When family assistance and various community services are not enough to maintain a safe environment and meet the personal and health care needs of an individual at home, families often begin to look for a care facility. The most appropriate type of facility will depend on the needs of the individual. Personal care homes (PCH) are a good choice for those who are still able to get around, either by walking (independently or with an assistive device), or self-propelling a wheelchair. Folks in a PCH may require cueing and/or physical assistance with medication management and personal care tasks such as bathing and dressing. All meals and housekeeping are provided by the facility. Skilled nursing facilities (SNF) provide care for those individuals who have more extensive health care needs. Personal Care Homes and Skilled Nursing Facilities may be freestanding or part of a larger community. Either way, the task of choosing a facility can be daunting. What should families look for in a care facility?
One of the primary questions when beginning a search for a care facility is the cost. In Central PA, the average cost of a PCH is $3,000-$5,000/month. If your loved one has dementia and requires a secure unit, this cost increases to $4,500-$6,500/month. A SNF will run about $8,000-$12,000/month. While these numbers may sound excessive, remember there are costs associated with staying at home also, such as a mortgage, taxes, property maintenance, utilities, and home care for example. An elder law attorney may be able to assist with planning to obtain public benefits to help pay for care in a facility, and provide information about managing assets relating to a spouse who will remain in the family home.
A second primary consideration is location. Does your loved one want to stay in the same area where they have lived for a number of years, or move somewhere closer to relatives who may live a few hours away, or even across the country? Individuals who have a spouse or strong social networks in the community may desire to stay and continue relationships with friends and community organizations. On the other hand, if relatives do not live in the area, a location closer to them may make it easier for family members who wish to visit often and participate in care. Keep in mind that an individual who loves to be outside and has been living in Florida may not do well when moved to be closer to a child who lives in Buffalo, NY. Carefully weigh the implications of a move for both the individual and family members.
Once the desired location has been decided, families can begin to look at individual facilities. For individuals with dementia, facilities that have secure dementia units should be strongly considered, even if the individual does not require that level of supervision at the current time. Choosing a place with this option may save a move later on. Personal care homes vary with regard to how extensive their levels of care are, so in order to avoid surprises down the road, find out about the types of care situations that they do not feel equipped to handle, such as when an individual becomes dependent on others for transfers or mobility. Different rates may be charged based on the types of care tasks for which assistance is required, so be sure to review how rates are determined in addition to what they are.
There are many questions that apply to evaluating any type of care facility. Some are listed below as a general guide. They are not in any particular order, and some considerations may be more important to some families than others.
What types of staff are available (licensed vs unlicensed) and how many are schedule
for each shift?
What types of regular and specialized trainings do staff members receive?
Observe how staff members interact with residents when you take a tour – are they
relaxed and friendly?
What is the facility’s employee retention rate? If you have an opportunity, talk to
various staff members. High employee satisfaction will translate to improved care for the residents.
Building and Grounds:
Is the building clean, without strong odors, and well maintained? Fancy décor may give a
favorable first impression, but try to look beyond appearances.
Are there outdoor areas which allow for activities and exercise?
Is there carpeting in rooms or hallways? While helping to control noise levels, carpeting
may make using a wheelchair or walker more difficult.
Is there adequate parking for visitors?
Is lighting adequate and soothing?
Is personal furniture allowed?
Are residents able to control the temperature of their rooms?
What types of programs/activities are available related to your loved one’s interests?
Are pets allowed to visit or reside in the facility?
Where are meals eaten, and at what times? Ask to see a menu.
Are specialized services, such as a hair salon, available?
What is the procedure for residents to voice concerns or suggestions?
Are there residents and/or families that you can speak with about their experiences at
Asking open ended questions will provide a more detailed picture of life at a facility. Every facility will have its own strengths and weaknesses. What is important is to find the place that will be the most comfortable for the one who requires the care. One additional question should be ‘What makes your facility unique?’
by Karen Kaslow, RN
Elder Care Coordinator