Step 1: His Care Needs Drive the Search 

Equipped with the details of the level of assistance that your mom needs, you can focus on the types of care provided by the various facilities in your area. Results of an assessment will help you pare down the list of communities in your area. 

To help determine who needs long term care, the healthcare industry categorizes personal care activities and adult living activities as Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). 

ADLs are the daily self-care tasks (like bathing or self-feeding) where your loved one is apt to need some assistance. More complex activities, such as shopping or managing finances are categorized as IADLs. 

Self-Administered Assessments 

A self-guided assessment is an easy first step. 

Print out a self-evaluation worksheet, such as the Activities of Daily Living Checklist. If possible, complete this checklist with your father, family and others who may be caring for him. This comprehensive list can guide you through the process of discovering daily tasks where your mom may need a certain level of assistance. 

To assess cognitive impairment needs, the SAGE test (Self-Administered Gerocognitive Exam) is available online to download, print and complete. 

Professional Assessments: 

If you need more information, consider a professional assessment by a geriatric specialist. Find your local “Area Agency on Aging” in any search engine, or enter your city/state into the U.S. Administration on Aging's AAA reference page for a list of local agencies or resources to contact for assistance. 

Tip: In the case of Alzheimer’s disease, other dementia or suspected cognitive impairment, share the SAGE test answer sheet with the patient’s physician to discuss any cognitive needs concerns. 

Key Point # 1: Use an assessment checklist to determine personal care and medical needs. 

Step 2: Match Up Facility Services to His Care Needs 

Completed assessments should now give you a better idea of the personal assistance and medical care your father needs. The next step is to align his needs with services that the various local long term care facilities provide. 

What are the different types of long term care facilities? 

There are three main examples of long term care facilities or communities that provide varying levels of care to their residents. Generalities regarding three senior care facilities are: 

● Assisted Living Communities (ALC) offer assistance to their residents with ADLs and IADLs. Medical care that requires skilled nursing is generally not available to residents in these communities. 

● Memory Care facilities offer assistance for patients with cognitive impairments, such as dementia or Alzheimer’s Disease. Memory Care facilities, typically associated with an ALC, are designed to meet the special needs of and provide a safe environment for cognitively impaired seniors. Depending on the facility, limited skilled nursing services may be available to memory care residents. 

● Nursing Homes (or Skilled Nursing Facilities) provide skilled nursing services to patients that have specific medical needs. Unskilled nursing services, such as assistance with ADLs and IADLs are also available in Nursing Homes. 

Tip: For more detailed information on the distinguishing features of each of these facilities, refer to AgeChoice’s article on Top 10 Things to Know When Comparing Long-Term Care Facilities. 

Key point # 2: Match the long term care facility type to the senior’s specific needs

Step 3: Determine Payment Sources and Set Your Budget 

Budget and cost considerations are realistically the most impactful components of this selection process. Long term care insurance benefits or personal financial constraints can limit your choices, simply based on medical costs and long term care facility bills. 

Let’s take a look at some possible payment sources. 

Source: Medical Insurance & Medicare or Medicaid 

Unfortunately, medical insurance typically does not cover long term care services and Medicare’s nursing home care coverage is generally limited to 100 days after a 3-day hospital stay or illness. 

Medicaid eligibility, generally based on income and other personal assets, varies from state to state. Some states have higher thresholds of income for Nursing Home coverage, so research Medicaid as an option, even if your loved one hasn’t previously qualified. 

Tip: Reference Medicare’s website to help you find information and other insurance options. 

Source: Long Term Care Insurance 

If your loved one has long term care insurance, obtain a copy of the policy and read it through to get a general understanding of the terms, benefit payments and claims process. 

Call the insurance company to understand what the policy’s benefit is so that you can set your cost budget. You may not be able to initiate a claim yet, but knowing your budget is critical to your decision process. 

Source: Personal Income and Assets 

You may have gone most of your life by respecting the privacy and details of your mom’s financial situation. But now, you need to have a straightforward conversation with your father (or his financial advocate). 

Work with your mom to understand the details of his assets and sources of monthly income like social security, pension and income from investments. 

Add his monthly income to any insurance benefits to determine the total monthly budget available to cover his long term care costs.

Key point # 3: Review insurance benefits and personal income to determine a budget for long-term care. 

Step 4: Advance Care Planning: Health Care Directives 

If he hasn’t done so already, encourage your father to have legal documents drawn up that specify his advance care plan. Documents to support his plan would specify a person who can make decisions for his health care if he’s unable to do so, and to what level of life-saving measures he agrees. 

What are Health Care Advance Directives? 

Health Care Advance Directives, typically requested by long term care facilities are legal documents that outline choices for treatments or care. Two common advance directives are: 

● Durable Power of Attorney: This names an advocate who is familiar with a person’s wishes and will help make medical care decisions for that person. 

● Living Will: This document states a person’s specific desires regarding life support should he or she become unconscious. 

Tip: Contact a social worker or refer to Eldercare Advanced Care Planning Fact Sheets for information on how to start these advanced care planning documents. 

Key point # 4: Gather or Draw Up Health Care Advance Directives 

Step 5: Gather Your List of Local Facility Options 

Before you start to gather information for your search, realize that you can easily get bombarded with “information overload”. It helps to get organized and grounded by setting clear expectations of the general location and facility type you’re searching for. 

Based on the needs identified by the assessment(s) from Step 1, you should be able to target a list of local facilities that offer the level of care your mom needs. 

Jot down your specific, personalized requirements that will help guide your search. Consider the following main criteria: 

● Type of facility that fits needs assessment 

● Within [x] mile radius of [zipcode] 

● Cost budget - in dollars per month

● Medical and/or dietary needs 

List some additional requirements or “nice to have” features, such as pet-friendly community, home-like environment, transportation or social activity options. 

Now, start your search! 

Solicit the help of a local senior health care advisor or your favorite online search engine to create your list of long term care facilities near you. Ask physicians and friends if they have recommendations as well. 

Tip: To make your search list and notes available to other family members, consider using the Google Drive share feature. File sharing can save a ton of time by providing family members visibility to your up-to-date logs. 

Designate one notebook page spreadsheet to each long term care facility that you’d like to consider. Log the community name with contact information like address, approximate distance, website URL, director’s name and telephone number. 

Make a list of community-specific information you need, like vacancies, waiting lists, costs for standard and non-standard services. If applicable, ask if the facility accepts Medicaid. 

You’ll need to call each community directly and talk to a community representative to gather this information. During your phone conversation, be sure to confirm that services to meet your mom’s personal and medical needs are provided there. 

Log responses directly on the sheets for each facility in your spreadsheet or notebook. 

Key point # 5: Be sure to research local senior care options. You can get started with this one by visiting agechoice.com and taking the quiz. 

Step 6: Review Their Report Cards 

Prior to visiting any communities, check the facility’s license with Medicare or your state’s Health & Human Services Department, who regulates long term care facilities. Be sure to read all reviews or complaints and note any recent changes in management, which could be a red flag. 

Depending on where you live, you might be able to review citations, complaints, and inspection reports online. In some locations, you may have to request this information in writing. It is important to note that no provider is perfect all the time. Humans run long-term care providers, and humans make mistakes. What you want to look for as you inspect these records are

patterns or a series of related problems. While the occasional violation should be considered during your search process, repeats of the same types of issues can be a significant red flag. For example, a one-time violation report mentioning a staff member left the medication cart open and unattended is important. But, seeing the same issues cited in multiple violations means there’s a more significant problem with how the community and its staff are managed. Ideally, your review of the community’s regulatory reports should go back two years. 

Having this information in hand before visiting a community can be helpful. When touring, ask about what you’ve learned, not as a gotcha situation, but as an honest attempt to find out what happened. The response by community staff can be revealing as well. A very defensive reply may indicate more in-depth issues, while a direct and upfront answer might mean they have nothing to hide. Don’t hesitate to ask different staff members, including department heads like the director of resident care or head of nursing. 

When considering the best place for Mom, understand this: 

Key point # six. Perform background checks and seek recommendations on senior care community options 

Step 7: See For Yourself: Schedule a Visit 

Now that your quality checks are completed, you should have a list of your top community options that you’d like to visit. 

Make a list of things you’d like to look for, questions you want to ask the staff or the residents, noting any questions that may be directed toward a specific community. 

Tip: Medicare’s Guide to Choosing a Nursing Home or Other Long-Term Services includes a comprehensive “How to choose a nursing home checklist” that can be used as a basis for your own long term care facility checklist. 

Call each facility to arrange your scheduled tour with a staff member from the community. Plan to take your father along with you (if possible) so that he can start to visualize himself in the community. 

Don’t risk getting pooped out! 

Do yourself a favor and limit the number of facility visits to one per day. You’ll be better equipped to remember details of each community if you discuss them at length with your father and family, then record them promptly in your notes. 

If possible, schedule a visit during lunch or dinner to observe how the staff interacts with the residents. You’ll probably want to sample (or at least ask residents about) the quality of meals

provided and talk to residents about their community. 

Key point # 7: Arrange visits to long-term care options in your area 

Step 8: Let Your Eyes, Ears and Nose Be Your Guide 

On the day of your visit, be sure to have your list of questions handy and a notebook to record any observations. Know what your mom would like to observe and encourage him to ask questions along with you. 

If you get there early, take the time to observe how the staff interacts with you or any other visitors at the front desk while you’re waiting. 

Allow your guide to conduct the standard tour around the facility, but don’t be afraid to record observations in your notebook as you go along. Ask to revisit something you may have missed or would like to see again. 

Tip: After your visit, take some time later in the day to review the literature you’ve been given, talk over any observations and note any open questions in your log. 

Once you’ve visited at least 5 or 6 community options, you should have a good feel for the facilities you’d like to re-visit. Consider visiting unannounced at a time of day different than your original visit. Seek out answers to any open questions you may have and of course, take notes! 

Key point # 8: During community visits, record your findings and ask questions. 

Step 9: Choose With Your Head and Your Heart 

The process of making a decision on a community as mom’s new home is an emotional one. 

Your father’s opinion counts immensely in this decision. Most importantly, you want to be assured that your father will receive the highest quality care, will be treated with dignity and respect and will be content in his new community. 

Take a look through your notes and weigh cost options and his possible need for additional care in the future. If a facility offers services that he may need in the future, consider selecting that facility over another to avoid moving costs and disruption of care. 

Discuss your long term care community options with your father and the rest of your family. You may be surprised how easy the decision is to make after all the research and discoveries you made along the way.

Key point # 9: Make a long-term care community selection 

Step 10: Prepare For the Move and the First Few Weeks 

Once your decision is made, and you’ve made arrangements for admission, you’ll need to plan your father’s move into his new community. 

Depending on the facility’s restrictions, have mom help decide what items he’d like to have in his new home, like furniture, household essentials and clothing. It’s impossible to take everything, but helping him select items will make his new place feel like home to him. 

When you help him to move in, be sure his things get organized and he knows where certain items are stored. 

Encourage your mom to select some social activities that he’d enjoy and keep the schedule handy for him. It’ll be great for him to make connections with other residents. 

Especially in the first month or two, call and visit often. The change of surroundings may initially bring on the blues for your father, but your voice and shining face will brighten his mood. 

Key point # 10: Pack & help with the move, then visit often! 

Summary: With Patience and Persistence, You Can Do This! 

The process to find a long term care facility for your loved one can be daunting, challenging, and emotionally draining. 

This step-by-step guide can help you progress through the selection process. There are many resources available online or through local services that are available to help you. 

Your loved one deserves to be in an environment that prioritizes his or her health, safety and well-being. You owe it to your loved one to conduct a thorough search for a long term care community that meets his or her care needs with dignity and respect. 

Your father has supported you and helped you make decisions most of your life. It’s now your turn to reciprocate! 

Top 10 Key Points

1. Use an assessment checklist to determine personal care and medical needs 2. Match the long term care facility type to the senior’s specific needs

3. Review insurance benefits and personal income to determine a budget for long-term care.

4. Gather or Draw Up Health Care Advance Directives

5. Be sure to research local senior care options. You can get started with this one by visiting agechoice.com and taking the quiz.

6. Perform background checks and seek recommendations on community options

7. Arrange visits to long-term care options in your area

8. During community visits, record your findings and ask questions.

9. Make a long-term care community selection

10. Pack & help with the move, then visit often!