Selecting an Elder Care Facility

Moving to a residential setting

Knowing if and when the time is right for an elderly person to move from the home to a residential care setting can be one of the most difficult decisions a family must make. Many persons continue to care for the elderly at home even though it becomes physically and emotionally exhausting for them to do so. Sometimes, moving to a residential care setting may become the most realistic decision to ensure the best care for the elderly person.

Moving from home and into residential care facility should be considered when one or more of the following situations applies:

• The elderly person requires round-the-clock care.
  
  
• The elderly person cannot manage activities of daily living (eating, toileting, bathing, etc.) without assistance.
  
  
• The elderly person is prone to violent outbursts (physical and/or verbal) or is a danger to himself or to others.
  
  
• The elderly person has "wandered" away from the safe surroundings of home or neighborhood.
  
  
• The caregiver's health and well-being is adversely affected by continuing to render care at home.

Types of out-of-home options for the elderly:

There are many types of out-of-home care options for the elderly, depending on the level of care required. These may include:

• Assisted living facility (ALF)
  ALFs provide maximum independence for elderly persons who remain relatively active and healthy. Typically, a healthy spouse and an impaired spouse can live together in an ALF. Most ALFs feature apartment-style living, including individual kitchens, and many services for the elderly, such as 24-hour security, transportation, and recreational and social programs.
  
  
• Residential care facility (RCF)
  RCFs are for those who are no longer able to live alone and independently, but do not require skilled nursing care. At an RCF, the elderly person can receive assistance with personal hygiene, grooming, and/or other activities of daily living, as well as bedside care for minor and temporary illnesses. Typically, RCFs offer rooms, not apartments, and provide some recreational and social services for the elderly.
  
  
• Skilled nursing facility (SNF)
  SNFs are also known as nursing homes, convalescent centers, and rest homes. At SNFs, elderly patients receive continuous nursing services under the care of a registered nurse or licensed vocational nurse. SNFs can provide more extensive care services than assisted living or residential care facilities. Such services include intravenous feedings, blood pressure monitoring, medication injections, and care for patients on ventilators. SNFs often provide recreational, rehabilitative, and social programs for residents.
  
  
• Others
  Special care centers are available for persons with particular medical conditions, such as Alzheimer's disease or dementia. For patients displaying violent or disruptive behaviors or presenting a danger to themselves or others, special psychiatric facilities may be an option.

What to consider when selecting an elder care facility:

In general:

• Is the facility staff amenable to your taking a tour and stopping in at mealtime to visit with residents?
  
  
• What care services are provided and do these services match your own individual needs?
  
  
• How much input does the individual and family have in daily life and care?
  
  
• What choices of accommodations are available?
  
  
• Are there graduated levels of care available? For example, can residents move from an assisted living environment to a higher level of care, should the need arise?
  
  
• What personal items can be brought from home? What items are not allowed?
  
  
• Can residents have their own car on the premises?
  
  
• What is the visitation policy?
  
  
• Does the facility have a particular religious affiliation, and, if so, is the individual satisfied with this affiliation?
  
  
• How would an emergency situation, such as fire or severe winter storm, be handled by the facility? Does the facility have an emergency or crisis management plan in place?

The facility:

• Is the facility clean and tidy throughout? Are sanitary standards strictly enforced?
  
  
• Are appropriate safety measures taken (clearly marked fire exits, well-lighted hallways, bathroom grip bars, in-room emergency call system, etc.)?
  
  
• Is the facility located in a safe and convenient location?
  
  
• Is 24-hour security provided?

Rooms:

• Are individual rooms bright, cheery, and roomy?
  
  
• Do room arrangements allow for privacy?
  
  
• Do individual rooms have windows, allowing for natural light and a pleasant view?
  
  
• Are the common areas (activity rooms, lobby, gathering rooms) large, bright, and well kept?
  
  
• Is the dining room welcoming, spacious and not too crowded. Is it easy to move around in the dining room?
  
  
• Is the kitchen area clean and organized?

Respect for the elderly individual:

• Does the facility have a written policy about patients' rights and responsibilities? Is it made readily available?
  
  
• Is the staff trained to treat residents with dignity and respect?
  
  
• Are patients and families involved in developing the patient's care plan?

Staff:

• What is the number of staff members available per shift?
  
  
• Is the staff friendly and respectful of patients?
  
  
• Are continuing education and training a priority?
  
  
• Specifically, what staff medical services are provided (i.e., physician, nursing, physical therapy, respiratory care, and occupational therapy)?

Nursing care:

• What is the patient-to-nurse ratio?
• Is nursing care provided 24 hours a day?
• What are the credential requirements for the nursing staff?

Licensure and certification:

• Is the facility licensed by the state?
• Is it licensed to provide Medicare and Medicaid coverage?

Costs:

• Which services are included in the standard rate? Are other services provided for additional fees?
  
  
• What are the facility's Medicare and Medicaid policies?

Medical considerations:

• Is a physician available for emergencies?
  
  
• Are personal physicians allowed to follow patients at the facility, or does a facility-appointed physician treat residents?
  
  
• Does the facility have arrangements with a nearby hospital, in case of an emergency?
  
  
• Is emergency transportation available?

Activities:

• Is there a well-rounded program of social and recreational activities for groups and individuals? For example, does the facility offer outdoor outings, arts and crafts classes, movie outings, exercise classes, reading clubs, and the like?
  
  
• Does the facility stay active and connected with the surrounding community?
  
  
• Are outside trips and activities planned regularly?

Nutritional needs:

• Are meals provided at the facility, and what are the meal plan options?
  
  
• Does a licensed dietitian approve all menus?
  
  
• Can the facility accommodate those persons with special dietary restrictions?
  
  
• For persons wanting to take some meals in privacy, is there a small kitchen or kitchenette available in the individual room or apartment?

Additional services:

• Does the facility provide chaplain services?
  
  
• Are housekeeping and laundry needs available? If so, are they included as part of overall fees or provided at an extra cost?
  
  
• Is transportation available for trips to the local shopping center, grocery store, library, and bank?

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