Navigating the Options: How to Choose the Right Long-Term Care Home
Long-term care (LTC) homes provide many services to those in need of long-term care, such as skilled nursing care, home care, and assisted living. But what are the differences between these types of LTC homes, and how do you know which one is right for you or your loved one? Let's take a look at the different types of LTC homes and discuss how to choose the right one for you or your family member.
Types of Long-Term Care
Long-Term Care (LTC)
Long-Term Care is assistance for people who can’t complete basic daily activities on their own, like bathing or dressing, or have ongoing illnesses or disabilities like Alzheimer’s, Parkinson’s disease, or dementia.
Home care allows seniors to receive assistance in their own home to continue living independently. Here are a few different types of assistance for home care:
Personal care assistance helps seniors with tasks like bathing, dressing, hygiene, going to the restroom, eating, and moving around the house.
Attendant care assists with meal preparation, laundry, light housecleaning, shopping for essential items, medication management, and transportation.
Home health care assists with medical or health related tasks like insulin injections, checking vital signs, and changing bandages.
Medical alerts, or personal emergency response systems, are a long-term care service that can help seniors continue to live on their own safely. There are systems that can detect a fall and automatically call for assistance, monitor the location of individuals who tend to wander, or simply provide an accessible way to call for help.
Adult Day Care
Adult Day Care provides care for adults in a community setting during the day. This type of care allows family caregivers to work or take a break from caring for their family member. Adult Day Care offers supervision, personal care assistance, meals and snacks, and recreational and therapeutic activities. Some day care facilities may provide limited medical care and physical therapy, occupational therapy, and speech therapy, and may also provide transportation to and from the facility.
Adult Foster Care
Adult Foster Care provides care for seniors in a home-like setting. This type of care is for those who require non-medical care and cannot live independently. In an adult foster care home, one or more seniors live with the caregiver and services such as room and board, supervision, companionship, housekeeping, and assistance with daily living activities, such as bathing, dressing, eating, mobility, transitioning, and toiletry may be provided.
Assisted Living provides care for seniors who don’t need nursing home care or 24/7 care, but can’t live independently in their own homes. Assistance like supervision, personal care, housekeeping and laundry, medication management, social and recreational activities, service coordination, and transportation may be provided depending on the level of care needed. Seniors who are physically weak or live with early to mid-stage dementia are candidates for assisted living.
Memory Care (Alzheimer's care or memory care units)
Memory Care is for adults living with Alzheimer’s disease or another form of dementia. This type of care is usually provided within an assisted living or skilled nursing facility, or a memory care residence. Within a memory care unit, the staff are trained to work with adults living with cognitive issues and the environment is designed to provide a safe place for those who tend to wander.
Skilled Nursing (Nursing Home Care)
Skilled Nursing facilities offer a higher level of care than assisted living homes. This type of care offers shared or private rooms, meals, 24-hour medical care and supervision, along with services like personal care assistance, medication management, rehabilitation therapies (occupational, physical, speech), and social and recreational activities.
Hospice Care typically provides care for those who may be in the final stage of their life. This type of care focuses on keeping the individual as comfortable as possible without delaying or expediting death. Hospice care offers services like symptom management and management of mental, physical, emotional, social, and spiritual concerns. Read more about the inner workings of hospice here.
Respite Care provides short-term relief for primary caregivers. This type of care can be provided for a few hours or a number of days or weeks and can be provided at the senior’s residence, in a healthcare facility, or an adult day care center.
After deciding on which type of long-term care fits your needs, the next step is to decide on the home.
Choosing an Option
To ensure that you choose a long-term care home that meets your needs and expectations, it’s essential to ask the right questions and look for specific factors. In this section, we’ll explore the key aspects you should consider when choosing a long-term care home. By understanding what to look for and what questions to ask, you’ll be able to make an informed decision and find a long-term care home that offers the best possible care and quality of life for yourself or your loved one.
Note: It’s important to visit the nursing homes to observe the environment and ask questions to make an informed decision.
Nursing Home Checklist (provided by Medicare.gov)
Is the nursing home Medicare certified?
Is the nursing home Medicaid certified?
Are the nursing home and current administrator licensed in my state?
Does the nursing home have a bed available?
Does the nursing home offer specialized services, like a special care unit for a resident with dementia or ventilator care?
Is the nursing home located close enough for friends and family to visit?
Are there resident policies I must follow? Will I get a written copy of these policies?
Are there extra charges for other services, like beauty shop services?
Will the nursing home tell me in writing about their services, charges, and fees before I move into the home?
Safety & Care
Have you checked the nursing home’s star ratings on Medicare.gov?
Is the nursing home taking action to improve quality or staffing as needed?
Can residents still see their personal doctors? If needed, does the facility help arrange transportation for this purpose?
Does the nursing home have an arrangement with a nearby hospital?
Are care plan meetings held with residents and family members at times that are convenient and flexible whenever possible?
Does the nursing home’s inspection report show quality of care problems or other citations (failure to meet one or more state or federal requirements)?
Has the nursing home corrected all citations on its last state inspection report?
Does the relationship between staff and residents appear to be warm, polite, and respectful?
Does the nursing home check to make sure they don’t hire staff members with a finding or history of abuse, neglect or mistreatment of residents in the state nurse aid registry?
Does the nursing home have policies and procedures on prohibiting and reporting abuse and neglect?
Is the nursing home taking action to keep residents safe from abuse, neglect, mistreatment, or exploitation?
Is there information about how to report concerns about the care and safety of residents?
Is there information about how the facility responds to concerns that are reported?
Has the nursing home been cited for issues related to abuse in the last year or two?
Nursing Home Appearance
Are residents clean, well groomed, and appropriately dressed for the season or time of day?
Is the nursing home free from overwhelming unpleasant odors?
Does the nursing home appear clean and well kept?
Is the temperature in the nursing home comfortable for the residents?
Does the nursing home have good lighting?
Are the noise levels in the dining room and other common areas comfortable?
Nursing Home Living Spaces
Is the furniture sturdy, yet comfortable and attractive?
Are exits clearly marked?
Are there quiet areas where residents can visit with friends and family?
Does the nursing home have smoke detectors and sprinklers?
Are all common areas, resident rooms, and doorways designed for wheelchairs?
Are handrails and grab bars appropriately placed in the hallways and bathrooms?
Menus & Food
Do residents have a choice of food items at each meal? Do they serve foods you like?
Can the nursing home provide for special dietary needs (like low-salt or no-sugar-added diets)?
Are nutritious snacks available?
Does the staff help residents eat and drink at mealtimes, if needed?
Do staff knock on the door before entering a resident’s room?
Do staff refer to residents by name?
Does the nursing home offer a training and continuing education program for all staff?
Is there licensed nursing staff 24 hours a day, including a Registered Nurse (RN) present at least 8 hours per day, 7 days a week?
Do Certified Nurse Aides (CNA’s) help plan the care of residents?
How many nurses, including CNAs, will be available to help me during the day, at night, and on weekends?
Is there a person on staff assigned to meet my social service needs, and can I meet with him or her?
Will staff call my doctor for me if I have a medical need?
Has there been a turnover in administrative staff, like the administrator or director of nursing, in the past year?
Is my primary language spoken by staff? If not, is an interpreter available or another system in place to help me communicate my needs?
Can residents have personal belongings and furniture in their rooms?
Does each resident have storage space (closet and drawers) in their room?
Does each resident have a window in their bedroom?
Do residents have access to internet, a computer, a personal phone, and television?
Do residents have a choice of roommates?
Are there policies and procedures to protect residents’ possessions, including lockable cabinets and closets
Can residents, including those who are unable to leave their rooms, choose to take part in a variety of activities?
Do residents help plan or choose the activities that are available?
Does the nursing home have outdoor areas for resident use?
Is staff available to help residents go outside?
Does the nursing home have an active volunteer program?
Do I get to choose what time to get up, go to sleep, or bathe?
Can I have visitors at any time – even early or late hours?
Would I be able to leave the facility for a few hours or days if I choose to do so? Are there procedures for leaving?
Does the nursing home offer the religious or cultural support I need? If not, what type of arrangements will they provide to meet my needs?
Caring for Residents with Dementia
Does the nursing home have specific policies and procedures related to the care of residents with dementia?
If so, does the policy include the use of non-medication based approached to care as a first attempt to respond to behavioral symptoms (which are often a means of communication) for residents living with dementia?
What percentage of residents who have a diagnosis of dementia are currently being prescribed an antipsychotic medication?
What’s the nursing home’s current rate of antipsychotic medication use?
Does the nursing home participate in any efforts related to reducing antipsychotic medication use in nursing homes (like the National Partnership to Improve Dementia Care)?
Know Your Rights
As a resident of a long-term care facility, you have rights that are protected by federal and state law. These rights ensure that you are treated with dignity and respect, and that your physical and emotional well-being is prioritized.
You have a right to
Be free from discrimination
Be free from abuse and neglect
Exercise your rights as a U.S. citizen
Have your representative notified about your care
Get proper medical care
Be treated with respect
Be free from restraints
Have protections against involuntary transfer or discharge
Participate in activities
Spend time with visitors
Form or participate in resident groups
Manage your money
Get information on services and fees
Get proper privacy, property, and living arrangements
Long-term care homes offer a range of services to meet the needs of individuals who require assistance with daily living activities or medical care. From home care to respite care, there are different types of long-term care available to accommodate various levels of care needs. When choosing a long-term care home, it’s important to visit the home, ask questions, and consider factors such as Medicare and Medicaid certification, availability of specialized services, and proximity to family and friends. By doing so, you can make an informed decision and find a long-term care home that provides the best possible care and quality of life for yourself or your loved one.