By Harpeet Sidhu, M.D. Princeton HealthCare System
Choosing a long-term care facility for yourself or a loved one is probably one of the most difficult decisions in life. And if you’re like most people, you likely have little idea of where to start.
To help, the following are some of the top questions to ask when selecting a long- term care facility:
1. What are their staffing levels? High nursing staff-to-resident ratios can help enhance residents’ experience and provide essential personal attention. Look at the facility’s overall staffing hours, including registered nurses (RNs), licensed practical nurses (LPNs) and certified nursing assistants (CNAs). There should be at least three nursing care hours dedicated to each patient. At the same time, ask about turnover and the average tenure of the staff — nursing and other health professionals.
2. Are there specialists on staff or who are routinely available? Many long- term care residents have chronic conditions that require regular checkups. Find out what specialists — e.g., cardiologists, pulmonologists, podiatrists — are either on staff or visit the facility routinely. For residents with dementia or Alzheimer’s disease, readily available psychiatric care is especially beneficial.
3. Where is its location? Are the building(s) and outdoor environment aesthetically appealing? Look for a facility that is conveniently located so family members can visit frequently. Visits from loved ones are important — especially in the beginning — to assure the resident he or she is not being abandoned, neglected or forgotten. Also look at its outdoor aesthetics. Are the grounds well kept? Does it have a nice environment, such as appealing landscaping or a park in the vicinity?
4. How are residents with Alzheimer’s disease or other dementia cared for? Residents with Alzheimer’s disease require special attention to keep them safe. Is there a security or alarm system to notify staff and prevent residents from wandering off and possibly getting hurt? The unit also should promote a calm and familiar atmosphere. Colors should be subdued and soothing, and noise should be low. Moreover, consistency among staff is especially important for residents with Alzheimer’s, as they typically do not respond well to change.
5. What level of therapy is provided, and what is the expertise of the individuals providing it? Physical and occupational therapy are important services of any long- term care facility and are key to helping residents recover from any hospitalizations that may occur. Take a look at therapists’ experience with older adults. Are they geriatric-sensitive? Do they have a special interest in and understanding of the different needs of older adults?
6. Can I keep my primary care doctor? Most people entering long-term care have been seeing their primary care doctor for years and have built a history and level of trust with that doctor. It is important to check with the facility and the doctor in advance to make sure the doctor can continue following the patient in the nursing home. If your primary physician is unable or unwilling to continue care in the facility, check the credentials and experience of the physicians available at the residence.
7. Is it clean? Cleanliness is a key indicator of how well a facility is managed and takes care of its residents. The facility should be free from unpleasant odors and be well kept, properly maintained and well lit.
8. How did the facility perform on routine health inspections and how does it compare with other facilities? Medicare maintains a website — www.medicare.gov/ NHCompare — to help families find inspection information and compare facilities. The site provides an overall rating of facilities, along with detailed information on health inspections, staffing, quality measures and fire safety inspections. In addition to seeing how many nursing care hours are dedicated to each patient, users can learn how many residents suffered bed sores, lost weight or had unmanaged pain. While some of these incidents may be unavoidable, a high number serves as a red flag.
In using this site, however, remember to compare apples to apples and not compare long-term care facilities to assisted living or rehabilitation facilities. It is also important to look at the information as a whole.
Facilities also are required to post their last survey results and a plan of corrective action on-site; look for that posting, review any issues and ask questions about any concerns you may have.
9. What recreational opportunities are available? Some residents could spend every afternoon playing board games or cards, while others would rather be outside gardening or reading a newspaper. Whatever your interest, be sure the facility provides a variety of recreational opportunities to satisfy your needs. This includes spiritual and religious activities and services, as well. Determine whether the facility offers community outings. And, observe the current residents. Are they engaged in activities, or are they sitting alone or grouped together near a nurses’ station?
10. How is the food? For many people entering long- term care, dining can be one of their few pleasures. Be sure the facility can meet individual food preferences and is willing to provide an alternative menu to suit specific tastes. For instance, some residents may prefer Kosher options, while others may not eat meat. If a facility cannot provide the food you want, look for one that does. Arrange to visit at mealtimes and taste the food as well.
11. How do I pay for it? Paying for long-term care services can be expensive. Most facilities traditionally accept private-pay funds from the resident or Medicaid after the resident’s personal assets are reduced to meet N.J. state guidelines. Medicare does not cover long-term care, since it does not meet skilled nursing requirements. Be sure to meet with the facility’s business office representative to have all of your questions answered.
Of course, the most important step in choosing a long-term care facility is to visit — and visit more than once. See the facility at different hours of the day — especially at mealtime. Come unannounced. Observe how the staff interacts with the residents and see whether the residents seem happy and engaged. Does your tour guide know the residents by name? Observe the residents’ appearance: Are they clean, appropriately dressed for the season or time of day, and well groomed? Also, take the opportunity to talk with the residents and their family members, and try to attend a resident or family council meeting, which will provide a window into any resident concerns.
Bring a copy of Medicare’s Nursing Home checklist — also found at www.medicare.gov/ NHCompare — with you to each visit to help keep track of your findings and enable you to make easy comparisons.
Harpeet Sidhu, M.D., is the medical director of Merwick Care Center. Merwick will be moving this fall to a new 200-bed facility in Plainsboro, currently under construction across from the future home of the new University Medical Center of Princeton at Plainsboro. For more information about Merwick Care Center, call 609-759-6000.

