Questions To Ask

About CCRCs & Life Care Facilities

Look and Plan Ahead When Choosing A Care Facility

Too often people choose a facility for an elder person based on their immediate care needs without thought for the future. It is much better to look for and choose a care facility that can meet their needs not just today and tomorrow but six months, a year or two years down the line.

In most cases, the Elder will need more help - not less - as time goes on, so it makes good sense to anticipate future needs and make sure  that the community or facility you select can provide the range of services they need not only today but need but in the years to come.


Make An Appointment For Your First Visit


If you think you might choose that facility, plan on dropping in unannounced at least two more times after that. The best times are around mealtimes so that you can observe how meal service is provided and dining accommodations are handled.  (It’s also a good time to observe the staff and residents’ interaction.)


Speak With Some Of The Residents Without Staff Present


Ask residents how they like being there. Try to get a feeling about whether your loved one would fit in and feel comfortable with the type of residents living in that facility. Do they experiencing similar problems and care needs?  What do they think of the staff and the care they receive?


Do NOT Be Distracted By A Perfect Looking Home


Although a residential care home or nursing home should be neat, clean, orderly and not have any offensive odors, ultimately you are looking for GOOD CARE, not perfect decor.You could find that some homes you visit are very well decorated but have managers and owners that have little or no experience or sincere interest in caring for elderly people.


Observe How Residents And Staff Interact With Each Other


Do the residents seem withdrawn and silent? Do they seem depressed and off in a world of their own? Do the staff treat residents as adults or more like children? If so, this may indicate that a facility is understaffed or that they don't understand the psycho-social needs of their residents. To a large extent the way the staff treat the residents will more than anything else determine the quality of life that a resident experiences in a facility. Competent, caring staff that respect the personal dignity of each resident is essential.


Read The Rental Contract Or Patient Agreement Carefully


Take the contract home with you to review - even ask a trusted advisor to look it over as well.  Look for - and really read - the fine print. What extra charges are there? What items are not covered in the care contract? If these are not listed ask the facility to list what is not covered and what it will cost for those extra services. Never choose a facility that will not specify basic rates and extras in writing for you. Another important thing to check is how much notice you contractually must give a facility if you must move your relative out of a facility either due to medical reasons or if you are not satisfied with the facility.


Observe The Dining Accommodations & Sample The Meals


Food is often one of the few pleasures that elderly people can enjoy on a daily basis. If the food is bland and tasteless or lacking in variety the quality of life of an elderly person is seriously impacted. Don’t underestimate the importance of the menu and the food when you evaluate any facility, whether it is a retirement community or nursing home.


Although it may not not possible to sample the food prepared in small homes, but in the larger facilities like retirement communities, assisted living facilities and nursing homes you may be invited to eat with the residents. If you are not invited, ask if you may eat a meal with the residents.

Observe how the meals are served to the residents. Are the servers courteous and friendly. Is the food served hot? Is the food easily managed by an elderly person (e.g. can they easily cut it up and chew it?) Is there a variety of drinks available? How many choices do the residents have at each meal? Are there adequate amounts of each item? Are there a variety of fruits and fresh vegetables available? Are their desserts tasty and attractive?


Ask To See The Latest State Licensing Inspection Survey


Every facility is visited at least annually whether it is a residential care home, assisted living facility or nursing home. In the case of nursing homes, the annual survey is supposed to be placed in a public area of the lobby or entrance to the nursing home.

If you don't see it , merely ask someone at the front desk for a copy of it or where it is located. Every nursing home will have some violations - but what you don't want to see in the survey are documented observations of poor or negligent patient care.  Many of the deficiencies can be for things that seem simple or even trivial, but the sheer number of deficiencies may indicate a facility with real problems.

A nursing home survey that is ten pages or less and has no significant deficiencies in direct patient care may be a good facility. One that 20-40 pages of deficiencies and lots of patient care deficiencies is a facility that you may want to avoid.


Ask To Speak With The Director Of Nurses


Every nursing home will have a D.O.N. (Director of Nurses). In speaking to the D.O.N. try to ascertain his or her philosophy of care and how long that person has been in that position. The D.O.N. sets the standards for care in a facility. If that person is good at their job and is supported by management (i.e. the Administrator) then care generally is good. Where there is turnover you are likely to see a facility that has real problems in caring for its patients.


What Happens If The Money Runs Out?


Find out what the facility's policy is if the patient's money runs out and they can no longer pay for private care. Nursing homes generally have Medicaid contracts with the state which provides for the care of patients who have exhausted their funds for care. 

No such provision exists for licensed residential care homes or assisted living facilities. They can not bill Medicaid for the cost of care. Your only recourse in that situation is to transfer the person to a nursing home under the Medicaid program.

Is it better to place a person into a nursing home rather than a residential care setting because their money will run out? Many state Medicaid programs suggest that if a person's funds will run out in less than six months it usually is better to place that person in a nursing home rather than a residential care home for two very practical reasons:

  1.     First, an elderly person finds it terribly upsetting to be moved, so the fewer moves they have to make is better, both physically and mentally for them.   

  1.     Second, the care home will just be getting the person adjusted to the routine of the home and then they will have to be moved. It is inconvenient not only for the family and the facility, but most especially for the elder person to have to undergo two moves in a very short time.


If funds allow the elder person to be cared for for longer than six months in a residential care setting  it is a good idea to opt for the residential care setting or assisted living facility (even though it may involve a move within a year). The quality of life is so much better in those settings (compared to a nursing home) that it should always be considered whenever possible.


In the final analysis there is no standard answer or perfect solution; only some that seem better than others. A solid understanding of the care system can help guide you to a decision that will be best for your your loved one and your family.  Provides Free, Reliable Senior Information and Resources

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