How to pick a long-term-care facility when your loved one can’t live alone

Our first column on Care Options focused on moving a parent or other relative who was still fairly independent into a new living situation as he or she needed a little more help with everyday tasks.

In this column, we’ll focus on more advanced care needs. You may be dealing with chronic or progressive conditions such as Alzheimer’s or Parkinson’s disease, diabetes or congestive heart failure, or a sudden crisis like a stroke. Care may be needed 24/7, and it might not be feasible for you to provide all the required care at home.

Before any decision is made about residential care, try to visit more than one care community with your parent and/or another family member. Ask to join the community for lunch and get a tour, view the activities schedule and menu, and take particular notice of how the staff interacts with the residents.

Speak with as many residents as you can. If the community under consideration is required to be licensed, ask to view the facility’s history of compliance with minimum standards and the number and types of complaints that may have been filed against the facility.

Costs: It’s important to understand that Medicare doesn’t generally cover the costs of long-term care, particularly when it’s provided at home or in an assisted living facility. Private long-term care insurance policies can help, but may have limitations and loopholes, and are quite expensive. They must be purchased before care is needed.

Options for Residential Care:

• Residential Care Facility (RCF): These facilities are small group homes (sometimes called board and care homes, residential care homes or adult foster homes) that provide supervision, meals and care for people who cannot be left alone but do not require skilled nursing care. Residential care facilities provide assistance with bathing, grooming, eating, using the toilet, and walking, and they also provide socialization, some recreational activities, and a more home-like atmosphere. Rooms may be private or shared.
• Assisted Living Facility (ALF): Individuals who are somewhat independent but require daily oversight and assistance with housekeeping, medication management and personal care will want to consider an assisted living facility. Assisted living facilities offer rooms or apartment-style accommodations and, often, social activities. Meals are provided in a shared dining room. Staff is available to assist with care needs such as transportation, bathing, medication management, grooming, eating or using the toilet, and care is arranged as needed by the individual. Nursing staff may be on-site or on-call. The monthly charge for assisted living is determined by rent plus the amount of care a person requires and varies widely throughout the U.S.
• Some assisted living facilities are dedicated to — or include a separate wing for — those with Alzheimer’s disease or other memory impairments. These dementia careor memory care units offer a special security-protected environment, and social and other activities designed for the abilities of the residents.
  There are several online guides to assisted living facilities to help find a unit in your geographic area, but the guides are not necessarily comprehensive. A little investigative work, along with personal recommendations, can help to find a facility that fits your family’s needs.
  
  
  There are also companies that will consult with you as you seek assisted living or an RCF, but keep in mind that although this service is generally offered at no cost to you, consultants are paid commissions by the facilities for referrals. Nonetheless, some of the consultants are very knowledgeable about resources in your community, and that’s another avenue to explore.
• Skilled Nursing Facility (SNF): Commonly called nursing homes, these facilities provide nursing services 24 hours a day and are designed to provide high levels of personal and medical care, such as administering injections, monitoring blood pressure and managing ventilators and intravenous feedings. People living in skilled nursing facilities usually require help with the majority of their self-care needs; it would be very difficult to provide this level of care in a home environment.
  Medicare may pay for a time-limited stay in a nursing home after hospital discharge, on a doctor’s orders. Medicaid may help cover the costs if residents meet specific financial and medical requirements. Some families qualify for Medicaid assistance after they have “spent down” their assets to a minimal amount. An elder law attorney can help you sort through the complex rules.
  
  
  One source of information on facility quality is Medicare’s online Nursing Home Compare, which provides ratings of nursing homes. However, please keep in mind that the data is self-reported. Use that as one tool, but combine the information with visits to the facility, recommendations from friends and/or professionals in the field, and your own intuitive reaction during your visit.
  
  
  Visit www.pbs.org to read the full article and to learn more about options for residential care.