Don’t wait too long before seeking assistance for the loved ones in your care.

There comes a time when families may have to consider if there is a better alternative than home care for a spouse, older parent or relative. Care of a loved one, at some point, can become overwhelming, whether in his or her home or living with the family. Reasons include age, infirmity, cognitive decline and disability. Other factors include the health of the caregiver and job or family responsibilities.

In an ideal situation, there is time to find an alternative living arrangement because planning enhances choice. Having a family conversation, or several over a period of time, about a person’s immediate and future care needs makes any transition smoother. Part of this planning process should be to find and evaluate a skilled nursing care center or assisted living community that offers needed services in proximity to a family member or the caregiver’s home.

When the time comes to plan for relocation, families should “think inclusion.” Take potential residents on tours of various settings and include them in meetings that relate to their health and future. Transitions can be stressful for older adults who suddenly have to deal with an unfamiliar situation and environment, leave a spouse or friends and give up some independence and control over daily routines. Always treat the person needing care as an adult.

The good news is that helpful information is readily available:

  • Many websites, like, offer free information.
  • U.S. News & World Report has an online list of the top 50 nursing homes.
  • State governments provide Medicaid eligibility and offer general consumer information.
  • Always check the Web pages of the facilities you are considering.
  • Medical professionals and members of the clergy can give good advice and referrals.
  • Licensed professionals, such as estate and financial planners and attorneys, sponsor seminars.
  • Recommendations from people who have had personal experience are useful.
  • The federal government website rates care centers nationwide.

Health professionals say that upon admission to a care center or assisted living community, residents are initially uncomfortable with their situation. Even if it was the loved one’s choice, family members may have feelings of anxiety or guilt. Social workers note that it takes at least 30 days for everyone to adjust, make new friends and settle into a new environment. On a promising note, families no longer need to be the caregiver and can focus on socializing with Mom or Dad, or a spouse.

Caregiver consideration  Here are a few things to keep in mind while caring for a loved one.

Things families should know

Is there is a durable power of attorney or living will? What financial institution handles banking or investments? Who is the family physician? Identify medications. Unfortunately, all too often people only deal with needing alternate settings when a crisis happens, such as a parent breaking a hip, becoming ill or wandering off. These cases force families to scramble to find an appropriate alternative with an available bed without properly considering all the ramifications of the situation.

Medicaid is the largest payer

People without substantial assets will most likely be immediately eligible for Medicaid, which is a means-tested government health care program. If a person plans to do estate planning, it has to occur well in advance of needing this program because state Medicaid will “look back” several years for large transfers of assets. If they find any, this may disqualify a person for Medicaid benefits for many years.

Medicare is easily misunderstood

Surveys routinely report that the public believes that Medicare or health insurance pays for care in a nursing home. It does not. Medicare pays partially for a short stay in a nursing home only after the patient has spent a minimum of three consecutive days officially admitted to a hospital. Medicare is primarily for beneficiaries who have sustained an injury, suffered a stroke, or had surgery (hip or knee replacement) that requires intense physical, occupational or speech therapy provided in a skilled nursing care center.

Understand services

In some areas, assisted living refers to “residential care centers.” These facilities offer, a home-like setting, greater autonomy and varying levels of supervision and personal or medical assistance. This setting is appropriate for individuals no longer able to live alone and who need help with tasks, such as medications. Nursing homes, professionally called “skilled nursing care centers” or “health and rehabilitation centers,” offer 24-hour staffing to provide comprehensive clinical and other services, such as rehabilitative therapies, to those requiring a greater level of care than assisted living, either for a short recovery period after a hospital procedure or as longer-term residents.

W. Thomas Burke is the Senior Director of Public Affairs for the American Health Care Association/ National Center for Assisted Living. He is a graduate of Syracuse University, and has served for over 20 years as a consumer specialist in skilled nursing, post-acute care and assisted living. Burke has also been a guest author and presenter in many media forums and venues.