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Guidelines for Selecting a Senior Healthcare Facility

(Assisted Living or Skilled Nursing )

Introduction

As our loved one's physical or mental status declines, we are often faced with the difficult decision of long term care placement. The following guidelines can be used in determining whether a nursing and rehabilitation center or an assisted living facility is appropriate.

1. Assess your loved ones mental, physical and lifestyle needs.

Do they require 24 hour nursing care as provided in a nursing home setting, or can they live in a semi-independent environment of an assisted living facility? Assisted living facilities provide residents with support in bathing, dressing, medication administration and other activities of daily living.  Nursing homes provide a higher level of care under the 24 hour supervision of licensed nurses. Both settings can provide support services for individuals having Alzheimer's disease, dementia, or other cognitive impairments. Facility personnel should perform an evaluation of your loved one to determine which type of facility and services are most appropriate.

2. Start with a list of recommended facilities in your geographic area.

A social worker at a local hospital or your local Department of Aging may be able to provide you with a listing of nursing homes or assisted living facilities in your area. Often these professionals have personal knowledge of these facilities and can be a valuable resource. When choosing a facility don't forget the all important location, location, location! It is important to try and select a facility that is close to the friends and relatives who will be visiting your loved one. Continued involvement by family and friends will help the resident transition to their new home setting.

3. Make a personal visit to the facility.

This will be a prime opportunity to observe the physical characteristics of the facility, and a more realistic impression of how the facility operates.. Consider asking the following questions:

A. Ask to speak to the people who are already in the facility. This includes residents and staff members. When talking with staff, determine whether they seem friendly, open and honest. Are they respectful, cheerful and loving? Members of the staff will be a part of your daily life; be sure that they seem kind and accommodating.

B. Ask to attend a meal and sample the food. Often, the assistance provided by the staff to residents in the dining room is a good reflection of the staffing patterns in the facility. Ask about the facility's capabilities to accommodate special dietary needs or preferences. Do they have many choices on the menu? Is the food tasty and nutritious? Does the meal appear appetizing?

C. Ask for a list of activities provided that week. Most long term care facilities provide various activities in an effort to keep their residents stimulated. This is important for purposes of maintaining good physical and mental health. Do they have outside activities, field trips, music, exercise classes, craft projects, game nights?

D. Ask about the staffing at the facility. What is the ratio of staff members to residents? Are there any state minimum staffing levels, and if so, how does this facility compare? Have the staff members received any specialized training for dementia or Alzheimer's care? Who are the medical professionals on staff and are they available at all hours? What is the typical response time once a call for help has been placed? Is medical care provided on-site or does the facility provide transportation to accommodate medical visits?

E. If your loved one has a disability that requires a physical therapy program, does the facility have a rehabilitative program in place to meet those needs? If so, does the facility have the equipment on site, or are the residents commuted to these services? How often is the rehabilitative staff at the facility, full or part-time? How often can the regular staff provide exercise activities to compliment the rehabilitation?

4. Check on the reputation of any facility that you are considering

Regulations vary from state to state, but all nursing facilities must meet certain Federal requirements. When interpreting these reports, remember that even the most reputable facilities may have a code violation. It is important to assess the violations on a case by case basis, since some are certainly more important than others. Contact the facility administrator to elaborate on these findings and ratings.  The Centers for Medicare and Medicaid Services (CMS) provides nursing facility survey results on their website at www.cms.hhs.gov.

5. Make inquiries about payment options for long term care

Ask about the accepted insurances and financial assistance available for services provided at the facility. Will the resident qualify for Medicare coverage? Is the facility versed on the Medical Assistance eligibility and application process? Does the facility accept Veteran's Benefits or have staff available to help you apply for benefits? Most nursing homes participate in the Medicare Program. However not all nursing homes participate in Medical Assistance. Medicare coverage may be available for the first 100 days of care in a skilled nursing facility.  Medicare pays 100% of the cost for the first 20 days.  For the next 80 days, the resident is responsible for a copayment of $133.50 per day.  Medicare establishes the copayment amount each January.  Once Medicare benefits are no longer available, alternative funding must be arranged.  

Medicare does not cover care provided in an Assisted Living setting. Certain states do have a Medical Assistance program that provides coverage for care in an Assisted Living facility.  However, not all Assisted Living facilities participate in the Medical Assistance Program.  In order to qualify for Medical Assistance benefits in either setting, the individual must meet certain medical and financial eligibility requirements. These requirements differ from state to state.

Compare prices among senior facilities. Some facilities have all services and amenities bundled into a flat daily rate and other facilities charge separately for supplies and additional support services.

Conclusion

By careful and well thought-out research, you can feel comfortable that you have selected the most appropriate care setting and facility. Frequent visits and ongoing support should be welcomed by facility staff.  Remember, continued involvement by family is important to the overall care of your loved one. 

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