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Choosing the right place

Many of us hope to stay in our homes as we grow older. Often we are able to do that. But later in life—usually by our 80s and 90s—some of us need a hand with everyday activities like shopping, cooking, or bathing. A few of us need more help on a regular basis. Maybe that means it’s time to move to a place where expert care is available around-the-clock.

Where to start

Do you think that your family member can’t live at home any longer? It might be your husband or wife, a parent, aunt or uncle, or even a grandparent. You’ve added a hand rail on the front step sand grab bars in the bathroom. You may have made pl ans for a home health aide to come to the house every day. You arranged for help with meals, and you visit every day. But now you wonder if staying at home is the best choice. Where do you go for help? Here are some answers to that and other questions that you might have as you look for the best place for you or your relative to live.

Sometimes the need for help grows over time.

What are the choices

There are two kinds of senior living facilities based on how much help is needed:

  • Assisted living facilities
  • Skilled nursing facilities or nursing homes.

You should think about an assisted living facility if you or your relative don’t need a lot of medical care but do need more help than can easily be gotten at home. Assisted living homes can give someone as much help as needed with daily living, but offer only some nursing care or none at all. People often live independently in their own unit. The place provides meals and house cleaning, offers interesting things to do, and takes residents wherever they need to go, like the doctor or the shopping mall. They can also provide help with bathing, dressing, and taking medicines, if needed.

Some assisted living facilities are part of a continuing care retirement community or life care community. These communities offer independent living and skilled nursing facilities as well as assisted living. Sometimes assisted living help is set up in a home with only a few residents. These are often called board and care homes.

If your relative becomes very frail or suffers from the later stages of dementia, more care could be needed. A nursing home or skilled nursing facility may be necessary if someone:

  • needs round-the-clock nursing care.
  • might wander away without supervision.
  • needs help with meals, bathing, personal care, medications, and moving around.
  • needs more help than the current caregiver can possibly give, or cannot live alone.

These places supply 24-hour services and supervision, including medical care and some physical, speech, and occupational therapy, to people living there. They might also offer other services such as social activities and transportation. As a rule, the rooms are for one or two people. Some places want residents to bring some special items from home to make their rooms more familiar. Some even allow a pet or make it possible for couples to stay together.

Both assisted living and skilled nursing facilities sometimes offer special areas for people with dementia. These areas are designed to meet the special needs of these people and to keep them safe from wandering.

How to choose

Ask questions

Find out about what is available in your area. Is there any place close enough for family and friends to visit easily? Doctors, friends and relatives, local hospital discharge planners and social workers, and religious organizations may know of places.

Also, each state has a Long-Term Care Ombudsman. They have information and may be able to answer questions about a place you are considering. The ombudsman is also available to help solve problems that might come up between a nursing home and the resident or the family. To find your state long-term care ombudsman, contact the Alzheimer’s Disease on Aging’s Eldercare Locator at 1-800-677-1116 or www.eldercare.gov.

Is the person in need of long-term care a military veteran? They might be able to get help through the Department of Veterans Affairs programs. You can check by going to www.va.gov, calling the VA Health Care Benefits number, 1-877-222-8387, or contacting the VA medical center nearest you.


Once you have a list of possible places, get in touch with each one. Ask basic questions about openings and waiting lists, number of residents, costs and methods of payment, and their link to Medicare and Medicaid. Take a few minutes to think about what’s important to you or your relative, such as transportation, meals, activities, connection to a certain religion, or special units for Alzheimer’s disease.


Make plans to meet with the director of nursing and director of social services. Medicare offers a nursing home checklist to use when visiting (see Help in Planning). Some of the things to look for include certification for Medicare and Medicaid, handicap access, no strong odors (either bad ones or good ones), contact between staff and current residents, volunteers, and the
appearance of residents. If the nursing home is a member of the Joint Committee on Accreditation of Healthcare Organizations, ask to see that group’s review of the home. Ask yourself if you would feel reassured leaving your loved one there.

Visit again

Make a second visit without an appointment, maybe on another day of the week or time of day, so you will meet other staff members. See if your first thoughts are still the same.


Once you or your relative have made a choice, be sure to understand the facility’s contract and payment plan. If you don’t understand it, you could have a lawyer look them over before signing.

How to pay

There are several ways to pay for nursing facility care for people over age 65. They are:

  • Medicare
  • Private pay
  • Medicaid
  • Long-term care insurance.

For More Information

The National Institute on Aging (NIA) has free information on health and aging. Call or write:
NIA Information Center
Gaithersburg, MD 20898-8057
1-800-222-4225 (TTY)

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About the Senior Citizens Bureau

The Senior Citizens Bureau (SCB) was found in 1998 and is a national, non-profit community resource for the elderly, children of the elderly and other caregivers, advocates and professionals.