Family Living Focus: Finding the best long-term care

Whether or not you have thought about long-term care for yourself or an elderly loved one, the reality is that human life expectancy has increased steadily over the past few decades. The number of people living past 70 has dramatically increased and because of higher standards of living, by the year 2040, the percentage of nursing home residents will jump from 50 to 130 percent.

The bottom line is that long-term care issues are here to stay. In fact, planning for long-term care should be implemented into every family’s order of business, just as planning for college or retirement would be done. Also, very important is the awareness that long-term care insurance premiums are usually less if you buy them when you are younger. This is not a preparation that should be postponed until one is nearing the possibility of needing long-term care. The best indicator as to whether or not you should look into long-term care insurance is to ask yourself if there are enough assets in your/elderly loved one’s estate to pay for it. Long-term care insurance does not pay all long-term care needs, only a part of it.

Assuming a family has made a wise decision to plan for long-term care, the next question is how to go about finding the appropriate level of care for you or an elderly loved one. Where is the best place to go? Consider whether or not you’ll need to make the decision to move yourself or a loved one to a local long-term care facility. Now like any other matter of family planning, assessment, investigation and/or research and ongoing evaluations will need to be considered. The following guidelines will be helpful as you start your planning for long-term care in a facility-based option.


There are basically a few major “levels of care,” commonly referred to as “L.O.C.” The main levels of care are independent living, either at home or facility-based; assisted living; rehabilitation, commonly referred to as “skilled nursing unit;” and acute care, which is hospitalization. There are now levels of care called long-term care acute for patients that are coming from acute care intensive care units. An example of this is when a patient has not successfully been weaned from artificial means of respiration.

Following is a list of some of the types of long-term care settings most commonly found in most communities:

– Adult daycare alternative

– Accessory dwelling units alternative

– Subsidized senior housing

– Board and care homes

– Assisted living facilities

– Continuing retirement communities

– Certified (Medicare) home health care option to facility-based alternative

– Hospice care alternative

– Respite care alternative

– Home and community-based waiver programs for the Medicaid eligible

– Programs of all-inclusive care for the elderly who are Medicare/Medicaid eligible

– Nursing Homes (custodial non-skilled non-Medicare long-term care)

– Retirement centers/apartments

– Senior citizens’ centers for supportive services

– Multi-level of care complexes

– Other community-based organizations

– Personal private pay non-medical sitter and/or relative


If you and/or a loved one do decide on facility-based long-term care, a screening will be done to determine eligibility status. For example, if your elderly loved one is no longer able to care for his/herself, then custodial care in a nursing home is what your doctor would recommend. Some physicians may refer their patients to a geriatric case manager if they are available in your area. He or she is a highly trained licensed nurse or social worker certified as a case manager or geriatric case manager to assist patients and their families in finding the most appropriate level of care.

The level of dementia, if any, must also be considered. Dementia is a broad term for symptoms associated with cognitive function such as memory loss or impaired perception and comprehension of everyday tasks and inter-communicative skills. If a physician diagnoses Alzheimer’s, one form of dementia, most facilities are required by their state laws that such a resident is housed safely in a “locked unit.” (This unit is a section of the facility, not to be confused with one room or one apartment, but a group setting or unit.)


Before actually going on a facility search, make sure you have a list of the facilities’ nearby conveniences such as a family member’s home, a market, and other personal choices, such as a park or other types of stores.

Since you are a potential customer, you have a right to check it out. The main question you will want to ask yourself as well as the facility administration is this: “Will my loved one be safe here; will they feel at home?” Remember, too, that this facility takes over the responsibility of the care of your loved one, not taking away who you are in relation to the loved one. Don’t forget your loved one, whether they are cognitively impaired or not, will need your ongoing evaluation of the care in which they will be receiving.

Find a quality care facility is through the use of your five senses: sight, smell, taste, touch and hearing. Beginning with your vision, what do you see in each place? Is the visual aspect of the facility pleasant? Is it clean and orderly? Is there a “garden effect?” The “garden” effect is a popular movement where plants and animals are placed in the facility to create a more pleasant atmosphere. Sometimes you will find the use of “bird windows” where the facility maintains an enclosure for birds with a large window placed in the foyer, recreational area or corridors of the facility for the residents to enjoy.

What other visual things are there to help you identify the character of the facility or of the care the residents are receiving? Are there wheelchairs haphazardly placed in the hallways? Or are the wheelchairs nicely placed along the walls out of the middle of the halls? Are any of the residents “unkept?” Does the staff appear professionally and appropriately attired? Are you welcomed? Would you feel at home here if you were an elderly patient?

Using all of your senses, what do you smell, and what do you hear? Does the smell of urine overcome the atmosphere or is there a resident who is yelling loudly? These things do happen, so what you want to know is to what extent. Keep notes for comparison on each facility visited. Don’t forget to ask what services are available, such as laundry and podiatry for example.

Finally, just remember that as a family member of a long-term care resident, you are a part of the team that cares for your elderly loved one. You are the most important part. You provide the love!


Information adapted from article by Dawn Waddell Elledge, RN, CCM-PGCM in Today’s Caregiver Newsletter, February 2014.


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