The types and number of assisted living facilities can be overwhelming. Solution: Do your homework. By asking the right questions, you'll find one with the right services and care approach.

An Assisted Living Facility is a place for people who don't need to be in a hospital but can't be cared for at home. Most facilities have nursing aides and skilled nurses on hand 24 hours a day.

Some facilities are set up like a hospital. The staff provides medical care, as well as physical, speech and occupational therapy. There might be a nurses' station on each floor.

Other facilities try to be more like home. They try to have a neighborhood feel. Often, they don't have a fixed day-to-day schedule, and kitchens might be open to residents. Staff members are encouraged to develop relationships with residents.

Some facilities have special care units for people with serious memory problems such as Alzheimer's disease. Some will let couples live together. facilities are not only for the elderly, but for anyone who requires 24-hour care.

Facilities can be:

• Hospital-like. This type of facility is often set up like a hospital. Staff give medical care, as well as physical, speech, and occupational therapy. There can be a nurses station on each floor. As a rule, one or two people live in a room. A number of facilities will let couples live together. Things that make a room special, like family photos, are often welcome.
• Household-like. These facilities are designed to be more like homes and the day-to-day routine isn't fixed. Teams of staff and residents try to create a neighborhood feel. Kitchens are often open to residents, decorations give a sense of home, and staff are encouraged to develop relationships with residents.

Some facilities have visiting doctors who see their patients on site. Other facilities have patients visit the doctor's office. facilities sometimes have separate areas called Special Care Units for people with serious memory problems, often called dementia. When looking for a facility, it's important for families to think about these special needs.

How Do You Choose?

The National Institute of Aging recommends you keep the following in mind if you are looking for a facility:

• Look. What choices are in your area? Is there a place close to family and friends? What's important to you—nursing care, meals, a religious connection, hospice care, or Special Care Units for dementia care?
• Ask. Talk with friends, relatives, social workers, and religious groups to find out what places they suggest. Ask doctors which facilities they feel provide good care?
• Call. Get in touch with each place on your list. Ask questions about how many people live there and what it costs. Find out about waiting lists.
• Visit. Make plans to meet with the director and the nursing director. The Medicare facility Checklist (see Resources That Can Help) has a good list to use when visiting. Some things to look for:
  • Medicare and Medicaid certification
  • handicap access
  • strong odors (either bad or good)
  • many food choices
  • residents who look well cared for
  • enough staff for the number of patients
• Talk. Don't be afraid to ask questions. Ask how long the director and department heads (nursing, food, and social services) have worked at the facility. If key staff change a lot, that could mean there is a problem.
• Visit again. Make a second visit without first calling. Try another day of the week or time of day so you will meet other staff members and see other activities. Stop by at mealtime. Do people seem to be enjoying their food?
• Understand. Once you choose, carefully read the contract. Check with your State Ombudsman for help making sense of the contract.

The Centers for Medicare and Medicaid Services (CMS) asks each State to inspect any facility that gets money from the government. Homes that don't pass inspection are not certified. Ask to see the current inspection report and certification of homes you are thinking about. Visit www.medicare.gov for more information.

Resources That Can Help

The rules about programs and benefits for facilities can change. Medicare has some helpful resources online. Visit www.medicare.gov for information about different care options.

You can find facilities in your area that are approved by CMS by visiting the Medicare website. You can also see summaries of recent inspection reports. Visit facility Compare at www.medicare.gov/NHCompare. The facility Checklist at the same website is a good guide to use when thinking about facilities.

Many States have State Health Insurance Counseling and Assistance Programs (SHIP). These programs can help you choose the health insurance that is right for you and your family. Visit www.medicare.gov/Nursing/Payment.asp.

Each State also has a Long-Term Care Ombudsman office that helps people learn about long-term care. Your local office may be able to answer general questions about a specific facility. Also, once you are living in a facility, the Ombudsman can help solve problems you may have with a facility. The National Long-Term Care Ombudsman Resource Center has more information. Visit www.ltcombudsman.org.

A veteran in need of long-term care might be able to get help through the Department of Veterans Affairs programs. Visit www.va.gov or call VA Health Care Benefits toll-free at 877-222-8387. You can also contact a VA medical center near you.

National Institute on Aging, U. S. Department of Health and Human Services, Public Health Service, National Institutes of Health, January 2007