As our loved ones age and face health challenges, there may come a time when residential care is the best option for their wellbeing and comfort. But with a multitude of care facilities available, choosing the right one can be overwhelming. Here are some of the steps you should take to find the best fit for your loved one. 

1. Start your research (and conversations) early

For many families, there is an inciting event that prompts a conversation about moving a loved one into a care facility – maybe a relative had an accident or fall, started showing increased signs of dementia, or was given a new medical diagnosis. And while these moments are appropriate for reconsidering your loved one’s care, starting your research and conversations before the need becomes urgent can make the transition smoother for everyone involved.

Ask your aging loved one what type of support they think they need, what symptoms or actions do they believe should trigger a move into a residential facility, and what’s most important to them in a new living situation. It’s also helpful to understand what worries or upsets them about leaving their home, so you can think about how to alleviate these concerns. Even when moving to a care facility is the right decision for their health, it can be an emotionally charged transition – showing that you’re willing to listen and acknowledge their worries can reduce some of the stress and tension of this process. 

2. Be clear about your loved one’s care needs

Before you start visiting care facilities, you need clarity on what types of support your loved one needs. Of course, physical and health needs will top the list – does your loved one’s medical condition require frequent monitoring, do they need help with personal care like getting dressed or bathing, are they able to move around on their own, what sort of memory care might be needed, etc. You also want to have a sense of their financial resources, so you can make sure you are visiting facilities that are within budget. Finally, consider what their future needs might be, so you can assess whether a facility could accommodate their care for years to come. 

3. Match these needs with the right type of facility 

Different types of facilities offer varying levels and types of care for older adults, so it’s important to choose one that aligns with the support your loved one needs. Here are the most common types you’ll come across:  

• Independent Living / Senior Living: These facilities offer independent residences within a complex that provides transportation, recreational activities, and amenities like restaurants or beauty salons. This option is often best suited for active retirees with minimal care needs as there are typically no health care services or personal assistance provided.
• Assisted Living: These facilities typically offer support services by trained care managers, but limited medical services on premises (though they often employ an on-site nurse to oversee and address changes in care). The care staff can assist with many activities of daily living (ADLs) like dressing, personal hygiene, eating, and medication management. Most assisted living communities also handle daily chores for the residents like cooking, housekeeping, laundry services, and transportation to appointments.
• Memory Care: While some assisted living communities offer memory care sections within the facility, memory care is a distinct care option you should be on the lookout for if your loved one has Alzheimer’s or another form of dementia. Staff should be specially trained to manage the unique needs of someone with memory loss and the facility itself is often modified to keep residents comfortable and safe. 
• Skilled Nursing Homes: If your loved one needs a higher level of medical attention, a skilled nursing facility may be the best option. These residences offer round-the-clock care by on-premise doctors, nurses, and therapists while also providing for other personal, housekeeping, and social needs. 
• Continuing Care Retirement Communities: These facilities provide a continuum of care from independent living to assisted living to skilled nursing. These communities can be a good option if you know your loved one will eventually require more advanced care or if you just want peace of mind that their future needs will be covered.

4. Research your local options

Once you’ve determined which type (or types) of facility is the best fit for your loved one, it’s time to research what options are available in their/your area. Resources like Eldercare Locator,  LongTermCare.gov, and Medicare’s Care Compare tool can be a good place to start, as are referrals from your loved one’s physician or others in their/your network that have navigated residential care. You can assess the quality of skilled nursing homes through the Joint Commission’s Quality Check, but for assisted living facilities that don’t provide nursing services, you’ll need to go through your state licensing agency to verify their certifications and learn about any complaints or violations. 

5. Conduct phone interviews with several facilities

Once you have a list of local options and completed your initial research, it’s time to reach out to the facilities to gather more information. There are dozens of questions you may want to ask depending on your loved one’s needs and interests, but here are some to get you started:

• Are you currently accepting new residents? If not, do you have a waitlist? How long is the typical waiting period? 
• What’s the ratio of care providers to residents? Is there a nurse on staff? Is the staff trained for memory care?
• What are the protocols for when a resident is sick? 
• Are residents able to move between levels of care? 
• What is your food program? How do you accommodate special diets?
• What social activities do you organize? Are these well attended? 
• What amenities are available on site or accessible to residents (beauty shop, shopping trips, cable TV, physical therapy)? 
• Do you provide companions and transportation for outings/appointments?
• What policies do you have for visitors, pets, personal items that can be moved in, etc.?
• What is the monthly fee and what does that include? (And of the services we’ve discussed earlier in the conversation, what would come with an additional fee?) 
• Do you accept Medicare or Medicaid? 

6. Tour your preferred facilities 

After you’ve narrowed down a short list of facilities that appear to meet your loved one’s needs, you’ll want to schedule in-person visits to tour the facilities. Beyond speaking with the admissions coordinator, you’ll also want to ask to meet with the nursing staff/caregivers, activity coordinators, and current residents. Note: If you aren’t able to speak with the families of residents while you’re touring the facilities, you can ask for references. 

During your visit you can ask more subjective questions that may shed light on how the facility really functions. Questions like: How would you describe this facility’s approach to caregiving? What do you like the most about working here? Can you tell me about a time a mistake was made in the care of a resident and how it was resolved? 

In addition to more probing questions, you should also use this time to observe the residents and the facility. Do people seem happy and engaged? Are there any strong/unusual odors? Do you see the staff interacting with the residents? How visibly clean is the facility? Is there enough sunlight or outdoor space? 

7. Include your loved on in the decision-making process

How much your older relative can be involved in the selection of a long-term care facility will depend on their needs and the options available geographically and financially. But it can be helpful to include them throughout the research phase, so the experience of moving into a new home is less daunting. You can start by showing them the websites or brochures of the facilities, sharing what you’ve learned so far, and asking what they think about these options. If possible, schedule some time for your loved one to visit with residents of the facility, either for a meal or a social activity they enjoy. 

Ultimately, your goal is to provide your loved one with a place where they receive the necessary care they need and can maintain their quality of life. While the process may feel daunting, taking these steps can help you make a decision that offers peace of mind for both you and your family member.