No one is ever quite prepared to find a long term care facility for their loved one. As President and CEO of Post Acute Medical, a specialty healthcare company that provides high-quality, post-acute care, and with a 35-year career in the healthcare industry, I’ve known this professionally for years.

I’ve seen the difficulties people face when their loved ones need significant amounts of care. But, as our parents, age we all need to be ready to have a conversation and make a plan.

When my mother’s dementia advanced to the point that she needed more care than we could provide her at home, I found myself in the same position as so many others I’ve met over the years. For the first time, I personally experienced the challenges that face families as they try to navigate the healthcare system.

How many families? According to the CDC (Centers for Disease Control and Prevention), in 2014, there were an estimated 1,369,700 current residents in nursing homes, and 835,200 current residents living in residential care communities.

That’s more than 2 million families who had to make a choice about where their loved ones would be cared for and safe. When my family became one of those families, I dove in with all the expertise I’d gained over the course of my career.

Quickly, I realized how different the view was from the other side of the table. Parsing out what I needed to know and asking questions as the concerned son rather than the service provider confirmed for me that everyone at this point in their life needs to know more than, “Mom needs help.”

Starting with the basics: insurance. It is vitally important to know exactly what insurance, or insurances, your loved one has. The details of what is provided and covered, under what circumstances, and for what time frame vary from plan to plan. For instance, everyone over the age of 65, who qualifies for Social Security also qualifies for Medicare Part A, which is a federal program. The coverage offered by this plan is pretty bare bones. While illnesses or conditions that require hospitalization or skilled nursing care will be covered for up to 100 days, standard nursing home care is not covered.

Medicare Part B covers doctor visits and other outpatient services and Medicare Part D was designed to help with prescription costs. Medicare supplements are often touted as a solution to the gaps in coverage, but some supplements actually cut away from services and benefits.

Many older people also use or qualify for Medicaid, which is a state program. There are also private insurance options.

If this sounds complicated that’s because it is. Which is why knowing exactly what insurance is in place prior to a health crisis, and the need for a long term care facility, is critical.

For help navigating the disjointed and jargon-filled world of insurance there are online resources, and most states have offices specifically designated to help the elderly population, often called the Office of Aging.

In order to know what questions to ask of insurance providers (and eventually facilities), it’s good to be familiar with the various levels of care.

Long-term care facilities will offer some, or all, of the following options:

  • Independent Living — for people in good health who need little or no help with Activities of Daily Life or Instrumental Activities of Daily Life (ADLs)

  • Assisted Living — for people who need help with one or two ADLs

  • Skilled Care — for people who need 24/7 help and have serious or chronic medical or mental conditions

  • Acute Care — hospital-level care

Aging is not a linear process, despite what the birthday card section at the grocery store tells us. Once a person hits a point in their life where their health is in decline, they may need different levels of care at various times. For instance, blood pressure and arthritis concerns can easily be monitored by staff at an assisted living level of care. But, if your parent falls and needs hip surgery, that would put them first in an acute care hospital and then possibly in skilled care for rehabilitation.

With each shift in living quarters and care level, there will be a shift in billing and coverage. Ask about this so you know in advance what the financial obligations will be during this part of your loved one’s life journey.

Once you are looking at the facilities themselves, there are a few questions that will help you make decisions about where your loved one should go.

First, how many nursing hours per patient, per day, are there? Federal law only requires 20-minutes of nurse time per day, although individual states often have higher standards. However, this number only applies to RNs and LPNs. Key to care is CNAs (Certified Nursing Assistants) who perform much of the day-to-day care.

The Centers for Medicare and Medicaid Services (CMS) recommends a minimum of three staff hours per resident, per day. Four hours are considered optimal and at least one of those hours should be by a nurse.

What are the staffing ratios? Ask, “who is really going to take care of my family member?”

Following up on this train of thought: how often will your loved one receive hands-on assistance with ADLs? Will they have help getting dressed in the morning and changing into pajamas at night if they need it?

Another important question is how often will they see a doctor. Will this be a doctor on staff, a doctor from outside the facility, a specialist, or your family doctor?

Which brings up transportation. Is there a shuttle or a driver available or is the family responsible for transporting their loved one (in non-emergency situations) to the doctor and other appointments?

You should also look into the food and food services available. These days there’s no excuse for food to be “institutional.” Quite frankly, in addition to checking out the lunch trays and dining rooms, it’s good to get a good whiff of the rooms and common areas. You can tell a lot by how something smells. Fresh and clean is good, soiled laundry or other unpleasant odors are bad.

For a quick overview of the long-term care facilities you’re considering, this Medicare website is a great resource. If there’s been an immediate jeopardy or possible loss of license within the recent past that’s a huge red flag.

One other thing my experience with my mother reinforced: The people who staff and run long-term care facilities must keep in mind that they are dealing with somebody’s family member. We need to treat the people on the other side of the table with the kindness, compassion, and care that we’d like to receive.

Someday, it will be your parent, or grandparent, or beloved family member and all the industry knowledge or work-related expertise in the world won’t make it any easier.