Finding a Care Facility for Your Loved One – Where to Start

Grappling with the decision of whether or not to place a parent, spouse or a sibling (less common, but my personal experience) in a care facility can be excruciating.

However, once the decision has been made and the guilt has been rationalized into a tiny little ball stored neatly in the pit of your stomach, finding the best home is critical.

I’ve been through the process twice with Robert and have to go through it again soon but hopefully, that will be it for a long while. I have tried to learn as much as I could while going through the process and I hope this information helps if you are ever in a similar situation.

The first step is to determine the level of care needed which will lead to the type of facility to search for. Assessing need is a critical step in finding a home which will be the best fit for your loved one.

Robert first needed a Skilled Nursing Facility, (“SNF” – go ahead and call it a “sniff” – those in the field will know what you’re talking about). Robert had a raging infection which required intravenous antibiotics and instead of leaving him in a hospital for six to eight weeks, we placed him in a SNF. At the time, this was a completely foreign area to me but the discharge coordinator at the hospital was an angel and helped me find a suitable SNF for Robert.

There are also (to name just a few other options) Residential Care Facilities for the Elderly (RCFEs), Intermediate Care Facilities (ICFs), and Board & Care Homes. Due to a variety of reasons, Robert currently lives in a RCFE but will most likely be moving to either an Intermediate Care Facility or a Board & Care facility.

Each facility has different levels of care. The information I provide here is geared toward California residents but other states should have similar information through their own Department of Health Services (or a related agency).

A Skilled Nursing Facility (as defined by Medicare.gov) is a “nursing facility with the staff and equipment to give skilled nursing care and/or skilled rehabilitation services and other related health services.” These facilities are generally for those needing a higher level of care than needed in an assisted living facility. Many times, stays in a SNF are for a short-term period in order to recover from, for instance, a hip or knee replacement or to receive rehabilitation services after a serious stroke. In Robert’s case, he needed intravenous antibiotics for more than six weeks and his living situation at the time was not conducive to accommodating his needs.

As far as payment, according to the California Advocates for Nursing Home Reform, most SNFs in California are certified to participate in both Medicare and Medi-Cal programs. Some private insurance also helps cover a short-term stay in a SNF but be sure to check the policy before assuming it is covered.

The California Advocates for Nursing Home Reform (www.canhr.org) is an excellent resource to use when searching for a SNF. Facilities can easily be searched by name, county or address and their website includes information about the types of insurance accepted, the patient population, staff/patient ratios as well as citations, complaints and deficiencies.

A Residential Care Facility for the Elderly is one type of assisted living facility. Residents do not need 24 hour care but cannot adequately care for themselves on their own. There is a wide range of care provided by RCFEs. Some provide just room and board, meals and housekeeping services whereas others provide additional support for the residents such as personal hygiene assistance and dispensing of medications. Residents can share rooms or, oftentimes, will have their own room or “apartment.” Couples can even reside together and some homes even accept pets!

Generally, an assessment is done prior to admission and an individualized care plan is created which should be updated on a regular basis. It is extremely important that the care plan be reviewed since residents’ physical and mental capabilities can deteriorate as they age or their health condition changes.

Unfortunately, private insurance rarely covers living at a RCFE. Medicare and Medi-Cal also do not typically cover payment for RCFEs but there is a program in California called the Assisted Living Waiver Program which uses Medi-Cal to pay for a portion of the care at an RCFE. The pilot program started in three counties but has since expanded to five and expects to include two more counties in 2011. The Department of Health Care Services website has detailed information and eligibility requirements (please see www.dhcs.ca.gov/services).

Intermediate Care Facilities provide 24-hour care to those with Developmental Disabilities and are licensed by the Licensing and Certification Division of the California Department of Public Health. A quick Google search shows other states with similar licensing divisions serving developmentally disabled clients. Robert was recently accepted into the Alta Regional Center Program and we are just starting the housing search through them. As we get further into the process, I should have more to report on this type of facility.

Board and Care Homes differ from the larger RCFEs or ICFs in that they are small family homes in a residential area providing care to four to six residents. Care provided by a live-in staff includes meal preparation, housekeeping and helping dispense medicine to those unable to care for themselves. These homes serve residents with developmental disabilities, mental illness or those who are elderly and physically frail. According the U.S. Department of Health and Human Services, many Board and Care Homes are unlicensed but there are many licensed facilities as well.

No matter which type of facility is needed, it is essential to have a family member be the appointed advocate for the resident so things like care plans or basic care do not slip through the cracks. My experience has only been with employees at SNFs and RCFEs and I find most of them to be caring, empathetic individuals. However, they are also extremely over-worked and underpaid and it is in the best interest of the resident for a family member to maintain a friendly yet vigilant relationship with the care home staff and administrators.

Determining the type of home to place your loved one is only the first step. The next step (which will be covered in a future post) is to find the best fit, a home that you can be confident will keep your mom, dad, spouse or brother (or whomever) happy, healthy and secure.

Good luck with your search!