Choosing a Long-Term Care Provider

By choosing the best possible provider from the very beginning, you greatly increase your chances of receiving quality care and services. Like any good business, the providers should be willing to answer your questions, and they should be able to provide references from satisfied customers. Be suspicious if a provider is reluctant to provide references or does not give you clear answers to all of your questions.

  • Make a Visit. Take any formal tour of the center of home offered by the provider, but try to go back unannounced several times, including evenings and weekends. Observe and spend time getting a feel for the facility. The facility should smell and look clean. If possible, speak to any current residents and any family or friends who may be visiting. Observe activities or classes. Ask to taste the food.

  • What are the provider’s staffing levels? Ask what the staff-to-resident ratio is. Ask about the daytime and nighttime ratios. The fewer residents a nurse, aide, or other staff person has to care for, the better!

  • What services are provided? Ask for a list of exactly what services are included in the rate you are paying. Also ask for the cost of other add-on services that are not included in the base rate. Do the best you can to drill down and get details.

  • Read the fine print. Ask for a copy of the contract or agreement and review it before you sign. In some settings, such as assisted living, the contract is the only way to really know what is provided and the costs. In both assisted living facilities and CCRCs, review contracts carefully to see under what circumstances you may be asked to move from your unit.

  • How will they honor your preferences and routines? Ask the provider how they will accommodate your habits, preferences, and choices. In addition, ask who determines when you need more services or when the services provided can no longer meet your needs – you or the facility.

  • Does the provider offer memory care? If the provider claims to offer memory care, ask what they mean by this term. What does "memory care" involve? What makes it different from other care? What training does the provider have in memory care or working with individuals with memory loss, confusion and/or behavioral symptoms?

  • How does the provider obtain informed consent? Will the provider obtain your informed consent before administering any psychoactive drugs, such as sedatives or anti-psychotics? How will the provider document the consent? Will the provider obtain consent from your legal guardian or power of attorney if you lack capacity to give consent?

  • Does the provider have regular staff assignments? Ask if the same attendant/aide will be assigned to you each time. This is called "consistent assignment" and has been shown to result in better care/services and increased satisfaction for both the person receiving and providing services.

  • Does the provider have good references? Request at least three references from consumers or family members who have used the provider’s services for some time. Don't be dissuaded if the provider says they don’t usually provide references.

  • Does the provider have a good track record? For adult care homes and skilled nursing homes, review the facility's rating. The Adult Care Home Star Rating System is maintained by the State of North Carolina. The Nursing Home Ratings System is maintained by the Federal Government Centers for Medicare and Medicaid Services. For more information, see Ratings for Long-Term Care Facilities.