to five stars for the best.
However, you'll want to do additional research. Consider these guidelines when evaluating facilities for your loved one.
Set priorities. What's most important to you? It might be nursing care, meals, housing, physical therapy, hospice care or special needs, such as care for dementia or Alzheimer's patients. Also, proximity to friends and family may be important.
Obtain referrals. You may know of someone in a long-term care facility. Contact relatives, friends and members of your local and religious community for their input. And check with local health care providers to see which facilities they recommend.
Schedule a tour of the facility. Once you've narrowed down your list of prospective caregivers to three to five facilities, visit the facilities on your list in person. The facility with the most impressive website or brochure might not necessarily provide the highest quality care or be the easiest to work with from a financial point of view.
During site visits, interview staff about important details, such as:
The number of residents,
The staff-to-resident ratio,
Levels of care available (for example, assisted living, full nursing care, rehabilitative care and hospice),
Security measures (such as surveillance cameras, locks on residents' dressers or apartment doors, and alarms on restricted areas),
Meals, snacks and beverages,
Rules regarding distribution of prescription and over-the-counter medications,
Activities (for example, games, arts and crafts, exercise classes, education opportunities and holiday events), and
On-site amenities (such as religious services, dental care, chiropractors, hair stylists and spa treatments).
Also arrange to meet with the facility director and head of nursing. Make a list of questions such as:
Is there a waiting list to get in?
What happens if the resident goes on Medicaid?
Which specific staff members would care for your relative?
What's included in the resident's monthly fee—and what will cost extra?
Is there a formula for price increases in the future, or is the monthly fee fixed?
Also, don't hesitate to ask the "really tough questions," such as whether the facility has ever been cited for any actions or acts of omission. For example, high turnover of key administrative positions could raise a red flag.
Even more important, watch the residents and their family members as you tour each facility. Do they seem happy, safe and clean—or agitated and unkempt? Does the food look and smell appetizing? Are there any strange odors or visible trash? Would you want to live at the facility or visit it on a regular basis?
Conduct a follow-up visit. This time, come unannounced. If you previously visited on a weekend, consider showing up on a weekday. A switch usually makes it easy to meet with different staff members because of weekly scheduling. Check out the activities going on at different times. Take a close look at all the meals being served.
Once you've made your final selection, examine the facility's contract carefully. It's likely to be lengthy, so take your time. Ask the director about anything you don't understand. Have someone else review it with you. Better yet, consult a legal professional if you're unsure about certain items.
Do Your Homework
Choosing a long-term care facility for your loved one isn't something you should do in haste or desperation. Take your time and conduct ample due diligence. A nursing facility that appears perfectly fine at first glance may be substandard when you dig deeper. A thorough, disciplined approach can provide much-needed peace of mind during this critical phase of life.