The decision to place a loved one in a nursing home is not an easy one to make, and it is not one to rush into. In all reality, none of us desire to go to nursing home, but there comes a time when a nursing home is the best solution. That said, before a placement decision is made, all of the facts need to be thoroughly examined because, truth be told, your family member may be better suited for something different – an assisted living community, a visiting nurse coming to his or her home – rather than a nursing home.

Often, the best place to start is with a thorough geriatric assessment to evaluate your loved one’s physical and mental status. A primary care physician can do this or, if you want a specialist, a geriatrician or nurse practitioner with geriatric training can be consulted.

There are geriatric nursing agencies that can also be consulted. They look at a person’s physical health, but also look at the home environment, to see if there are fall hazards (rugs, stairs, etc…) as well as other issues that you and the family may not have considered. That service will cost a fee, but the report is unbiased since it’s from a third-party.

When doing the assessment, the professional will concentrate on the patient’s ability to conduct the five activities of daily living: feeding, toileting, bathing, dressing and walking/transferring. Assessing a senior’s functional abilities helps the family and medical professionals determine the individual’s current senior care needs. Other factors will be checked as well including balance issues, memory deficits, signs of depression or anxiety, or indications of dementia or Alzheimer’s disease.

The family will also be consulted during the evaluation. Particular day-to-day concerns, such as persuading your loved one to take a shower, letting the dog out, or his or her habit of forgetting to turn off the stove, will help guide the assessment.

Once all of this information is gathered, it will be presented to the family and a recommendation will be made.

What is the next step?

The next step will depend on the report’s final answer. Your family member may not need a nursing home, but may instead need some level of supervised care. If that’s the case, there are agencies available where a nurse, certified nursing attendant or other can visit the home daily or multiple times a week to see that your loved one’s needs are met. These services are enormous important, especially if the adult children live out-of-state. The professionals doing the assessment can provide a list of community resources.

What if we do need a nursing home?

More often than not, determining whether nursing home care is necessary is a process and not a rush to judgment. Finding the proper nursing home is a little like car or house shopping: you do your homework. To make the best decision, you should tour multiple facilities, talk to the staff, and speak to the residents and their families to make sure that the facility’s services fit your family member’s needs. Often, the assessment report provides nursing home recommendations to which nursing home would be best for your loved one, depending on the circumstances.

Your loved one’s safety and health trump all issues. If you discover that a nursing home’s online evaluation included safety and health violations, you will want to ask administrators how they were handled. The mere fact of a violation may not rule out a proper home environment.

There are issues to consider when finding a nursing home. Distance is one of them. The best prescription for fending off depression and feelings of isolation in nursing home residents is to make sure that they frequently see significant people in their lives: adult children, grandchildren, neighbors.

Adequate staffing is an issue to study. Without enough nurses and aides, care may suffer. Feel free to ask the facility’s administrator about the patient-nursing staff ratio. (Another thing to keep in mind, after your family member is placed, is to visit frequently. That shows the staff that you are actively involved in your loved one’s life.)

Perhaps most important is cost. The average nursing home cost is approximately $200 a day, or $6,000 per month. If more specialized care is needed, such as staying in a memory-care unit, the daily cost increases. You don’t want to economize in ways that compromise your loved one’s quality of life. It’s recommended to meet with an elder law attorney or certified estate planners to see what options are available, i.e., qualifying for Medicaid.

There are instances where you don’t have the luxury of shopping around for the best nursing home: your relative broke his hip and isn’t capable of going home. The hospital staff (discharge nurses, care coordination, patient management) will find an available bed for your loved one, and if that doesn’t meet your criteria (too far to drive, too expensive) at least you have time to look for another one while your family member’s needs are being met.

Remember to ask questions! Ask about the quality of the food and when meals are served. Ask if the residents are free to make decisions on their own, such as when to sleep, when to watch TV, when to participate in group activities. Can they arrange and decorate their rooms with personal items? These questions might sound mundane to you, but they are important for your family member and will help toward their overall mental well-being.