Cartoons: Roz Chast
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Selecting Senior Housing
By Dimitra Kessenides
Eight practical suggestions to ease the transition.
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One of the more difficult decisions you'll face as a caregiver is whether to place a parent in an assisted-living facility or a nursing home.
Assisted living (AL) offers elderly residents the chance to retain as much of their independence as possible in a supervised residential setting and is often a step between having parents living alone at home and moving them into a nursing home.
The emotional terrain of making the decision is challenging, but once you choose to move a parent—whether you've planned ahead or have had to make a quick choice—follow these eight guidelines:
- Take the initiative. With all the information available today, the burden is on you to research the matter aggressively. Ultimately, you have to go with your own instincts about a place and how it will serve your parent's needs.
- Decide what type of home is best for your parent. The staff at AL facilities provide help with tasks such as bathing, dressing, housekeeping and transportation. But while meals are offered in a communal dining room and there is daily supervision on-site, there isn't the 24-hour skilled health care that's provided in nursing homes. AL is not an option for people whose illnesses are so debilitating that they're unable to leave their beds, or for people suffering from severe cases of dementia, although some AL facilities now offer special units for patients with Alzheimer's disease.
- Weigh the finances. AL costs less than a nursing home, and these facilities usually are owned and operated independently, but some nursing homes also have an AL component. In general, Medicare does not cover assisted-living facilities and pays for only a small part of nursing-home expenses. Go to AARP's Web feature "Housing Options for Older People" for details on various choices.
- Check the ratings. State licensing requirements for assisted-living facilities vary from state to state. Certified nursing homes are required by federal law to make available to visitors the annual state and federal survey of their facility. When you are visiting a nursing home, ask to see this survey, and check on how the home's track record fares in categories such as cleanliness, administering medications, nutritional quality of the food and nursing care.
- When checking a nursing home, look for warning signs. Items called "Tags" or "Deficiencies" on the survey flag problems. Some things to look out for: a high incidence of bedsores among residents, as well as frequent falls and the use of restraints, which can indicate low staffing levels.
- Ask questions. Take notes as you tour a facility and read the survey. Then sit down with a representative from the home to address your questions. Some good ones to ask: Who owns this nursing home? What is the staff-to-patient ratio on each shift? How do you recruit and retain good staff? What improvements are you currently working on?
- Be a careful observer. However, don't be put off by appearances. The physical condition of residents is often a reflection of their illness and does not necessarily indicate neglect. Some residents will scream or shout, which is not uncommon in those suffering from dementia. The location and surrounding neighborhood of the facility also may not relate to the level of care.
In particular, perform the following checks:
Observe residents. Is their hair clean, their clothing soiled? What about staff? Are they stressed, are they surly or curt?
Check out the surroundings. Cleanliness is important, so look for uncollected garbage, dust and dirt. (Odors are normal in nursing homes, especially when hallways are filled with bins of dirty bed linens.) Check the bathrooms, look under the beds.
Ask to see the menu. Is there variety and nutritional balance? Is the home sensitive to different dietary needs? You can ask for a copy of the menu and later show it to your parent's doctor for feedback. Check on where residents eat breakfast. Is it served in bed on a tray? Superior homes will have residents up and out in the dining room.
- Be thorough even if you must act quickly. What if you have little time to plan ahead? Faced with a medical emergency, you should still try to follow as much of our advice as you can. However, if your parent has been admitted to a hospital, the first person to turn to for help in finding a nursing home is the hospital social worker or an ombudsman. Check the database at the National Long Term Care Ombudsman Resource Center, in our list of resources.
Try to avoid making a decision without visiting a home. Even if you are pressed for time, it's a good idea to visit at least three nursing homes. If you can afford it, hiring a geriatric care manager (GCM) can speed the process along (see Resources for More Info about Picking a Nursing Home). You'll need to meet with the GCM once to discuss the particulars of your situation, and then that person will go about searching for the best option.
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