Making a decision about a long-term care facility for an older family member is a difficult decision for most families. Yet, it can be the best decision when a family member’s health fails, community services are no longer adequate, and caregiving is impacting the family caregiver’s health.

In selecting a facility, think about it as a place where people go to live. You may find, as many families have found, that a care facility can enhance an older person’s quality of life and have a positive effect on your relationship with him or her. You can be together and enjoy each other's company without having to devote all your time to caregiving tasks.

The goal is to find a facility that you and your family member are comfortable with and that best meets your family member’s needs and financial resources. These guidelines may be helpful:

• Identify your family member’s needs. Develop a list of your family member’s medical, social and emotional needs. Do they need help with personal care activities, such as bathing, grooming and dressing? Or are there behavioral issues; for example wandering, agitation, or angry outbursts? If so, be as specific as possible about these care needs. If you are unclear about your family member's needs, consider getting a professional evaluation.
• Know the level of care your family member needs. In general, nursing homes provide two levels of care: skilled and intermediate. Skilled care is for people who need 24-hour medical or nursing supervision, or rehabilitation, but do not require hospitalization. A physician’s order is required. Intermediate care is for people who need help with the activities of daily living from health services such as nursing, but don’t need continuous nursing. A third level of care—sometimes called assisted living, residential or custodial care—is appropriate for people who do not need nursing supervision, but do need help with personal care and other activities of daily living. Some facilities also have special units designed to meet the needs of people with Alzheimer’s disease or other dementias.
• Get recommendations. Talk with people who know firsthand about local facilities. These may be families of care facility residents, physicians, clergy members, or hospital social workers. The Area Agency on Aging is also a good source for information about local long-term care facilities. If you don’t know the Area Agency on Aging that serves the area in which your family member lives, contact the Eldercare Locator at 1-800-677-1116 weekdays, 9:00 a.m. to 8:00 p.m., or visit www.eldercare.gov on the Internet.
• Screen by telephone. Call prospective facilities to learn about vacancies, admission requirements, levels of care provided, and participation in Medicare and Medicaid. Call during business hours and talk with the admissions coordinator, administrator or director of nursing.
• Tour prospective facilities. After you have completed your telephone screening, visit potential facilities. It’s the only way to truly evaluate a facility. Two primary questions you will want to answer during the visit are:

1. What is the quality of care provided by the facility?
2. How well will my family member fit into the facility?

In addition to cost, other considerations in selecting a care facility include the atmosphere and attitudes of staff, social and medical services available, activities and location. Observe carefully how staff members interact with the residents. Are staff kind, caring, and friendly? Are they gentle and patient with residents? Do they treat them with dignity and respect? Is the staff pleasant to you?

It’s unlikely that any facility will be "perfect." You and your family member must decide what your priorities are for a care facility.

For more information you may want to see these related eXtension articles:

• Choosing a Long-term Care Facility
• Housing Options
• Health Related Programs and Services
• Nursing Facilities
• Continuing Care Retirement Communities
• Assisted Living Facilities
• Geriatric Care Managers

Also, you may want to see the publication, Making a Decision About a Nursing Home, which offers specific information for each guideline. It discusses when to consider a care facility, who to involve in the decision, paying for nursing home care, specific questions to ask when touring a care facility, what you can do to make the transition to a care facility and adjustment a bit easier for everyone, and ways to make visits meaningful. The information is applicable to other care facilities for older adults.