What to look for when choosing residential care for your loved one
Sometimes a health crisis forces families to move quickly toward a new care setting, the kind of shift that can follow events such as a fall that causes a broken hip, memory problems that create danger, or the death of a partner who handled care. Associated Press reporting with guidance from consumer and legal experts said that while the search can feel abrupt, families can narrow options by combining government information with real-world observations and detailed questions.
Federal oversight can help start that narrowing for nursing homes, Associated Press reported. Regulation for assisted living varies widely from state to state, but nursing homes are monitored by the federal government, and the Centers for Medicare and Medicaid Services keeps records that cover who owns a facility, what the staffing looks like, and what types of violations have led to fines. CMS also assigns each home a star rating, from one to five.
Sam Brooks, director of public policy for the National Consumer Voice for Quality Long-Term Care, told the AP that the star rating “can be notoriously unreliable,” and he linked that unreliability to the ratings’ reliance on self-reported data. Brooks said that with “one or two stars” families should “expect it to be bad,” while he suggested that those looking for quality should take a closer look at four- and five-star facilities and also consider ownership, noting that nonprofit homes are often better staffed.
The reporting emphasized that families can use ratings as a filter to rule out the worst options but should not assume that star counts alone will identify the best placements. Associated Press cited Brooks saying that the “data” only goes so far, and described how families often need to build a shortlist and then visit potential facilities in person.
During tours, the reporting urged families not to let decorative elements in lobbies steer their evaluation. Mark Sanchez, CEO of United Hebrew, said that when he tours a building, he listens first, including whether it is loud and whether call bells are ringing nonstop. Sanchez then urged visitors to switch senses and look at what daily life looks like: whether odors are present, whether residents gather near the nurses’ station or appear clamoring for help, whether staff speak respectfully and make eye contact, and whether workers seem rushed.
The AP also pointed to additional sources of information beyond what is visible on a tour. The reporting said that families of current residents can provide useful input and that families can turn to a local long-term care ombudsman. Ombudsmen are funded by the federal Older Americans Act and are described as available in every state to investigate complaints from long-term care residents.
As families gather information, Associated Press said, decision-making can still feel overwhelming. In the reporting, Jennifer Fink, of Auburn, California, described making a difficult memory-care selection and said she did not consult state databases or Google ratings, instead relying on her “gut reaction.” Fink told the AP, “Trust your gut. Keep top of mind that the salesperson wants your loved one’s money,” adding that if the experience gives someone “the ‘ick,’ then move on.”
The reporting said that staffing is a central factor in how residents experience care, stressing both the quality of hands-on help families witness and the average staffing levels reflected in reported data. It gave an example of how seemingly small differences can translate into meaningful changes in day-to-day assistance, such as whether residents receive time-critical help like showers, help at mealtimes, or prompt discovery after a fall.
During visits, Associated Press said families should watch how quickly call bells are answered and whether residents appear engaged in activities. It also urged visitors to ask staff how long they have worked at the facility and to consider whether workers stay for years, since continuity can matter for residents.
Evan Farr, an elder law attorney in Lorton, Virginia, who wrote The Nursing Home Survival Guide, told the AP that visiting at night or on weekends can be especially revealing. Farr said those are times when staffing is reduced and “the true operation of the facility becomes apparent,” adding it is “entirely possible to have a five-star rated facility that is woefully under-staffed from 5 p.m. Friday until 8 a.m. Monday morning.”
With an urgent decision, the AP reporting said families can focus only on what is in front of them, but urged a longer-range view. It described questions tied to what happens if residents’ funds run out: for nursing homes that accept Medicaid, families can ask how many beds are allocated to Medicaid residents and whether a loved one would get a slot; for assisted living, families can ask whether the facility even accepts people on Medicaid.
Because billing can change as care needs increase, the reporting described assisted living contracts as often having complicated pricing structures. Families were urged to ask how costs might change over time and whether there are additional charges for tasks as needs expand—for example, separate costs for help with toileting. Geoff Hoatson, founder of the elder law practice Family First Firm in Winter Park, Florida, told the AP, “Four-thousand dollars a month can become $8,000 overnight.”
The AP reporting also said that families should understand how facilities handle residents they view as unsuitable over time, a process it described as occurring often through transfers. Dementia patients were singled out in the reporting as targets for orders to leave, with the explanation that symptoms and care needs can sometimes bring aggression. Hoatson urged families to ask what conditions would require a transfer. The broader instruction across the reporting was that a facility’s day-to-day culture, staffing behavior, and policies for cost and transfer decisions can shape outcomes long after the initial tour.