Your loved one may prefer to move into a community specifically designed around the needs of elderly people. These facilities provide different levels of assisted living, for elders who have difficulty with any of the activities of daily living, such as dressing, bathing, eating or using the bathroom.

Congregate and Board and Care Housing

Congregate housing complexes provide a private apartment, meals served in a group setting, and housekeeping services. These units also have social and educational activities and offer security and staff to keep an eye on your loved one. A board and care home is similar to congregate housing, except that the staff in the board and care facility pays closer attention to the residents (private rooms are not always available). Costs are typically higher in a board and care facility than a congregate housing facility.

Check to see what services are offered as well as the visitation policies. You will probably want to pick a location that is close enough for friends and family to visit.

Continuing Care Retirement Communities

A Continuing Care Retirement Community (CCRC) includes a town house or apartment, social and recreational facilities and most of the services the resident will need, including an on-site or nearby nursing home. Your loved one can move between independent living, assisted living, and nursing home care based on changing needs at each point in time.

The cost of living in a continuing care retirement community includes almost all living expenses including custodial care. These services are guaranteed for as long as the resident lives there (presumably for the rest of his or her life). These complexes are also called Life Care Communities.

The cost for a CCRC can be very high. The actual cost of a facility varies based on features and services offered and whether your loved one is single or moving in with a spouse or other partner. (A couple costs more, since it is conceivable that one spouse could be in the nursing home facility while the other is still in the apartment.)

Nursing Homes

The last resort in the care for a loved one is usually a nursing home when he or she has reached the point of needing around-the-clock skilled nursing care.

States certify nursing homes. There are rules in many states that prohibit people and companies from operating a nursing home if they have prior convictions for abuse. States also judge facilities on the level of training, health code compliance and general safety. Do not admit your loved one to a nursing home that is not certified by the state. Not only will it be potentially dangerous, but also most insurance companies (including Medicaid) will not pay for it. State regulations define the services that nursing homes can provide.

You should always visit a home before admitting a loved one.

Questions to Ask and Things to Look for in Selecting a Nursing Home *

• Does the home appear well maintained? Look at residents' rooms. A bad home can still have an attractive entryway.
• Is the facility relatively free from offensive odors? If you detect strong waste or disinfectant odors, this could be a sign that residents are being neglected and rooms are not being cleaned regularly.
• Is the facility well heated and cooled?
• Does the facility seem crowded? Is there enough common space for residents to congregate? Is there any outdoor space?
• Are the residents well attended to? Are they clean and well-groomed?
• Are patients simply staring at televisions or are they engaged in activities? Are there enough activities on the weekends? Do many residents remain in bed the entire day?
• Does the staff seem friendly, polite and responsive? How does the staff interact with the patients? Do they have an apathetic attitude?
• Is the facility properly staffed, or do the employees seem overworked? Is there adequate staffing during evening and weekend hours by both aides and administrators? There is no easy ratio to follow to determine proper staffing, but observations of the quality of care should give you a sense of whether or not staffing is adequate.
• Is the food appetizing? Is hot food hot? Are residents offered choices? Are meals served on time? Are snacks and drinks readily available throughout the day and night?
• Does the facility check to see how much each resident eats? Loss of appetite can be a symptom of serious problems. Is the dining room empty during meals? This could be a sign that staff are failing to transport residents to meals.
• Are residents getting the help they need with eating, grooming, and walking? Is staff helping residents with walking, or are they putting them in wheelchairs for convenience sake?
• Does the home have an adequate number of doctors on call? How often are scheduled examinations? Can your loved one's own doctor be involved? Do residents have the right to change doctors?
• How long will the nursing home hold a bed for your loved one if he or she needs to be hospitalized (this is called the bed hold policy)? If he or she is hospitalized longer, is he or she prioritized for the next available space?
• What is the policy on the use of restraints? Are many patients physically restrained or do they give the impression of being under heavy sedation? Who decides when a patient is restrained? Look for a home that will use these techniques only as a last resort and only under doctor's orders. Ask if a doctor ordered such a restraint. You will be able to learn a lot from the reaction of the staff person.
• Does the facility accept Medicaid patients? Nursing homes do not have to accept these patients; if they do, they are not allowed to discriminate in favor of residents paying private rates.
• How accommodating does the staff and management seem to you? Are they reluctant for you to completely tour the facility? Do they allow you to see a recent and complete state inspection report?
• What is the roommate selection process? Can roommates be changed?
• Can residents have personal items? Is there a safe place for valuables?
• Can the facility respond to your loved one if he or she does not speak English?
• Is there access to religious services?
• What is included in the daily rate? What will extra services cost? (This is not an issue if your loved one is on Medicaid.)

* Compiled in part from information from Friends and Relatives of Institutionalized Aged, Inc. and the Consumer Reports Nursing Home Guide.