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Hi Judy,Good question. For this I would like to pull some information directly from the book Caregiving 101: A Practical Guide to Caring for a Loved One. I think you might find the answer more complete that way.Choosing a Long-Term or Residential Care FacilitySo now you know a little more about what’s out there and the care they offer. How do you choose? You will need to consider how this type of facility will be paid for. Your medical care providers, especially your social worker, can help you in this discussion. Note: Medicare can pay for 100 days in nursing homes following a medically related three-night hospitalization. They will pay the first 20 days in full, then require a copay for the next 80 days. In 2016 the copay amount was $161 per day. This is still less than the full costs, but it adds up quickly. The following link gives a good rundown of costs and benefits Https://www.medicare.gov/your-medicare-costs/costs-at-a-glance/costs-at-glance.html#collapse-4808If your loved one qualifies for Medicaid, they do not have a time limit for assistance, and a caseworker can help immensely. For more on this, see Chapter 8, Medicare, Medicaid, and Private Insurance.Make a List of Places to ConsiderMake a generous list of the places you are considering. I like to pin-drop them on a map program just to make it easier to keep track of it all. Your social worker or caseworker can be your best resource in this. If your neighbors and friends have experience with any of the places, they can help with local knowledge and personal experience. Medicare keeps a list of all the certified nursing homes by Zip Code at https://www.medicare.gov/nursinghomecompare/search.html. Your state Medicaid office may also keep a list of facilities by region. In many states this includes assisted-living facilities, adult family homes, board-and-care homes, and adult foster care (if they use that term). Your state’s Medicaid office or Long-Term Care Ombudsman’s office may generate a list. Try http://theconsumervoice.org/get_help to find your states office. You may also search “Medicaid” and the name of your state.There are private referral services, which may be easier to use than doing it yourself. A Place for Mom www.aplaceformom.com is a pretty good service for this. Keep in mind that “free” placement agencies may require membership of the facilities they list, and thus their lists may not be complete. Many charge a fee to the facility when your loved one is admitted, often your first month's payment. There have been problems. If the facility wasn’t a good fit, the resident could not get a refund of the first month's payment, because that money went to the placement agency. This could be several thousand dollars.Each facility's websitewill most likely be promotional, but they should give some view into the location, size, services offered, and overarching vision or mission.Now let's narrow the list. As you look through the facility websites, consider what your loved one's goals are and what their needs are now and may be in the future:What care is needed or will be needed?Consider the level of medical attention, assistance, rehabilitation, and any special services or equipment.What is the length of time that is or will be needed?Will this be temporary or long term?Is the location close to loved ones, friends, and caregivers?If your loved one is mobile, is it a location they are used to or could get used to and like?Where will your loved one find comfort, purpose, and fulfillment?Will they find companionship and social connection there?If the facility is inpatient, are visiting hours important? Can your loved one go on day trips with the facility or with you?Are there cultural and/or language considerations?This should narrow your list to those facilities that are appropriate for your loved one. The order in which you do the following steps may vary depending on how long your list is and how easy it is for you to drop by versus do desktop research. I think you’ll see a natural sequence that works for you. Any way you go about it, don’t skip steps, especially reading the contracts.Research Reports on the FacilityFor nursing homes, the Medicare website has a function called “Nursing Home Compare”, which publishes their annual inspection results and any complaints that required action or “letters.” The site also has a five-star rating system, which seems simple enough, but at the time of this writing, it did not seem representative of people's experiences or reports of problems.For assisted-living facilities, adult family homes, and other long-term care facilities with a state license, Washington State's Medicaid agency, the Department of Social and Health Services, maintains a complete list on their website. Under the tab “letters,” you will find letters regarding enforcement actions against the facility in the past year. This type of reporting varies state by state, but it is worth a telephone call or look at your state’s Medicaid website.The state ombudsman's office http://theconsumervoice.org/get_helpmay be allowed to give you information regarding care-based complaints for a specific facility you might be interested in. They may also be able to steer you to the best local resources in your state for information on particular facilities. It’s worth a call or a look at your state’s website.Call the FacilityIf you haven’t yet, consider the questions and the priorities you might ask a long-term care (LTC) facility. Again, look at the questions listed above under “Make a List of Places to Consider” to help you write specific questions. Create a question page for each place you will call. Record who you talked to, their contact information and job title, their answers, and how you felt about the conversation. You might use this conversation to arrange a visit.Make an Arranged VisitChances are, if you arrange a visit, you will get a tour. If the arranged visit is your second-to-last step, you might do this with your loved one. This visit also gives you more time to ask more-direct questions, such as:Who draws up the resident's service plan?How involved is the resident and their family in this process?How often is the service plan or plan of care reassessed?Are fees based on this?How much advanced notice does the resident have if fees will rise?How does the facility manage changes in the resident's needs?Does the facility have access to higher levels of care, like an attached nursing home or rehab facility?What would make the facility need to transfer a resident out?How is that handled? If the resident’s transfer is temporary, do they save the resident's living unit for them?How does the facility handle a medical emergency?Do they have a waiting list?Is there a probationary period?How are grievances handled?Is there a family or resident council?When do they meet?Take home a copy of the Resident’s Rights, the facility's rules, the price list, a floor plan if you think that location within the building is important, and any contracts or other documents that will need to be signed. This can all go in a folder for each facility that you visit.Explain the specific needs and preferences of your loved one: "My mom’s situation is …" Ask real questions: "What if she needs this? What if she needs that?" If they have difficulty accommodating your loved one's individual needs, maybe you should consider somewhere else.Make More than One Drop-in VisitAn unscheduled visit gives you a chance to talk candidly with the rest of the staff, other residents, and their families. Try for a mealtime. Try for a resident council or family council meeting. Keep in mind that it will be busy at mealtimes and in the morning, and it may feel unorganized at shift changes.Read the ContractsYes, read the contracts and all that other paperwork. Are there discrepancies between what they have promised, what their brochures and/or website say, and what the contract says? Other red flags include “responsible party” provisions that make family members or loved ones liable for expenses, claims that injury or harm is common or unavoidable, or provisions that give unauthorized justifications for eviction or that limit arbitration. Assisted-living facilities' contracts might also include red-flag provisions such as pricing of additional services that can be exorbitant or claims that residents can agree to accept a lower level of care than they actually need. A facility might also cloak eviction in terms of not being able to meet the care needs of the resident, so they might write themselves a lot of leeway in their contract for this.Other OptionsIf you are in a long-distance caregiving situation, care management companies can help with selecting, vetting, and monitoring placement in LTC facilities. Ask directly if they physically visit or just talk with the facility on the phone. Aging Life Care Association https://www.aginglifecare.org/ is the professional association of care managers. They have a referral service to local care managers.Helping Your Loved One After They Move into a Long-Term Care FacilityIf your loved one does move into a long-term care facility, you can still be tremendously helpful for them. See Helping Your Loved One During Hospitalization earlier in this chapter: you can do much the same if they are in an LTC facility.Visit often.A regular visit schedule helps give your loved one structure and lets them plan their time. I remember our neighbor Bea was so gregarious she needed some help to manage her social calendar while she was in a nursing home.Go on outings.Take your loved one on outings if possible. Life is short. There is no good reason not to live it as well as you can.Help them remain engaged in activities they enjoy and find meaning in.See how many ways you can encourage favorite activities. They may start new meaningful projects such as creating a memoir or visiting their friends, who may have their own health problems. Can they help make a care package for a friend? Do they like to work in the garden? Often, LTC facilities have one for residents who garden. Often people find terrific relationships with pets. Can their pet join them there? Some facilities have “therapy animals” that live at the facility.Attend care meetings.As with the hospital rounds described earlier in this chapter, let your loved one lead the discussion with the facility's health-care providers if possible. Ask what is missed. Take notes. Consider well the risks, costs, and benefits of any changes or of not making changes. Talk to staff about any changes you observe in your loved one's behavior or condition. Chances are that they have noted these too, but it doesn’t hurt for them to hear it from you as well.Addressing Problems in a Long-Term Care FacilityThere will most likely be some things that you and your loved one won't like about a move into an LTC facility. For instance, moving into most long-term care facilities does come with some loss of personal freedom. But you don’t need to accept everything passively, especially if it is something the facility promised but is not delivering.You and your loved one’s first venue for addressing grievances is the Residents Councilor the Family Council. This is a formal meeting of the residents to voice concerns and help direct the staff and their policies to address such issues. The Family Council is a similar body for family members. By law, nursing homes have to allow a space and time for these meetings. The Missouri Ombudsman Program developed this document to describe better what a Resident Council is and how to set one up http://health.mo.gov/seniors/ombudsman/pdf/HowToOrganizeAnd_DirectAnEffectiveResidentCouncil.pdf. These councils can approach the facility directly, or they may file formal complaints to the state Long-Term Care Ombudsman.Each state has a Long-Term Care Ombudsman Office.The ombudsman advocates for people regarding long-term care in the state, fielding complaints and solving problems. They also monitor the licensing agencies and inspections, publish reports like those you might have reviewed when looking for a place, and act as your advocate in addressing lawmakers regarding regulation of these facilities. To find the Long-Term Care Ombudsman in your state, search “Long-Term Care Ombudsman” and the name of your state, or check into the Consumer Voice http://theconsumervoice.org/get_help.Most grievances can be solved through the council’s or the ombudsman’s office. Unfortunately, sometimes it is indeed a matter of law and you may need a good lawyer. The National Academy of Elder Law Attorneys'websitehttps://www.naela.org/ has links to attorneys who specialize in elder law by region. For public-assistance lawyers, the National Legal Resource Center(NLRC) publishes a map by state that links to legal resources by statehttp://nlrc.acl.gov/Services_Providers/Index.aspx.The best publication on this I have come across concerning resolving problems in long-term care is “20 Common Nursing Home Problems and How to Resolve Them,” published by Justice in Aging, a legal advocacy group focused on laws and issues affecting seniorshttp://www.justiceinaging.org/20-common-nursing-home-problems/.