How to Choose the Right Senior Care Facility for Your Loved One

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Article Summary:

• The first step is to clarify your loved one’s care needs, budget, and personal preferences before touring facilities.

  
  

• Evaluate how senior care can be paid for, including private funds, long-term care insurance, veterans benefits, and Medicaid.

  
  

• Compare facilities by visiting more than once, reviewing inspection history, and asking targeted questions about staffing, policies, and quality of life.

  
  

• Speak with an elder law attorney for guidance on Medicaid planning and for a thorough review of any senior living or nursing home contract.

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The decision to move a loved one into a senior care facility is often one of the most difficult and stressful choices a family will face. It typically comes during a health crisis, and the time crunch can make it feel impossible to do thorough research. We believe that an organized, thoughtful approach is essential to finding a community that ensures comfort, safety, and a high quality of life.

Here are some thoughts, based on our prior experience helping clients with these questions, on how to approach this critical decision.

Part I: Start with an Honest Self-Assessment

Before you start touring facilities, you must first clarify your loved one's needs, budget, and preferences.

Suggestions for Initial Considerations:

1. Define the Level of Care: What kind of support does your loved one need now? This is the most critical question. Determine if they need help with Activities of Daily Living (ADLs) such as bathing, dressing, diet, or medication management. This will determine if you are looking for Assisted Living, a Skilled Nursing Facility, or specialized Memory Care.

   
   

2. Area Agency on Aging:  Every county has an Area Agency on Aging.  They can help assess your loved one’s needs and suggest the level of care that is appropriate for them. 

   
   

3. Involve Your Loved One: It is crucial to involve your parent in the search to help alleviate their fears and worries about losing independence. Ask for their opinions and preferences regarding the facility and its activities.

   
   

4. Prioritize Quality of Life Factors: Consider the facility's location, transportation options, social and religious offerings, and financial compatibility. If they are moving a distance away, you will need to find new medical providers and identify where they will do everyday activities like shopping, socializing, and volunteering.

Part II: Taking Stock of Finances and Payment Options

The cost of long-term care in Pennsylvania is a significant factor for every family. A critical first step is assessing what your family can afford monthly and exploring the available payment avenues.

How Senior Care Facilities are Paid For

Long-term care is typically paid for through a combination of sources:

• Private Pay: Most seniors initially rely on private funds, including personal savings, income, retirement accounts (like 401(k)s and IRAs), pensions, and proceeds from the sale of a home or other real estate assets.

  
  

• Long-Term Care Insurance (LTCI): This type of private insurance is specifically designed to cover the costs of services and supports in various settings, including at home, in assisted living, or in a nursing home.

  
  

• Veterans Benefits: Eligible wartime veterans and their surviving spouses may qualify for Aid and Attendance or Housebound benefits from the VA, which can provide monthly, tax-free payments to help cover care costs.

  
  

• Medicaid: This is a joint federal and state program for low-income residents and is the largest source of long-term care funding. In Pennsylvania, Medicaid covers nursing home care and some personal care.

  • PA's Community HealthChoices (CHC): For individuals who want to remain in their homes or the community to prevent or delay nursing home placement, CHC is a managed care waiver program that provides a broad range of home care and support services.

The Role of Your Elder Law Attorney

Do not attempt to navigate the complex world of financing and eligibility alone. Our experienced elder law attorneys can provide valuable insights and assistance with:

• Financial Planning: We can help you navigate the eligibility requirements for government programs like Medicaid, including "spend-down" strategies, while also ensuring you avoid potential penalties related to asset transfers.

  
  

• Contract Review: Before you sign anything, an attorney should carefully review the nursing home or assisted living contract to protect your loved one and identify any hidden or unforeseen costs.

Part III: How to Compare Facilities and Key Questions to Ask

Once you have a shortlist, it’s time for thorough due diligence. Don't be fooled by the "glitz and glam" of fancy décor; focus on the quality of care and the facility's operational model.

Tips for Comparing Facilities:

• Visit Multiple Times: Schedule an initial tour, but be sure to conduct at least one unannounced "drop-in" visit at a different time of day, such as an evening or weekend, to see the facility under regular operating conditions.

  
  

• Check Regulatory History: Before making a final choice, check with the local ombudsman about any citations or serious issues regarding the community. You can also review the facility's star ratings and detailed inspection reports through the PA Department of Health and Medicare’s Care Compare website.

  
  

• Make a Pros and Cons List: After each visit, use a list of pros and cons to help narrow down your choices objectively.

Key Questions to Ask Staff and Management:

Area of Concern	Questions to Ask
Staffing & Care	What is the typical staff-to-resident ratio during different shifts? What is the staff turnover rate? (High turnover can indicate quality issues) Is there a nurse on staff 24/7? If not, how are medications managed, and by whom is this person trained? What are the nighttime staff arrangements? Do you provide transportation to medical appointments?  If not, how do you facilitate transportation? If my loved one’s needs increase, can you accommodate that?  Is there a price modification? What are the emergency plans in place for medical and non-medical situations?
Policies & Payments	If the resident is hospitalized, do we still have to pay for levels of care even when they are outside the community? What are the parking arrangements if our loved one still drives? May we have a copy of your resident agreement in advance to review? Do you have a medical assistance license to accept long term care Medicaid benefits if our loved one is eligible for benefits?
Quality of Life	What in-house activities are available, and what are the participation rates? Are there religious services on site?  Is pastoral care available? What is the ratio of men to women? How does the facility typically welcome new residents and help them adjust? What protocols were in place during the COVID-19 pandemic (or similar events) for keeping residents safe, stimulated, and connected to family?

The process of choosing a new home for your loved one is complex, but with the right guidance, you can make an informed decision that honors their dignity and needs. If you have questions about payment options, government program eligibility, or need a contract reviewed, contact our elder law attorneys today to schedule a consultation.