Choosing the Right Nursing Home for Loved Ones: Elder Law Attorneys Weigh In

The signs are getting harder to ignore. Your elderly parent is falling more often, forgetting to take medications, and you’re physically and mentally exhausted from caring for them. “That may be a time for family members to step in and say, ‘You need a different level of care,’” says Marilyn G. Miller, an elder law attorney with a solo practice in Dripping Springs, Texas. 

But choosing the right nursing home can be daunting. Where do you start? For legal advice on finding the right facility and resident’s rights, speak with a local nursing home lawyer.

Include the Parent in Care Planning Early On

Lawyers recommend including the parent in the discussion as soon as possible. Ask these questions:

• Would downsizing to a smaller house be enough?
• What about in-home care or assisted living?

Talk to their doctor to see if there’s an underlying medical condition that needs to be addressed. 

“There are a surprising number of clients that have said, ‘I took Mom to the doctor, she had a UTI, and it all cleared up.’ Because the effects of that will mimic dementia,” Miller notes.

Research the Quality of Care at Nursing Facilities

If a nursing home still seems the best choice, lawyers say, do your research. You can compare ratings on Medicare’s website.

Consider hiring an independent social worker or case manager to narrow your picks. Look for a facility near you, or the family member most likely to look after them, and show up at a time when it’s likely other visitors will be in the facility so you can ask about their experiences in addition to looking around.

A fancy façade can be deceptive, says Wesley E. Wright, an elder law attorney with Wright Abshire in Bellaire, Texas. “It’s really nice to be able to pull up and see a brand-spanking new facility with pretty parking lots and landscaping, as opposed to walking into an old, rundown facility. But what’s more important: How good the care is, or how the facility looks?”

Once inside, says Miller, “First, you smell. If it doesn’t pass the sniff test, walk out. You can go back again to see if it was a one-off. But unpleasant odors are coming from somewhere, and there shouldn’t be any when you walk in the door.”

The place should also be clean, comfortable and neither too hot nor too cold.

Questions for Assessing a Good Nursing Home and Quality of Life

Don’t hesitate to ask key questions about the long-term care facility:

• Is there a licensed doctor on staff?
• Are they on the premises or on call?
• Do all employees undergo background checks?
• What activities of daily living are available?

Even watching TV in the lobby with other residents provides a social outlet and keeps elders from sitting isolated in their rooms.

“Nobody is ever satisfied with [the food],” Miller admits, “because the biscuits and gravy aren’t like Grandma used to make. But does somebody watch to make sure they eat? And if they don’t eat, is that noted?”

Medicaid and the Quality of Medical Care

Make sure that the facility is Medicaid-certified and there are ample Medicaid-funded beds in case your parent needs one in the future. Nursing home care can cost anywhere from $6,500 to $15,000 a month and most people can’t afford to pay out of pocket, Wright says. Medicare doesn’t foot the bill, either.

“Most people think that Medicaid is for poor people, and when it first started in 1965, it was,” Wright says. “But because of changes that Congress made to the rules, it became a mainstream American program.”

Today, Medicaid can be a smart choice for all but the wealthiest nursing home residents, Wright says. A few years ago, a woman and her four adult children, all visibly upset, came in for a consultation. “I put my husband in a nursing home five years ago, and we had $600,000. Now I’m down to $300,000,” she explained. When Wright told her he could secure Medicaid for her spouse and preserve the rest of their assets, “she was so happy.”

Timeline of Medicaid

Keep in mind that Medicaid takes at least 90 days to kick in after the application is filed. An elder law attorney can help with the process and advise on other matters. Miller says clients should pay particular attention to the nursing home contract.

“The agent, child, whoever, can’t be made to be responsible for the payment. Some contracts still say that. So don’t sign your name as being [financially] responsible for anything. Either come back to me and say, ‘What can we do about this?’ or go someplace else because you don’t want to have to fight it down the line.”

Staying Inform on Your Loved One’s Wellbeing

Once your parent has moved in, lawyers say, keep visiting — unannounced and at different times. Ask other visitors how they feel about their parents’ treatment. If you live out of town, pay a social worker to stop by and check on your loved one.

And if you suspect a problem or have a complaint, contact the long-term care ombudsman for your region. “It’s the same kind of due diligence you would do finding daycare for your child,” Miller says. 

Failing to keep an eye on your loved one’s living conditions can have catastrophic effects, Miller points out. “They can end up, worst case, staying in their room without any kind of interaction other than someone checking the bedpan once a day. Something could be terribly wrong, and you wouldn’t know it until it was too late.”

Find Legal Help for Your Loved One’s Needs

For legal guidance on assessing the right facility, speak with an experienced nursing home law attorney.