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All too often the choice for moving to a nursing home or assisted living facility is made during an emergency. A hospital discharge worker calls around to see who will take a patient. The patient and her family seem to have little, if any, choice and no time to make it.

But as anyone who has visited these facilities will tell you, they differ widely.

But by facing reality and planning ahead, we can increase the likelihood that if we do have to live in one, we will live in one we can tolerate, where we enjoy life more and heal better.

Even if the decision must be made at the last minute, family members or a geriatric social worker can visit, can talk with family members of current and former residents and can keep our personal preferences in mind.

Resources that help you eliminate the worst choices in nursing homes

We can eliminate the worst choices using these resources: Medicare’s Nursing Home Compare, nursinghome411.org and ProPublica’s Nursing Home Inspect. Reviewing the minutes of the residents’ council and family council meetings and the emergency management plan can add important information. So can asking about staffing, absence and turnover ratios.

Questions to ask when choosing an assisted living facility or nursing home

Asking questions can help when choosing a nursing home or assisted living facility. Can you see your regular doctors? How you will get there? Even some private pay only facilities do not arrange this. Can you bring in your own therapists, aides and companions? Are you required to use those of a sister organization? What activities are available? Not just organized activities, but a woodshop, a garden, and other places to pursue hobbies. Is the van is full of people going to dialysis or can it regularly and frequently be used for shopping, library, church, theatre or other outings? Many costs and restrictions can be hidden by general statements.

There is nothing like being there. Is the food tasty? Served at the right temperature? Nutritious? What special diets are accommodated? Not just diabetic or high blood pressure but vegetarian or vegan, kosher or halal, and “ethnic” preferences? Nothing tastes as good as the food we grew up on.

The easiest way for perennially understaffed facilities to deal with residents is to keep them in their beds or parked in wheelchairs in front of a television or a window. This can be seen at even the most expensive private pay only facilities. At others restless residents with no meaningful activities in which to engage roll up and down the halls, pathetically seeking some stimulation and autonomy. None of this encourages health or happiness.

Are the residents well-groomed with clean-cut hair and nails? Is there enough padllockable storage space not just for clothes but for craft items, books, games and photo albums? In nursing homes, even dentures tend to disappear.

Does every resident have a window with a view of nature?

Must every resident share a room with someone who keeps the television on day and night?

Can people keep pets? Plants? Is the nursing home part of the Green House movement, with single rooms and bathrooms clustered around a common living room and kitchen? This can reduce a nursing home stay by a good 1/3rd. If not, is the nursing home part of the Eden Alternative, with animals, pets and an adjacent preschool or regularly visiting grade schoolers. Does the nursing home participate in Music and Memory, helping residents with declining memories keep alive inside?

Where is the facility? The best predictor of good nursing home care is frequent, unscheduled visits, particularly on weekends and during the evenings and shift changes. Despite their moniker, nursing homes are only required to have a nurse on staff eight hours a day. At other times med techs and aides are on their own.

Checklist for evaluating nursing homes

The link below includes a download for a checklist and more questions to ask when choosing an assisted living facility or nursing home.

Evaluating nursing homes checklist

No one wants to go to a nursing home. Even an assisted living facility is an unwelcome compromise. But by planning, researching and visiting ahead, we can find one which will suit us better and maybe even shorten our stay.


Estate Planning attorney, Terry Garrett, is a member of the National Academy of Elder Law Attorneys and is active in the Texas and Austin Bar Associations. She graduated with honors from Cornell University. She was on the Dean’s List at Wharton Business School. She earned her J.D. at Columbia Law School, receiving the Parker Award and a Mellon Fellowship.

She assists families of people with special needs, people planning for the retirement years and people administering estates.

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