A Guide to Choosing a Nursing Home for Seniors
You may be emotional about moving your senior parent, uncle, or aunt to a nursing home. But know that you are not alone. Moving older family members to a nursing home because of factors like their debilitating health conditions, need for rehabilitation services, and special nutritional requirements is not uncommon.
The good news is you have access to various senior care living options including the following:
- independent living
- assisted living
- nursing homes
- memory care
- continuing care retirement communities CCRCs
- residential care homes
- home care
Regardless of the reason, the admission of a loved one to a care facility can be overwhelming. However, familiarizing yourself with how such places work can ease your fears and help build your confidence for the next steps. Here is a quick guide for you!
What is a nursing home?
A nursing home is a residential care facility that provides various health and personal care services for older people. People often refer to such homes as care homes or long-term care facilities.
A nursing home is for older people who don’t need hospitalization but need more caregiving assistance to do their everyday activities than what they get at home.
A nursing home provides custodial care that involves assistance with daily living activities such as meals, laundry, medication management, and even moving around. Also, it is different from most other senior housing facilities as it focuses more on providing better medical care.
Common reasons to find a nursing home
Here are a few common reasons why people usually start searching for a nursing home for their senior family member.
As a family member who is the primary caregiver
- Your health has started deteriorating.
- You are the only caregiver.
- You have constantly started to worry about your senior family member’s health and well-being.
- You cannot care for yourself, your children, or your partner, as the caregiving responsibilities take up all your time.
As the senior
- You are experiencing fast declining health.
- You are having frequent accidents, falls, or injuries at home.
- You feel isolated.
- You need rehabilitation services.
- You wish to age among your peers.
- A care home will cost far less than at-home care services.
- If you are wondering “Can a doctor put someone in a nursing home?” then yes, it would be best to move into one when a doctor or a care team recommends it.
Types of nursing homes
Long-term care facilities generally offer a few standard services, such as 24/7 monitoring, personal care assistance, and on-site medical care. However, some care facilities offer extra levels of care services. Here are a few common types:
Intermediate nursing care
These facilities offer basic level care. The residents here do not require help with daily activities. They are only given health-related care, such as medication management and meal services.
Skilled nursing facilities
These facilities offer a higher level of medical assistance and care. Residents here are mostly bound to the bed or need dialysis. This is why a skilled nursing facility has a nurse and a physician round-the-clock. Moreover, you can also expect a skilled nursing facility to have in-house rehabilitation services such as occupational, physical, and speech therapy.
Memory care nursing facilities
They offer specialized facilities such as 24/7 monitoring and care for those with Alzheimer’s or any other type of dementia. These facilities are designed to meet the unique needs of residents with memory impairments. They offer many services and amenities to provide the best possible care. The staff members at these facilities are trained to provide therapy and activities to dementia patients. Some facilities may also have separate units for memory care or Alzheimer’s. The atmosphere at these memory care facilities is generally designed to be more home-like for the patients.
Subacute nursing units
These units provide services that involve highly intense monitoring or therapy. These can include intense rehabilitation services and the 24-hour availability of licensed registered nurses trained in administering complex IV therapy or using ventilators.
Services to consider
All nursing homes are built differently. Most look like a hospital, with one or two nurse stations on every floor. A few facilities may add certain features to make the place feel like home or a small community.
The care home you pick must be able to care of seniors in all aspects, including medical, nutrition, fitness, and social. It should have essential medical equipment and facilities. While the precise services may differ, here are a few commonly provided services.
- 24/7 monitoring
- On-site medical services
- Assistance with daily activities
- Availability of shared as well as private rooms
- Basic services such as meals, housekeeping, and laundry
- Social activities such as game nights, book or cooking clubs, crafting, and movie nights
- Opportunities for outdoor as well as indoor physical activities that are senior-friendly
- Assistance to keep in touch with family and friends through video or phone calls and visits
How to go about admissions
You should follow specific steps when admitting someone to a nursing home.
- First, choose a care home.
- Second, learn about the various criteria for admission.
- Third, determine what medical assessment(s) are required for admission.
- Lastly, gather all documentation and do the paperwork.
Choose the right nursing home
Despite being well-acquainted with the different types of assisted living facilities and their services, it may still be difficult to choose the right one. So you need as much information as possible to increase your chances of selecting the right one. Here are a few tips to help you pick a suitable facility for your loved one.
Ask for referrals
Talk to a person with first-hand experience with long-term care facilities. It is beneficial to gain knowledge from someone who is familiar with the various nursing homes in your area. You can also consult your family doctor. They might have some suggestions that could help you decide.
Make sure you thoroughly research the available senior care homes in your area. Check various resources such as blogs, forums, and official websites of some facilities to verify information about the shortlisted care facilities. Make sure to choose a senior care facility which is well-versed in the individual’s requirements.
Take into account the medical requirements of the senior
Since different types of nursing homes specialize in different areas, consider the senior’s medical needs to make your decision. For example, if you’re looking for a care home for a senior with Alzheimer’s, memory care centers would be the best option for them.
Consider the distance of the nursing center from home
It will be easier for everyone if the care home is located closer to where the family members of the senior stay. It will be convenient for friends and family to visit regularly.
Visit the places you’ve shortlisted
Once you’ve shortlisted a few nursing homes that you like, make appointments with them for a visit. Most of them let family members look around the facilities before making a decision. A visit is crucial to understand if the place would be safe and comfortable for your loved one.
Meet the staff
When you visit different care homes, ensure you also meet the staff. After all, they are the people who will be taking care of your loved one. A few things you can look out for include checking the frequency of staff turnover and the staffing level on weekdays, weekends, and evenings. Also, note whether they interact with you or if everything feels rushed.
Look around and observe the current residents and their families
During your visit, try to observe the residents currently staying there. Note whether they seem engaged or overmedicated. Check if they are well-groomed. Observe the interaction with the family members.
Check the hygiene and cleanliness
Don’t forget to examine how clean the facility is. Check if you see any house cleaning staff on duty. Ask them questions regarding the cleaning routines and schedules.
Ask about the meals served
Some long-term care facilities will let you have a meal with the residents in their cafeterias. This is an excellent opportunity to examine the meals typically served. Ask the staff about the meal services if there is no such facility. Check whether they provide special meal services based on the health conditions of the residents. Also, ask what kind of help is available with meals.
Inquire about the various activities they have for their residents
You will want your loved one to be engaged and able to socialize with other residents as much as their health allows. So make sure you ask whether the facility plans events and activities for their residents.
Learn about the criteria for nursing home admission for seniors
Several criteria must be met, and most of these rules are mandated by the state. Therefore, document all medical conditions and confirm them by a medical practitioner. This will make it easier to prove that you’ve met the state’s criteria.
What are a state’s requirements for nursing home admission?
The requirements will be different across states. However, the Centers for Medicare & Medicaid Services (CMS) have mandated general guidelines for all states. But, all the states have the flexibility to have their assessments in addition to the CMS’s regulations.
Therefore, a senior may meet the criteria for admission in one state but may not be eligible in another. So, ensure you contact the local government agency or the local Medicaid representative to understand the state’s standards and regulations.
Moreover, you will need an assessment of your loved one’s medical requirements to ensure they meet the state’s regulations for admission to a long-term care facility. Here’s how you can get official assessments.
Determine what medical assessment(s) are required for admission
Through a physician or primary care doctor
You can consult a physician or a primary care doctor to help you with the assessment. They will examine the senior’s medical history and ascertain the various health-related requirements to ensure they meet the state’s requirements for nursing home admission.
Through attending staff of a hospital
In case your senior parent or family member is hospitalized, the attending staff will do the medical assessment during their stay at the hospital. This can also help to ascertain whether they meet the state’s admission criteria.
Through the state
In some states, free healthcare assessments for seniors are provided. For instance, Maryland has the Adult Evaluation and Review Service (AERS) program. Through this program, a social worker or qualified nurse performs an assessment to verify if a senior meets the nursing home admission criteria set by the state.
Gather all documentation and do the paperwork
Once the medical assessment is done, you will have to gather all the required documentation for the further procedure. Here’s a list of documents that you will need. Providing all the necessary documents is mandatory before getting admitted. Here are a few common documents required for the nursing homes admissions process. Check out the list before you visit the nursing home facility for seniors:
Written proof that seniors have consented to stay in the nursing home
Since nursing homes are regulated by federal and state laws, all residents must provide written proof that they are staying at a facility of their own free will. The document must state that they have consented to treatment in the long-term care facility.
A physician’s order for admission
This is similar to a prescription given by a doctor. It states and confirms that a person needs care at a nursing home.
A physician’s order for treatment and medication
At the residential care facility, a new physician and caregivers will be responsible for the health and well-being of your loved one. So to enable a seamless transition, the care home will require written recommendation of treatments and medications from a primary care physician or a physician at a hospital.
Documentation citing medical history and physical examination
Before admission to the nursing home, a person must undergo a physical examination. In addition, the primary care doctor must make a report of the medical history. This needs to be documented and provided to the facility.
All the states have a set of mandatory forms that must be filled for nursing home admission by a physician or the hospital. These forms certify that a senior is eligible for long-term care facilities and that they meet all the criteria. You can get these forms at the care home you have chosen for your loved one.
All nursing homes provide tests for tuberculosis and shots for flu and pneumonia. But if a newly admitted resident has already taken these tests and shots, they should provide proof.
In some cases, additional documents may also be required. These include the following:
- Social Security card of the senior
- Documentation related to Medicare or Medicaid
- Insurance cards
- Nutritional requirements
- Medical orders for life-sustaining treatment (MOLST)
- Living will
- Power of attorney documents (POA)
- Do not resuscitate (DNR) documents
- End-of-life care wishes
Based on the paperwork and documentation you need to provide, it may take a few hours or a day to complete the admission process. In most cases, all the paperwork is usually done one day before or on the day of admission at the facility. However, this varies from one nursing home to another as well as the state of residence of the senior.
Transitioning to an assisted living facility from one’s own house is difficult for seniors and their family members. To make things easier, include the senior in the decision-making process. Moreover, asking for their opinion and considering their wishes regarding admission to a nursing home will help them cope with the new changes.
- Caregiver Guide: Choosing A Nursing Home. Health In Aging. Published July, 2015. Accessed May 2023. Caregiver Guide: Choosing a Nursing Home | HealthInAging.org
- Hoyt Jeff. What Is a Nursing Home? Senior Living. Published May 2023. Accessed May 2023. A Comprehensive 2023 Guide to Nursing Homes (seniorliving.org)
- Saisan Joanna, Russell Doughlas, and White Monika. A Guide to Nursing Homes. Help Guide. Published July 2022. Accessed May 2023. A Guide to Nursing Homes – HelpGuide.org
- How to Choose a Nursing Home. National Institute of Aging. Published May 2017. Accessed May 2023. How to Choose a Nursing Home | National Institute on Aging (nih.gov)
- Centers for Medicare & Medicaid Services (CMS). Home – Centers for Medicare & Medicaid Services | CMS. Accessed May 2023.
- Health Services – Adult Evaluation and Review Services (AERS). Accessed May 2023. Carroll County Health Department (maryland.gov)