Transitioning to Care—How Do You Know What to Ask?

Mom has severe dementia and wanders outside the home at night. Dad has fallen three times in the last six weeks and now is in the hospital with a broken hip. Once you realize a loved one needs more help than can be given at home, you need to make some big choices. You might feel overwhelmed with the amount of options and uncomfortable with making such a life-changing decision. Being an advocate for a loved one when deciding where to seek extra care is important because it can mean the difference between quality care and inadequate care. Before you can make the decision, you need to understand the differences in long-term care.

  • Assisted Living Facility—sometimes referred to as a CBRF, or Community Based Residential Facility. This form of long-term care offers 24-hour care to those who need help with personal care, medication management, and sometimes disease management. In an assisted living facility, personal care aides offer the bulk of help to residents. There may be a nurse on staff part of the day, or as a consultant to the organization.
  • Skilled Nursing Facility—sometimes referred to as a nursing home. This type of facility offers 24-hour skilled nursing care. A skilled nursing facility offers not only 24-hour care for those who need help with personal care and medication management but also registered nurses to coordinate care for those with more significant medical problems. This type of long-term care facility employs certified nursing assistants (CNAs), licensed practical nurses (LPNs), and registered nurses (RNs) to help residents with any need. Most often there are physical therapists (PTs), occupational therapists (OTs), and speech therapists (STs) on staff as well.

Before choosing a care facility, it is important to talk to your loved one about her needs, hopes, and wishes; make a “must have” list together. Then talk with the provider about what type of facility might be the best fit. Get a solid understanding of your loved one’s needs so you can communicate them to the facilities you visit. When you do visit, make sure to ask as many questions as possible to better understand what the facility can offer your loved one based on her specific needs. Here are some good questions to get you started:

  • Are you Medicare and/or Medicaid certified? (Not only does this help you better understand funding, it also can reveal if they offer quality care to residents—organizations that have lost the ability to be certified may have had poor quality of care in the past.)
  • Has your license ever been revoked?
  • Can I see a copy of the latest review of the facility?
  • What is your staff-to-resident ratio? (number of CNAs, LPNs, RNs per resident)
  • Can you tell me about your activity program?
  • Do you have an ombudsman? Tell me about your resident rights program.
  • Do you have a resident or a family council to help form your decision making?
  • What are the training requirements for your staff?
  • What are your security measures to keep residents safe?

These are just some questions to start the conversation. As you are talking and touring, feel free to ask any questions you feel are pertinent to the facility. Take note of the smells, the food offered, the staff and resident interactions, the activities residents are engaged in, response time to call lights, and the cleanliness of the facility. Be sure to go back through the facility afterward to see if the experience matches the scheduled tour. Most importantly, ask your loved one which facility he prefers before committing.


Learn more about Carrie’s publication’s CNA: Nursing Assistant Certification Textbooks and Workbooks.

Adopters of her publications are able to receive consulting work to adapt the book’s curriculum and also presentations on the following topics:

  • What are the determinants of good health?
  • Health Literacy…how to better understand the language of health care to navigate the health care system effectively.
  • Does nutrition and physical activity play a large role in how we age?
  • Managing medications, traditional vs. alternative.
  • How to support an older adult who wants to “age in place” and what that means.
  • How to know when an older adult needs extra services and what those are. Skilled care facility vs. assisted living facility.
  • How to adapt caregiving to the “silver tsunami” who have higher expectations of care and are more informed on their health care options than ever before.
  • Why is there a current caregiver crisis in the U.S.?


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