Devin Pinaroc, FNP-C The decision to place a loved one in a long term care facility is not easy. Every situation is unique, but preparation and planning is key. Clinicians should encourage patients and their families to initiate the conversation well before the decision becomes unavoidable. Unfortunately, there may be times when this is not an option. Before researching facilities, clinicians should suggest that the family prioritize needs and define what is most important. Suggest making a list of the top 5 important factors for a long term care facility and some “non negotiables”. These may be convenient visiting hours, a low ratio of staff to patients, or financial requirements. Practical factors, like location and monetary restrictions, will reduce the list to realistic places and can be helpful to narrow down options. For instance, some facilities have waiting lists that may not be feasible to the situation. A case worker is a good resource to utilize during the transition from hospital to long term care facility. If one is unavailable, calling the insurance company directly can provide details regarding long term care facility benefits and the copay requirements. If the patient’s insurance company does not give the family specific answers, each specific facility can be helpful in understanding benefits. Common top priorities include the safety of the residents and the quality of the facility. Medicaid and Medicare certify nursing homes that pass government quality inspections and usually only pay for these certified facilities. Inform families that nursing homes are required to make the most recent state/federal facility survey available to families/residents, which will display how well the nursing home meets federal health/safety regulations. Families should also inquire about lawsuits/accusations of elder abuse for each facility. The Medicare.gov website displays if facilities have been cited in the last 2 years for elder abuse and show the star ratings for individual nursing homes, but observing the interactions between the residents and staff can be telling as well. Furthermore, understanding the safety of your loved one’s possession is necessary. Where will their possessions be safe? What type of privacy measures are taken for the residences? (Your Guide to Choosing a Nursing Home or Other Long‑Term Services & Supports, 2019). The next step may be to consider the medical requirements of the patient’s condition and the reason long term care is needed. These questions might include: What type of medical care is required? How long will the patient need to stay in this facility- months versus years versus lifetime? What medical services are required and what are the qualifications of the staff? Patients who struggle with activities of daily living and need daily, constant supervision will require a different atmosphere than those who require simple medication management and have only minimal mobility issues. If there is time, suggest families visit the sites. During these site visits, families and patients speak directly with staff, meet current residents, and observe a typical day. Families should ask about the staff-to-resident ratio as a small staff-to- resident ratio may be beneficial if their loved one requires constant supervision or intricate medical care. This is a good time to ask about the available services, like meal plans, extracurricular activities, clubs, etc. Ensure families ask about the facility’s visitor policy, and consider if the visiting times are convenient to promote frequent visits and sustained family connection. Some long care facilities allow patients a certain degree of independence, and families should consider if this will make the loved one happy or place undue stress. Lastly, remind the family that this is (or will be) a very difficult time, and there is no “wrong” choice. Support families through the entire process, even after choosing the facility. Prepare the family for an adjustment period while their loved one settles into their new place of dwelling. This transition may last months and can be just as difficult as choosing a facility. Want to know more? The Center for Medicaid and Medicare have developed a booklet to help with all parts of the process: https://www.medicare.gov/sites/default/files/2019-10/02174-nursing-home-other-long-term-services.pdf References Department of Health & Human Services: Centers for Medicare & Medicaid Services. (Oct 2019). Your Guide to Choosing a Nursing Home or Other Long‑Term Services & Supports. https://www.medicare.gov/sites/default/files/2019-10/02174-nursing-home-other-long-term-services.pdf Jenkins, S. (2021, January 7). Choosing the right long-term-care facility for your loved one. NAFC. Retrieved September 17, 2021, from https://www.nafc.org/bhealth-blog/choosing-the-right-long-term-care-facility-for-your-loved-one.