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Home health care services
Local agencies and associations may offer services for the aging community still living in a home setting. These services range from friendly visiting, home-delivered meals, personal home care services, senior centers, transportation services, financial counseling programs, etc.
Contact your local agency on aging or senior center in your community to learn more about available services.
Senior housing is apartment or condominium properties for persons age 55 years or older. Senior housing complexes do not generally provide meals or personal care services to residents but they may offer social activities, transportation or other services. Services will vary depending on size, location, necessity and cost.
Independent living communities
Independent living communities are usually large groups of senior housing units. Like senior housing, independent living communities are age- restricted and services will vary from community to community.
Assisted living residences provide the same services as senior housing and independent living communities but also provide residents with assistance for daily activities. Services might include 24-hour assistance with eating, housekeeping, laundry, dressing, bathing, managing medications, etc. but assisted living residences do not provide major nursing or medical care. Be sure to ask what services are provided. Assisted living residences are registered, licensed or certified at the state level, usually by the department of health.
Continuing care retirement communities
Continuing care retirement communities (CCRCs) are usually a combination of independent living, assisted living and skilled nursing home services and are available all in one location. CCRCs services may include meals, housekeeping, 24-hour assistance, personal assistance with daily activities, nursing and other medical care.
Unlike other senior housing options, many CCRCs offer residents a legal agreement stating the CCRCs will provide housing and services for life. There is usually an entrance fee plus rental fees and monthly payments for selected services.
Nursing homesNursing homes offer 24-hour nursing and medical services, personal care services (help with dressing, bathing, eating, etc.), therapies (physical, occupational, speech) and social activities for residents.
There are two categories of nursing homes: intermediate care facilities and skilled nursing facilities. An intermediate care facility (ICF) must provide eight or more hours of nursing supervision per day where as a skilled nursing facility (SNF) must provide 24-hour nursing supervision.
Costs vary depending on services, location and size.
- Home health care services: The average cost of services is $56 per day (American Association of Homes and Services for the Aging)
- Senior housing: $500 - $4,000+ per month (Helpguide.org)
- Assisted living: $2,500 – 4,000+ per month (Natl. Inv. Center for Seniors Housing & Care Industry)
- Nursing home: $3,000 – 8,000+ per month (Natl. Inv. Center for Seniors Housing & Care Industry)
- Continuing care retirement communities: The monthly expenses per resident for a nonprofit CCRC is $2,672 or $32,064 annually (American Association of Homes and Services for the Aging).
WHN TIP: Plan Ahead.
Look for senior living facilities well in advance. You will be more comfortable knowing you’ve selected a plan and know the staff and location of the facility.
- Start a "senior living" folder, notebook or binder - choose a method that works best for your needs.
- You may need a folder to keep track of receipts, notes, questions, paperwork, photos, brochures, etc.
- Keep a separate folder or a separate section in your binder for each facility.
- If there is a social worker with whom you’ve had contact regarding the senior’s care, that person may be able to help you with your search.
- If the senior is a veteran, the Veteran’s Administration may have some resources you can use. Don’t hesitate to tap into all the resources that are available to you - you don’t have to struggle alone with this issue.
- Do you want it located near family?
- In what areas of daily life activities does the senior need assistance (i.e. bathing, eating, transportation, medical needs, etc.)?
- Religious affiliation?
- Other preferences that are important to you and/or the person on whose behalf you are doing this.
- Look over the list of questions below and select those that are most important to you.
WHN TIP: Over The Phone.
If you're looking at several facilities, you may be able to narrow down your list quickly by asking about your most important considerations over the phone. Also, ask if they have vacancies at the moment. If not, ask if there is a waiting list.
- Make appointments to visit the facilities you've chosen.
WHN TIP: Meal Times.
Try to tour the facility during or close to meal times - it will be easier to see interactions between the seniors and caregivers.
- This may help you choose between two facilities.
- It will also help you remember the size of the room, which can help come moving day.
This is a "starter" list of questions you may want to ask the management or staff of each facility. Feel free to print this list to take along with you or to modify the list to meet your needs.
- Who runs (manages) the home?
- Does the owner run the home? Who is on site?
- How long has the manager been running the home or others like it?
- How do you get in touch with the owners and managers?
- Ask for a copy of the most recent financial report, if you can get it.
- The financial report can help you see how your money will be spent. Look at areas like staff wages, food costs, home and room improvements, activity budgets, etc.
State Certification Questions
Just like workplace safety or restaurants for health regulations, nursing homes and some senior living places have to be evaluated by state certification boards.
To find out certification information about a certain facility, you can start by using Medicare's Nursing Home Compare. Please know that this site only lists homes under the Medicare program.
For assisted living facilities, contact your state health department. Assisted living facilities are regulated at the state level.
- Is the home supposed to be licensed or certified by a state or local agency? If so, is the license or certification up-to-date?
- What were the results of your last state certification review?
- What problems were uncovered?
- Have the problems been resolved? Or is there a plan in place to resolve them?
- When is the next certification?
- In your last certification, what did you report in terms of number of staff hours per resident?
- How many aides do you have total and per shift?
- How many RNs do you have total and per shift?
- How does that compare with other facilities in the area?
- How are new staff screened and trained?
- What qualifications do the staff members have? RNs and aides?
- What on-site training do staff members get?
- In addition to RNs, what other kinds of health professionals are on staff?
- Is there a full-time social worker?
- Get their name, experience and how long they’ve been associated with facility.
- Is there full-time therapy staff?
- Get their name, experience and how long they’ve been associated with facility.
- How many residents are assigned to each nursing assistant for a shift?
- Number in mornings _____.
- Number in afternoons _____.
- Number in evenings _____.
- Number during night _____.
- Number during meals _____.
- Are the night staff members in the home and awake or on call? .
- Who should I contact in case of questions?
- Get their name, phone number, e-mail, and work hours.
Services and Policies
- What are the services offered at the home?
- What services are included in the base rate?
- What services are not included in the base rate?
- Is there a volunteer program?
- What is the name of person in charge and their experience; how long have they been associated with the facility?
- How many volunteers are there and from where? How many volunteers are trained?
- What is the facility’s bed-hold policy (if someone has to leave the nursing home and go to the hospital, will the facility hold the bed? Look for the pricing, length of time)?
- How does the nursing home safeguard resident’s personal property?
- What is the facility’s policy on replacing lost or stolen articles?
- What are the procedures on taking residents out of the facility for family/friend gatherings or events?
- What policies/processes do you have for resolving "issues"?
- Who is in charge of this?
- Get their name, phone number, e-mail, and work hours
- How many people (residents) live in the home?
- How do you include residents in decisions regarding their care?
- Is there an active resident council? When does it meet?
- Is there a family council? When does it meet?
- How often are care conferences held with the resident, family and friends?
- Do residents have a say in how they are cared for and helped?
- Can necessary care be provided? (For example, help with bathing, washing, and going to the bathroom)
- Can family and friends help the patient with personal care?
- Will health care needs be met?
- Does the patient's current physician make rounds at this facility or will they have to change doctors?
- Will the patient be able to see a doctor whenever they need to?
- Is there a physician available in emergency situations?
- What hospital is used if hospitalization is needed? Is that in network with the insurance company?
- Is there a doctor nearby who sees the residents in the home? If so, does this doctor visit the home regularly and what are the days and times?
- Do other health care providers visit the home regularly? (Examples may include dentist, podiatrist for feet, physical therapist, occupational therapist, and physiotherapist.)
- How will the resident obtain his/her medications? Does a resident have to use a pharmacy that's related to the facility?
- How often are care conferences held with the resident, family and friends?
- If the patient's health gets better, will they be able to continue to live in the home?
- If the patient's health gets worse, will they be able to continue to live in the home?
Costs and Insurance Questions
- Does the nursing home have a contract with the patient's insurance company?
- Is it Medicare certified?
- Does the patient have a Medicaid contract?
- Is there an entrance fee? Is it refundable? Under what circumstances?
- How many residents per room and what is that cost?
- Are there private rooms and what would be the cost?
- Can I see a price breakdown list of costs?
- What services are included in the base rate?
- What services are at an additional cost?
- Do you have financial assistance available?
- Is the atmosphere warm, pleasant, cheerful?
- Are patient rooms roomy, bright, attractive?
- Can residents use their own furniture?
- Is there plenty of closet and other storage space?
- How does the facility prevent residents from wandering out of the facility?
- Are there special areas for activities?
- Are there outside areas for walking, sitting, or outdoor activities?
- Are hallways free of clutter?
- Is there a pay phone or private phone for residents to use?
- Is the ombudsman poster displayed in a prominent place?
- Is the state survey posted in a place accessible to patients and visitors?
The Activity Calendar
- Are there meaningful, interesting activities planned?
- Are activities planned for evenings and weekends?
- Are there individual activities as well as group activities?
- Who is responsible for leading activities? If that person is unavailable, is there a “back up” leader, or are activities cancelled?
- Is there a volunteer program for activities? Who leads it? Get name, their experience and how long they’ve been associated with facility; request a list of volunteers/where they are from.
- Is there community involvement for activities? Who leads it? Get name, their experience and how long they’ve been associated with facility; request a list of participants.
- Can family members attend activities? Which ones? What is the fee?
- Are residents up and dressed?
- Are residents clean and well groomed? Hair combed? Fingernails clean?
- Are residents engaged in activities, or just "parked" in the halls?
- Do residents have visible bruises or injuries?
- How many residents are restrained?
- Do staff members treat residents with courtesy, respect, and kindness?
- Are staff members neatly dressed and groomed?
- Does staff appear patient and gentle
- Is the atmosphere pleasant and relaxing?
- How many residents eat in the dining room?
- Are residents encouraged to eat in the dining room?
- Is there adequate staff to assist residents who need help feeding themselves?
- Do residents with special needs have adaptive devices to assist them? (special spoons for example)
- Does food look and smell appetizing?
- Look at menus, is there a good variety?
- Do residents have alternate food choices?
- Is food served hot?
- What is the facility’s policy on families bringing in special foods?
- Can family members or friends assist with feeding?
- Can family members eat in the dining room with the residents? Are reservations needed?
Bathrooms and Bathing
- Are public and private bathrooms clean and well kept?
- How often are residents bathed?
- How often is hair washed?
- Do residents have a choice of when they take their bath or shower?
- If residents are not bathed daily, how often are their faces and hands washed?
- How often are sheets changed?
- Do male attendants assist female residents, or female assist male, with bathing and toileting?
- Do residents have the option to request “same sex” CNAs
- What types of rehab or therapies does the facility provide?
- Are therapies provided by facility staff, or outside contractors? Get names, their experience and how long they’ve been associated with the facility.
- Is there a separate room for therapies? Look at it.
- Are therapists available seven days a week? If not, when are they available?
- How does the nursing home accommodate individual needs and preferences? For example, can residents sleep late in the mornings?
- Is there a bladder-training program for residents who are incontinent?
- Does the nursing home provide assistance with tooth brushing?
- Does someone come to the home to cut and fix hair?
Family Involvement and Visiting
- Are family members included in care planning? How are they notified?
- What are the visiting hours?
- Are there any restrictions on visiting? (age?)
This is a list of questions the senior may wish to consider (or you might want to ask the senior) when selecting a place to live.
First Impressions of the Home
- Does the home seem friendly, safe and comfortable?
- Does it smell okay?
- Is the temperature comfortable?
- Do the people who live there (residents) seem content?
- Do they seem happy with the way the staff talks to them?
- Are the residents treated with respect and in a friendly way?
- Will it be easy to see your family and friends?
- Is it easy to get to local stores, social clubs, church, or other places/events that you want to get to?
- Is there transportation to help you get to where you want to go?
- Can someone in a wheelchair easily move around the home?
- Is getting in and out of the home or to other floors safe and easy?
- Are there convenient ways to call for help if you need it?
- Are there call buttons or bells near the bed, in the bathroom and common areas where residents gather to visit?
- Are the rooms, stairs and hallways lighted well enough to see?
- Is there a garden or other outdoor area where you can spend time outdoors?
- Are there smoke alarms and fire extinguishers easily accessible?
- Is there a building security system (electronic and personal) to protect the residents?
- Are all parts of the home accessible to people who use wheelchairs?
- Is there a choice of furnished and unfurnished rooms?
- Can you get a room to suit your needs (a single room, a double with a roommate?)
- Do the bedrooms have their own bathrooms?
- Do they give the residents privacy?
- Are the toilet and shower easy to use?
- Are there grab bars in the bath or shower and by the toilet?
- Are there toilets within easy reach of all the areas where residents get together for social activities and meals?
- If you have to share a room, can you meet your roommate before you move in to see if you get along?
- Can you change rooms if you don't get along with your roommate?
- Are there screens in shared rooms to give privacy?
- Can you bring some of your own things like knick-knacks, pictures or furniture?
- Can you lock your closet or drawers?
- Can you have your own TV in your room?
- Can you have air conditioning installed if there is none?
- Can you have your own phone line and Internet connection (find out if it's DSL, wireless)? Is this included in the fee or an extra fee?
- Is there room for a computer?
- Is there enough furniture for most residents to have some choices of where they sit?
- How many rooms are there for activities like watching TV, playing cards, and the like?
- In these rooms, is the furniture arranged in a comfortable way?
- Is there a room where it is quiet (no TV)?
- Where is smoking allowed?
- Is there a safe place to keep personal and valuable things?
- Does the home have insurance that would cover your personal items that may be lost or damaged? Or, do you have to carry your own insurance or a rider?
Rules and Recommendations
- Are you comfortable with the rules (house rules) about things like pets, visitors, and smoking?
- Would you have a say in what happens in the home? How?
- Is there a residents and families group that is not sponsored by the home?
- Is there a special person in the home with whom you can talk about problems and who will act on your behalf with the managers of the home?
- Can you get up from and go to bed when you want to?
- Will your room be cleaned at least once a week?
- Will someone make your bed for you? If so, how often?
- Can you buy items like stamps and books at the home?
- Are newspapers and mail delivered to the home?
Language, Culture, Religion
- Does anyone on staff speak the language you prefer to speak?
- Are interpreter services available for language, or for a resident who is hearing impaired?
- Do the staff members know about your culture; and do they understand that it may affect the type of and way you are cared for? Are they equipped to work with you so that you are comfortable?
- Will you be able to practice your own religion?
- Is there a place of worship nearby?
- Do people of your faith visit the home regularly?
- Do they serve the food you like?
- Are there food choices?
- Are special diet meals served?
- Are the meals healthy?
- Can you get snacks when you want them?
- Can you have meals at times that suit you or are they served at certain
times every day?
When you want___.
Only certain times? List times.
- Can you eat in your room?
- Are there social activities? How often? Ask for a listing of examples from the past.
- Are there trips to events outside the home? How often? Ask for a listing of examples from the past.
- Are there activities you like? (Such as exercise groups, crafts, cards, and games like Scrabble)
- Can you have a telephone in your room?
- Can you use the telephone without being overheard by others?
- If you need a special phone, is there for one for you to use? (People with hearing problems often have special equipment on their phones.)
- Can family and friends visit when they want, or must they come only at certain
- When they want?
- Only certain times (list times)?
- Are there private places in the building where you can visit with your company?
- Can your visitors join you for a meal?
- Can your visitors spend the night? Where?
- Can you offer your company a drink or snack?
- Does the facility provide transportation for residents?
- Is it close to public transportation?
- Are you allowed to have a car if needed?
After you have visited several facilities, compare your notes from each facility. Examine the most important needs for the senior: services, cost, location, individual needs, activities and so forth.
WHN TIP: Visit Again.
Make second or third visits to help you decide. Choose nontraditional times such as weekends or nighttime hours for your visit.
Take your time. When you're ready, notify the center of your choice of your decision to go ahead with their services.
- If the senior is moving to an assisted living or skilled nursing facility, there will be a meeting with the senior's physician, facility staff and family members to make an assessment of the senior's current condition.
- Following that assessment, the facility staff, physician and family members will meet to discuss the plan of care for the senior. The plan of care will
outline the services, schedule of services, costs and so forth. The plan of care will be reviewed and revised according to the patient's condition.
WHN TIP: Ask Questions.
This is a good time to ask about costs, additional services or visits and other questions you might have. Ask how often the patient's plan of care will be reviewed and revised. Ask how you will be notified of price rises or changes in services.
WHN TIP: Talk About the Future.
Also, this is a good time to discuss future plans. Ask what signs or instances would trigger the discharge of the patient to another facility or type of care.
- Take the time to get to know the senior living staff.
- Discuss concerns and questions with the senior living staff.
- Write down any health or care problems (date, time, staff) to discuss with the senior living management.
- Share details about the resident’s likes, dislikes, and daily routines.
The information provided here is not meant to be a substitute for professional medical or legal advice. These tips are from doctors, nurses and people who have shared real-life advice; always check with a doctor, lawyer or appropriate professional you trust before making any legal or healthcare- related decisions.Thank you ...
A special thank you to the industry professionals, lawyers, insurance agents, doctors, nurses, seniors and families who gave us their time, insight and real-life advice.