Choosing a Long Term Care Facility


If you are reading this, then you have likely already made the difficult decision to move a loved one to a long term care facility.   Choosing a facility can be overwhelming, with a dizzying number of decisions to make along the way.  Having worked with several families during this process, I thought it might be helpful to give a general overview of the journey with some suggestions.  Hopefully the steps below will be helpful.

Step 1:  Identify which level of care is appropriate for your loved one.  

There are a three levels of long term care:

Assisted Living (also known as Rest Homes or Adult Care Homes) provide 24 hour care for individuals who require supervision but do not need ongoing medical/nursing intervention. Services in these facilities include meals, assistance with Activities of Daily Living (such as eating, bathing, toileting, administration of medication, and transportation to medical appointments), and social and recreational activities.

Assisted Living with Memory Care (also known as Special Care Unit): Some Assisted Living facilities have Dementia Units, which are special areas in the facility designed specifically for residents with dementia.  One feature of these units is that they are either locked or have an alarm system in place.

Skilled Nursing (also known as Nursing Home): These facilities are appropriate for individuals who need ongoing nursing/medical intervention and require a higher level of care than that which is provided in Assisted Living. Skilled nursing staff are available to provide 24 hour medical attention.

Step 2:   Evaluate finances

As I am sure you are aware, long term care can be quite costly, so it’s important to have a family discussion about financing long term care.   Funding sources can include long term care insurance, social security, pension, and other assets.   Please see this post I wrote last month on resources available to assist with paying for long term care.

Step 3:  Explore options

Once level of care has been determined and you have a budget, it’s time to start searching for a facility.   This decision can include many variables, from location (will the move be to another town, (perhaps to be close to family?), size of facility (they can range widely from a very small, homelike environment with as few as 5 rooms, to large facilities with as many as 80 residents), and types of social/recreational activities.

Step 4:  Visit!!

There is no substitute for visiting a facility.  Suggestions:

  • I encourage families to visit at least three facilities, and if possible, to visit more than once (ideally during different types of day, or visit once during the week and once during the weekend).  Try to plan both scheduled and unscheduled visits if possible.
  • Observe an activity  (there should be a list of daily programs posted).  Are there activities of interest to your loved one?  Do residents seem to be enjoying the activity?
  • Plan to have a meal at the facility, not only to get a sense of food quality, but to check out the atmosphere in the dining room.  Do residents seem engaged and happy?
  • Observe employees (and if possible, talk with them as well).   Do they seem to enjoy their jobs?  Are they engaged with residents in a positive manner?
  • Ask administration about staff turnover.  If staff are staying with the facility for a number of years, this is a very good sign on many levels!

Additional resources that might be helpful:

Choosing a Long Term Care Facility (checklist developed by Wake County Resources for Seniors)

Nursing Home Compare ( search engine using information from facility site visits)

NC Division of Adult Care Regulation inspection report (with information about cited deficiencies and plan of correction in NC Adult Care homes).

State guide to Assisted Living Records and Reports (availability and request process for state records on Assisted Living communities throughout the US)

Many families find it helpful to work with a Geriatric Care Manager (also known as Aging Life Specialist) during this process.    You can find a specialist in your area here.



About Author

Kim Andreaus

Work Life Program Manager

Kim Andreaus is the Aging and Eldercare Program Manager for Work/Life. She has experience in geropsychiatry; both inpatient and in a community mental health setting. In addition, she has been a faculty member at NCSU, UNC-CH and Wake Tech and has taught courses in gerontology and conducted training in geriatric mental health.


  1. Jennifer Andrassy on

    Hi, Kim. Thanks very much for your blog. After experiencing a variety of different long-term care facilities as my dad went from assisted living to memory care to hospice care, I must say that my favorite option by far was a family care home. My dad received much more personal care and it was nice that he got to be in an actual house instead of a facility. Each home is different, and each person has different needs, but I think anyone exploring long-term care options should consider this option. I loved that I could take my kids to the house and they felt at home there. There were toys for them to play with while I visited my dad. The staff was so attentive and knew us all by name. They loved my dad and he loved them. It was like a second family ... so much better than the larger facilities he had been in previously.

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