5 Things to Look For in Long-term Care

man in wheelchair accompanied by nurse and wife
Before move-in day, what sorts of things should you look for?
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­When we're looking for our dream home, we usually have a list of must-have features in mind. Some people can't live without walk-in closets, natural light and built-in bookcases, while others require two-car garages and big backyards. When it comes to long-term care options for ourselves or a loved one, however, we often don't know exactly what we're looking for. And because the decision that an aging adult needs long-term care can already be difficult in and of itself, we may let emotions get in the way of an objective search.

As it turns out, we can consider long-term care facilities with the same critical eye we bring to crown molding or skylights. First, there are some basic decisions to be made regarding the level of care and supervision needed, the financial resources available to pay for the care -- and location, location, location. Once you have a list of places that fit those criteria, how do you pick? Take a look at the five things on this list for some must-have features in long-term care.



5: Your First Impression

elderly people playing cards
Do you see happy scenes like this one when you walk around the facility?
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Feel free to trust your first impression when you walk into the doors of a long-term care facility. Use all your senses -- does the place smell pleasant, or is there an industrial or unpleasant odor in the air? Is it well-lit and pleasingly decorated? Is there a television blaring, serving as a babysitter for residents, or are there spaces for quiet and for conversation?

As you walk through the facility, you should get a sense that this is a home, not an institution. It's important to see the rooms to determine if the layout, lighting and sense of security are adequate. Privacy is important to many people, so find out if there are single rooms or if sharing will be required. Do residents live in long, anonymous rows of rooms, or are they grouped into small households or living units? Will there be opportunities for residents to make their spaces their own, such as bringing in their own furniture and decoration? What rules regarding noise and visiting are in place?


While people tend to focus on their own rooms, take time to visit common areas as well. You might inquire if there are outside areas where residents congregate, or in which activity rooms residents tend to spend a lot of time. Evaluate these areas for homeyness and cleanliness.

You'll also want to get a sense of the eating facilities -- more information on that can be found on the next page.

4: The Food

lunch at the nursing home
Be sure to have lunch or dinner at each facility.
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When you're touring a nursing home or assisted living facility, you'll likely be provided with a long list of social activities available to residents -- everything from bingo to swim classes. And while a long list of activities is a good way to pick a summer camp, there's no guarantee that the aging adult in question will want to spend a Tuesday afternoon making lanyards. That's why it's more important to focus on the one social engagement on everyone's calendar: meals.

Even if assisted living residents insist on spending all of their free time parked in front of the television, they're usually required to show up for meals. Since meals are often the primary activity of the day, take time to visit the dining areas and have a meal there. Consider whether the food is tasty enough to eat every day, and request a week's worth of menus to see if there's a variety of options.


Two other things to check are how dietary restrictions and preferences, such as keeping kosher, are handled, and whether a resident can get extra food or a snack throughout the day. These last two considerations will give you a clue as to whether the facility sees its residents as numbered mouths to feed or as distinct individuals with their own needs and desires. If the residents are given special attention when it comes to meals, then that standard of care usually carries over into other spheres as well.

3: Staff-to-patient Ratio

nursing home resident with caregiver
Try to determine how comfortable residents are with their caregivers.
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­Most long-term care facilities strive to maintain residents' independence and autonomy as much as possible. However, that doesn't mean that residents should be deprived of care and help when they need it. For that reason, it's important to consider the staff-to-patient ratio of any care facility. In particular, you'll want to investigate the number of personal care aides, as they provide the bulk of resident care; a good ratio would be one aide to every five or six residents during the day and 1-to-15 at night [source: Matthews].

Good patient care is more than just numbers, though. Residents aren't likely to feel comfortable if they never see the same person twice, and if caregiving is merely a revolving door of who's available. A resident's transition into a long-term care facility will likely be made smoother by receiving individualized care from a trusted caregiver. Ideally, as you tour a long-term care facility, you'd observe positive interactions between caregivers and residents, such as staff greeting residents by name and staff quickly and cheerfully responding to residents' needs and requests.


We're not done judging other people yet -- on the next page we'll do some more spying.

2: The Other People

nursing home residents
Size up your potential neighbors.
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While scoping out the environment of the long-term care facility is important, so too ­is observing how people fit into that environment. That means taking a look at the current residents to see if they seem happy and engaged. They should look clean and well-groomed, because this will indicate that someone has taken care of them recently. Are there people moving around, taking part in activities, or are most people staying in their rooms by themselves?

To truly get the vibe of other people, you should visit more than once. Your formal visit, with the facility's tour guide, will obviously be the residence's attempt to show you the best of the best. Stop by at least twice more, unannounced, to see how people behave when tours aren't going on. By checking into common rooms and dining areas at different points in the day, you'll get a sense of what a full 24-hour period might be like in the home.


1: Report Card

While visiting a residence can give you a sense of all that goes well there, you may have to do some digging to find out what goes poorly there. If a facility receives Medicare or Medicaid funding, it is inspected every 15 months by a state surveyor. The surveyor's most recent findings are required to be kept onhand and shown to anyone who asks to see them. On this report, you'll learn what violations have been reported, such as physical abuse or health violations. Some of the violations may be minor, and no facility has a perfect record, but by asking staff members about these shortcomings, you might get a sense of whether they take complaints seriously or whether complaints are routinely blown off.

Another good resource is your state's long-term care ombudsman (some communities also have local ombudsmen). The ombudsman acts as an advocate for long-term care residents and their families and visits facilities regularly. He or she will have a good idea of the issues and problems at certain facilities, as well as a sense of what residences might particularly suit a certain type of person. The ombudsman's services are provided for free.


Lots More Information

Related HowStuffWorks Articles

  • "A Consumer Guide to Choosing a Nursing Home." NCCNHR. May 2007. (March 9, 2009)http://www.nccnhr.org/uploads/NhConsumerGuide.pdf
  • Chapin, Meldrena. Lecture at HowStuffWorks.com. Feb. 26, 2009.
  • Matthews, Joseph L. "Choose the Right Long-Term Care." Nolo. July 2002.
  • Morris, Virginia. "How to Care for Aging Parents." Workman Publishing. 2004.
  • "Nursing Home Care." The AGS Foundation for Health in Aging. March 15, 2005. (March 9, 2009)http://www.healthinaging.org/agingintheknow/chapters_ch_trial.asp?ch=15