How to Select a Care Facility

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What to Look for as You Tour

One way to approach a tour is to imagine that you are the person who will be living there. What do the accommodations look and feel like? What are the residents doing? Are the staff members friendly? What is the quality of care? These are only a few of the things to ask. The following is a list of other topics to consider. And remember to take notes!

Getting started:

Call the admissions or marketing office to schedule your visit or tour.

Arrive fifteen minutes early so that you can observe what is going on before your guided tour.

Be prepared to take notes and ask questions.

First impressions:

Note the driving distance from your home to the center.

Are the grounds well kept and attractive?

Is the street busy or quiet? Is it located in a neighborhood setting?

Are there ample sitting areas, gazebos, chairs, accessible gardens and swings?

What is the lobby like? Does it seem sunny and open or dark and gloomy? Remember, however, that the lobby is rarely used by residents and may be decorated to please visitors such as yourself on their first visit.

Look for the official inspection document in the lobby. Nursing homes are required to make that report available to the public. You can ask to see it, and even to have it explained for you. When your tour guide greets you, make note of how you are welcomed. Do you feel the person has taken ample time to get to know you and understand your situation or do you feel rushed or that you are just getting a standard guided tour?

On your tour, ask to see areas that are important to you, for example, the available accommodations both private and shared, dining areas, common spaces, activity areas, exercise areas and other special departments.

On the tour:

Note how people around you are interacting, even if you are not talking directly with them. Do they smile at the residents? Greet one another in a friendly, professional fashion? Imagine yourself or your loved one in that situation, how would you feel?

There shouldn’t be a lingering unpleasant smell in the facility (barring normal medical odors). If there is, it may be an indication of improper care.

Take note of the residents and their appearance. Are they clean? Hair combed? Wearing jewelry or clean clothing?

Are the common spaces homey or inviting? Are the chairs comfortable and the areas large enough for wheelchairs and walkers to maneuver with ease?

Do the hallways provide ample room for several residents to travel at the same time? Are they clean and uncluttered? Are there handrails for the residents to use?

Is the signage clear, easily understood and marked with large numerals?

Is there an activity calendar in easy reading distance of the residents? Is there a wide variety of activities scheduled? Are there activities that would interest your loved one?

How is the temperature of the building overall?

Ask about accommodations for smokers.

Are pets allowed? Is pet therapy provided?

Residents’ rooms:

How much room is there around beds and chairs for residents to maneuver? Can residents bring their own furnishings?

Are rooms inviting to guests?

Do the rooms seem to reflect each resident’s personality or preferences?

Does the tour guide knock before entering a room, and ask before showing a closet space, etc.? This will indicate the level of respect for privacy this facility embraces.

What are the residents doing? Staring at the wall, interacting with family members, watching television, lying in bed?

If an active resident population is important to you, gauge the activity level of the residents you see. If you are visiting in the afternoon, remember that residents may be more tired than if you visit mid-morning.

Recreation area:

Ask how the facility gathers residents for activities. Are all residents required to participate in any or all activities? How are they invited?

Ask how the activities are planned. Do residents give input?

What kinds of activities are available? Take note of any that are of particular interest to your loved one. Do residents go out for

programs and events? Do community groups or volunteers participate in activities?

If your loved one is more sedentary, ask about activities that can be brought to their room.

Does every resident receive a copy of the monthly activities calendar?

Religious observances:

Are all religions embraced and/or celebrated in the facility?

What kinds of services are held on-site? Is there a chaplain?

Are there prayer groups or religious text (Bible, Koran, Torah, etc.) discussion groups available?

In the event of a critical health emergency or death, what clergy are immediately available to the resident?

Physical therapy department:

Meet the staff. Ask about their qualifications, the general length of employment and whether they are staff or outside contractors.

Watch how the employees interact with the residents. The room should be pleasant and not crowded. The therapists should be working one-on-one without distractions from other residents.

Are there model kitchens, bathrooms or bedrooms for occupational therapy opportunities?

Is speech therapy available? What special programs do they offer?

Dining room:

Not all residents are able to physically attend meals in the dining room. Ask what dining options are available.

Ask to see where residents who need help eating their meals eat, and ask how they are fed (individually, in a group with a nurse sitting in the center of a semi-circular table, etc.)

How much attention are residents getting in their meals?

What happens if a resident misses a meal? Does the staff follow-up to ensure that they’ve eaten?

Is there a selective menu? What if a resident does not like the meal choices?

How are special diets handled?

Does the food look appetizing?

Are menus posted, or given to each resident?

Can family members or guests dine with the resident? Is there a charge?

Can you sample a meal?

Restrooms:

Are there grab bars or other safety devices in the toilet areas, showers, bathtubs?

Are sinks and bathing areas accessible for residents who use wheelchairs?

Are restrooms clean and fresh smelling?

Are there common restrooms for residents as well as private restrooms in their bedrooms?

Is there a call button near the toilet and the tub so the resident can summon help?

In assisted living, how much help is given with toileting?

Administrative:

Is the home for-profit or not-for-profit? Does the home have a religious or fraternal affiliation? Who sits on the board of directors? What is their function?

Not-for-profits often have community leaders on their boards. For-profits may be run by a corporate board across the country.

How many beds does the facility have?

What levels of care does the facility provide? How are transfers made from one level of care to another?

What is the staff-to-resident ratio for each level of care?

What is the facility’s restraint procedure for upset or agitated residents?

Which physicians visit and how often?

What are visiting hours for family members?

Are there suites or rooms for rent in which out-of-town visitors can stay?

Is there a resident council that helps make decisions and/or policies for the facility?

Listen closely for not only the words used in answers, but also the tone, the willingness to share information and the attitude that seems to be projected toward residents.

How can families get involved? Again, listen closely for the reaction to this question. Do they welcome family involvement, or merely tolerate it?

Ask for a copy of the contract to take with you and read at home. You may want to share it with your attorney.

Ask for prices and payment plans. Make sure you understand what is included in the price and what is not. Ask for a copy of ancillary or additional charges. Ask for a written copy of their pricing policy.

Special concerns:

Ask to see special departments, even if you may not need their service. It’s important to gauge how residents at all levels of functioning are treated.

Short-term rehab unit: these units will have fewer personal items in residents’ rooms due to their shorter stays.

If there is no short-term unit, ask whether these residents share rooms with long-term residents. This may be a minus, because long-term residents may have difficulty adjusting to a number of different roommates over time.

If your loved one has Alzheimer’s Disease or another form of dementia, be sure to ask about staff training, special programs and activities and special measures to keep residents secure. Is there a safe outside area as well?

After your tour, use the following checklist to compare liked and disliked about the facility. Visit several facilities and use your checklist to compare. Visit the one you like best at different times of the day and on the weekend. Listen to your gut! Your impressions will be strong. Remember how important this decision is, and insist that you get all the information you need before making it.