How to Choose a “Nursing Home” for Your Elderly Parent

iStock_000010317954Medium-200x300Physical therapist, Derek White, shares his 5-step guide for choosing the right healthcare facility for your elderly parent who can no longer live at home.

At some point it’s bound to happen: your elderly mother or father is no longer safe to live at home. It may be because they’ve had a long illness that has left them debilitated—or they keep falling and hurting themselves—or they just need a little help to take a shower and get dressed.

Whatever the reason, if your parents live long enough (and let’s hope they do!), it’s likely that at some point you’ll have to decide where they can safely live.

And it doesn’t help that there are many types of facilities with very specific titles and purposes—yet most people lump them together as “nursing homes.”

Yet, if you understand, 1) why you shouldn’t feel guilty about “putting Mom in a nursing home”, 2) what your parent needs, 3) the technical names for the different facilities—and what they offer, 4) how they are paid for, and 5) how to choose a good one, the task becomes a little easier.

Step 1: Don’t Feel Guilty

I’ve seen some people struggle for years with the idea of moving their elderly parent into a healthcare facility—all while their parent struggled physically or emotionally in a home that compounded all the problems.

But if your mom or dad can’t participate fully in today’s busy world—they may be isolated and left alone far too often.

And “home alone” for an elderly person can mean risk of accidents and depression.

There’s a reason why modern healthcare facilities for the elderly have steered away from calling themselves “facilities” for the more friendly title of “communities”. Why? Because elderly care is much more community-oriented and home-like than what it used to be.

These days, the best “communities” are designed for a more neighborhood-like experience—including cozy rooms, more gathering places, better food, engaging activities, regular entertainment, real socializing with other seniors, etc.

So, as much as you think that your dad or mom will be happier in your home—or their own home—it’s quite possible they will be more content (and safer) in a more stimulating environment with their own age-group.

Step 2: Identify What Your Parent Needs

Healthcare facilities for the elderly are tiered in a hierarchy based on how much assistance the person needs.

Is your mom or dad generally in good health and basically independent—but wants to be around other seniors? Then an “independent living” (IL or ILF) community may be perfect.

Does your mom or dad simply need some help with bathing, dressing, and meals?  Then an “assisted living” (AL or ALF) facility would fit the bill.

Maybe your parent has some complex health issues that need monitoring—or recently had a hospital stay for an illness or surgery. In that case, he or she may need a “skilled nursing facility” (SNF) with 24-hour nursing care.

Does your parent have serious dementia, e.g., Alzheimer’s or other dementia? And are they safest when they’re in a controlled and monitored environment? Then you probably need to choose a skilled nursing facility with a “memory care unit” with strictly-controlled access so your mom or dad can’t wander off.

Or maybe you can see that your parent is likely to experience all of these needs—perhaps in slow, chronological order—and you don’t want them to switch facilities every time they have a greater need. Then you might consider a “continuing care retirement community” (CCRC) where all levels of care are offered.

Step 3: Know the Technical Names of Elderly Care Facilities

The term “nursing home” has become a vague, generic term used to describe any facility that provides elderly care. It’s too vague to be useful when you’re making decisions, so it’s important to know the real names.

From the lowest amount of care to the highest, here are the names that are normally used in this industry:

“Senior Community” or “Independent Living Community” is the name for a facility (or sprawling campus!) that is designed for active seniors who are in relatively good health and who don’t need assistance with anything. They are designed to enhance quality of life by grouping seniors together who may have common interests or needs for socializing. Normally, these communities feature individual apartments or townhouses, have lots of recreational and socializing activities and have a cafeteria or restaurant for meals if the residents don’t want to cook.

An “Assisted Living Facility” is designed to help those who have trouble with “activities of daily living” (ADLs). What are ADLs? Think about what you did this morning…you got yourself out of bed, bathed, groomed yourself, and got dressed. Those are ADLs. An assisted living facility has the personnel (certified nursing assistants or CNAs) to help each resident who has challenges with ADLs. Assistance can also include medication reminders, transportation, and meals.

“Skilled Nursing Facility” is the name for facilities that provide true, 24-hour healthcare for patients with fairly complex health issues.  These facilities staff nurses 24 hours a day and provide rehabilitative therapies like physical, occupational, and speech therapy. They are staffed with a social worker and have a medical doctor assigned as the house physician (although you can use your own doctor if you prefer). I like to think of these facilities as one step down from a hospital—in fact, many elderly patients who have a hospital stay for an illness or surgery are discharged from the hospital directly to a skilled nursing facility to get “rehabbed” before they eventually return to their home. However, many of these facilities also have a “long-term” group of patients that will live there—receiving care—indefinitely.

A “Continuing Care Retirement Community” (CCRC) is a facility that usually includes all of the above. Within a large CCRC can be an independent living community, an assisted living facility, and a skilled nursing facility. 

Be aware that most of these facilities are not exclusively for the elderly—but could include some younger patients or residents.

Step 4: Know How to Pay for the Care at Each Facility

Costs of these facilities will vary significantly by area and amenities.

Facility Provider of Funds and General Cost
Senior Community or Independent Living Community Normally private pay. Some limited Medicaid funds for low-income seniors. Often starts at $3,000 per month but could be much higher.
Assisted Living Facility Normally private pay, but sometimes covered by long-term health insurance and Medicaid. Often starts at $3,000 per month but could be much higher.
Skilled Nursing Facility Medicare pays for up to 100 days of care after a qualifying hospital stay. Medicare HMOs also pay for care. Long-term care can be funded by private pay, Medicaid, or long-term care insurance. Care often costs $300 or more per day.
Continuing Care Retirement Community Different levels of care can be funded as described above—but some CCRCs require private pay only.


Step 5: Choose a Well-Run Facility

The internet is a great resource for reviews and ratings of specific facilities. Try a search for “assisted living facility ratings [name of city]”, or search for the specific name of the facility you’re considering. For skilled nursing facilities, Medicare provides detailed statistics and ratings at At the Nursing Home Compare website look for facilities with 5-star ratings and/or high staff hours per resident.

Healthcare professionals who visit multiple facilities on a regular basis—like nurses and therapists from home health agencies—will have excellent insight about the quality of specific facilities. Consider calling a home health agency and asking to talk with one of their professionals.  Doctors and hospital discharge planners are also good sources of information.

Finally, nothing beats a tour of the facility. Visit the facility with someone you trust so you get their impressions—and take Mom or Dad along if possible. A good tour will include all areas of the facility, including bedrooms, activity areas, and dining rooms. Ask about the menu, how often activities are held, and what kinds of activities are provided. Don’t be afraid to introduce yourself to some of the residents and ask their opinions of the facility—most elderly people will be happy you asked and they’re not afraid to give you an honest opinion.

I’d love to hear about your own experience, so please leave a comment in the comments box.

Derek White, MPT is a licensed physical therapist, and a business owner. He and his partners’ companies employ over 1200 healthcare professionals and include an award-winning home health and hospice agency—Envision Home Health and Hospice—and a nation-wide contract rehab company, Independence Rehab. His approach to business and marketing incorporates his experience as a top-selling sales manager for a national telecommunications provider, and as a producer of marketing videos and other media.   

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