There may come a time in your caregiving journey that the most loving and care-conscious choice for your loved one is to find residential care options for them. Finding residential care for a loved one can be gut-wrenching, but it’s often necessary, to give the loved one in your care the support they need to live safely and comfortably. Often that support is beyond what you can reasonably or responsibly provide. If you’ve decided that residential care is the right choice, this guide will walk you through 20 practical tips for finding residential care.
20 Practical Tips for Finding Residential Care.
1. Know your options.
To begin your search, educate yourself on the various levels and cost of care. In general, your options include Retirement Communities/Independent Living, (which may also offer communal meals and activities for more independent residents), Residential Care Facilities (RCFEs - also known as Board and Care Homes), and Skilled Nursing Facilities (SNFs).
Residential Care Facilities (RCFEs) are licensed by Community Care Licensing through the State Department of Social Services, and provide, for the most part, nonmedical assistance. Nonmedical assistance includes help with activities of daily living (bathing, dressing, eating) and "instrumental" activities of daily living (preparing meals, taking medications, etc.).
Skilled Nursing Facilities (SNFs)* are designed for people who qualify for a higher level of care and supervision. SNF residents typically require 24-hour nursing supervision and are confined to a bed for some portion of the day. *There are special SNFs designed for people with dementia.
2. Make Use of Resources.
This article is focused on finding residential care and understanding your options, but there are additional resources worth noting. Contact the California Advocates for Nursing Home Reform by phone at (800) 474-1116 or visit their website (www.canhr.org). CANHR also has a comprehensive, up-to-date, online guide to thousands of facilities in California, including nursing homes and residential care facilities.
3. Consider what is most important to you and your relative.
Is it important for you that your loved one is nearby? Do they want to bring their pet to the facility? What level of daily activity do they hope to have? These are the types of quality-of-life questions you’ll need to think through before making your choice.
Understanding the general atmosphere of a facility and the services that are important to your relative is essential. Narrow your search based on what is most important to you and your family member.
4. Use your informal resource system.
First-hand information on residential care facilities and nursing homes is invaluable. Don't hesitate to ask friends or support group members if anyone can recommend a care home. Daycare providers, hospital discharge planners, or community care nurses are also excellent referral resources.
5. Contact a Private Placement Service.
A placement service can help you focus your search and recommend a few facilities that match your income and the needs of your relative. To locate placement services in your geographic area contact the Family Caregiver Alliance, the Orange County CRC (that’s us!), or your local CRC if you are in a different California county at 800.543.8312. Your local Area Agency on Aging or senior center may also have useful information.
Note: There is no fee to you for using a placement service, though they may collect a commission from the facility. There is no obligation to move your loved one to a recommended facility.
6. Visit a few care facilities before you are in a crisis situation.
It's always best to be prepared. Knowing your care options before you are in a crisis situation is very helpful and might ease your fear about moving your loved one, so start reviewing options early if you can.
7. Make an appointment with the administrator.
Come prepared for your interview with lots of written questions. If you are interested in the facility, make a second, third, and even fourth visit at different times of the day. You especially want to observe mealtime, whether the food is appetizing and healthy, and how participants are accommodated.
If you are not invited to visit at any time, unannounced, you might want to rethink that particular facility. Most residences have an open-door policy for families and friends. For a comprehensive list of interview questions, call CANHR or visit their website. (See Tip 2 for contact information.)
8. Understand that you or your loved one may get emotional.
Your first visit to a facility might cause a strong emotional reaction. Be prepared to see residents with varying levels of impairment. We advise you to bring a friend or another relative with you for support. They can also help you remember the questions you would like to ask.
9. Observe the general environment.
Is there a cheerful, warm interaction between the staff and the residents? Does the administrator know the residents by name? Do you feel welcomed? How clean is the facility? Do the staff and administrator seem comfortable with each other? These non-verbal cues and gut feelings may help you to see the full story.
10. Remember that appearances aren't everything.
Spend time speaking with the staff, other family members, and residents living in the facility to get a better assessment. Ask what they like most about living or working at the facility and what they like least.
Recognize that if your relative moves to this facility, these are the people with whom you will be developing important relationships.
11. Ensure the facility is licensed.
Every facility must have its license displayed. The license lets you know they are registered with the State Department of Social Services and meet state requirements.
There should also be an Ombudsman Program poster displayed. Each licensed facility is assigned a person from the state, an ombudsman, to investigate and try to resolve complaints made by, or on behalf of, individual residents.
12. Ask about a dementia waiver or hospice waiver?
Residential care facilities are not required by state law to have a dementia waiver. However, facilities with a waiver are required to train staff on care for individuals with dementia to safeguard against accidents and wandering.
Note: If your loved one has dementia, it is important to look for a facility that has a dementia waiver.
A hospice waiver for end-of-life treatment is another important consideration. Many facilities are licensed to have hospice services come into the facility to care for a resident who is terminally ill. In this way, care is not disrupted and you and your relative do not have to adjust to a change in environment at a fragile time.
13. Considerations and Questions to Ask About Cost.
What costs should I expect? In addition to the average monthly cost for an RCFE (which can range in the thousands of dollars per month), the family is responsible for incontinence and personal care products. There are also usually add-on costs, which might include help with bathing, dressing, eating, or incontinence.
How often are rates increased? And how much notice is given before an increase?
How do you determine when to advance to the next level of care? Typically, there is a change in cost when the next level of care is needed.
RCFEs are "private pay" only, which means they do not qualify for Medi-Cal coverage.
Most SNFs, on the other hand, accept Medi-Cal for qualified individuals.
Note: Medicare only pays for a short-term nursing home stay for rehabilitation purposes. The average cost for a nursing home in California is approximately $9,247 per month, though some can cost more.
14. Be up-front about your situation.
If your relative sometimes refuses his/her medication or a shower, let the administrator know. This is also an opportunity for you to ask how the staff might handle these behaviors.
Remember, your role is to try to make the transition for you and your family member as easy as possible. If the facility’s care philosophy doesn’t align with yours, it may be worth seeking care elsewhere.
15. Consider staffing patterns and staff retention.
Staffing Patterns: A good staff ratio during the day shift in an RCFE is one direct staff person to eight residents. This does not include the activity coordinator, program director, or on-call nurse. For evening and night shifts, a smaller staff-to-resident ratio is fine. In a small Board and Care Home, the required ratio is two staff to six residents. However, Board and Care Home staff are usually responsible for cooking and cleaning as well as resident care.
Staff Retention: To get a sense of the satisfaction level of the staff, you might want to ask how many employees have been with the facility for more than one year.
16. Find a balance of cost and amenities that works for you.
Personal care and attention to individual needs (essentially, quality of life), should be a major priority in choosing the care home for your relative.
It’s worth noting, however, that if you find something lacking at a facility (outside of personal care), it might be possible for you to supplement what is missing. For example, you could take your relative out to a beauty shop if there isn't one on-site, or volunteer to call bingo if you believe there are too few activities.
Typically, more expensive facilities will have more amenities and special features.
17. Changing your care home.
Sometimes caregivers discover that their first facility choice is not a good match for their relative. This can be a learning experience. Now that you know what is most important to your relative, you can be more successful when choosing another site.
While we recommend you work with staff to help your relative adjust to their living situation first, we also encourage you to trust your instincts. If you believe there is a better living situation for your loved one, make the move.
18. Help the staff get to know your relative.
Although there is a brief social history of your relative taken during the intake process, you should supplement this information with your own "Personal Profile."
For the Personal Profile: Include information about the care receiver's occupation, place of birth, etc., and information on the care receiver's parents and siblings. Include details about what made them unique in the family, their special attributes, hobbies, and contributions.
Create a Poster: You and your loved one might enjoy creating a wall poster with pictures from your relative's past, with brief subtitles under each picture. This will be fun for your loved one to look at and it will help the staff to become familiar with your relative's history in a positive way. Knowing someone's past is the key to developing rapport and a trusting relationship with the staff. When trust is established, your parent is more likely to feel comfortable at his or her new home.
Profile their Typical Day: A written description of your relative's typical day can be very valuable to the staff who are trying to help your loved one adjust and feel comfortable in their new home. Write down your relative's daily schedule including sleep time, bathing schedule, and preference for time of bath and meals. You can also let staff know if your relative would prefer a male or female caregiver to provide personal care.
19. You are still the caregiver.
Even after you move your loved one, you are still their caregiver. If the facility is unsupportive in your continued involvement, it may be a red flag.
While your role in these facilities shifts from hands-on caregiver to advocate, (though you should still have the option of doing this if it is important to you), your role is still vital to the health and well-being of your loved one.
20. Take Care of Yourself.
Although everyone's experience is different, moving a relative to a care facility might be the most difficult decision you will have to make as a caregiver. When making the transition from home to a community setting, reach out to people who understand and will support you.
In all likelihood, there will be a shock and adjustment period. After this period, it’s important to remember that you now have the opportunity to enjoy spending time with your relative in a new way, free of the 24-7 demands of caregiving.
We invite you to check out our library of information for family caregivers by clicking here for further reading and resources. You are also welcome to give us a call at 800-543-8312 to find out more about how we can support you in your caregiving journey.