by Ryan McNeill
Deciding to move a loved one into a long-term care facility is one of the most difficult choices a
family can face. As the population ages, the number and variety of care options have expanded
to meet growing demand. Today, families can choose from independent living communities,
assisted living, specialized care units like memory or palliative care, and skilled nursing facilities.
Some locations, known as continuing care retirement communities (CCRCs), offer a full range of
services in one place, allowing residents to transition smoothly as their needs change.
Finding the right fit can be stressful—especially when a health crisis forces quick decisions. Not
all facilities offer the same quality of care, so it’s important to research and use available
resources to make an informed choice. If you’re in North Carolina, several tools can help guide
your search.
- North Carolina adult care facilities are licensed and inspected by the state. There is a star
rating system based on the annual inspection results. You may search by county, city, or
facility name. This is a good place to start but should not be the only factor in your decision.
The search page is located at https://info.ncdhhs.gov/dhsr/facilities/search.asp - Take advantage of Medicare’s Nursing Home Compare tool at
medicare.gov/nursinghomecompare, which lets you compare up to three facilities side by
side. This resource is especially helpful as Medicare is rolling out an updated star rating
system. The site provides clear explanations of how the new system works and how it
compares to the previous one, helping you better evaluate the quality of care at each
location. - Visit the facility more than once, ideally at different times of day and on different days of the
week, to get a fuller picture of daily life there. Pay close attention to what you see, hear, and
even smell—it can reveal a lot about the environment. Ask to review inspection reports from
the past year, and if possible, talk with staff, residents, or visiting family members to gain
personal insight. Their experiences can provide valuable perspective as you make your
decision. A list of adult care homes in North Carolina can be found at
https://www.ncdhhs.gov/divisions/aging-and-adult-services/adult-care-homes - Reach out to the Department of Social Services in the county where the facility is located.
Ask for a detailed explanation of the services the facility provides and whether any
complaints have been filed in the last three years. This can offer a clearer picture of the
facility’s performance and potential red flags. - North Carolina has Regional Long-Term Care Ombudsmen who advocate for residents in
long-term care. These professionals are valuable sources of unbiased information and can
help you understand a facility’s strengths or areas of concern based on their experience in
the field. - Research the facility online. Look up the facility on search engines and review its social
media pages if available. Be cautious not to rely on a single review—focus on recurring
patterns, themes, or recent news. This can give you a general sense of the facility’s
reputation and how it interacts with residents and the community. - Check out rating websites like A Place for Mom or Senior Advisor. These platforms provide
user-generated reviews and ratings of facilities that can give you an idea of the quality of
care and services offered. They can be a helpful starting point in your search. - Consult your loved one’s doctor(s) or a local elder law attorney. These professionals often
work with multiple patients or clients in area facilities and can offer valuable insights into
which ones are most highly regarded in the community. - Verify Medicaid acceptance and availability of beds. Not all long-term care facilities accept
Medicaid, and those that do may have limited spaces, especially if your loved one is entering
from home. If Medicaid eligibility is a critical factor, confirm upfront whether the facility can
accommodate your loved one under these circumstances. - Inquire about payment options and terms. Many continuing care facilities require a “buy-in”
for admission, and it’s essential to understand the agreement before committing. Some
facilities may have non-refundable or partially refundable deposits, so it’s wise to have an
elder law attorney or financial advisor review the terms. Be cautious when signing as the
“financially responsible person,” ensuring that the capacity in which you sign is clearly
understood. - Check the Better Business Bureau or Chamber of Commerce. While not all facilities are
listed, checking these organizations can give you a sense of the facility’s reputation in the
community. Additionally, visiting adult daycare facilities may provide recommendations based
on their knowledge of other long-term care options. - Consider a facility that offers a full continuum of care. Facilities that provide care from
independent living through skilled nursing care can offer peace of mind, as your loved one
won’t need to relocate to a different facility if their care needs change. - If you anticipate your loved one needing long-term care following a hospital stay, ensure the
hospital identifies them as an “inpatient” for at least three days. This is crucial for Medicare
coverage of nursing home placement following discharge for rehabilitation purposes. Discuss
this with the hospital upon admission.
Finally, talk to people who have made similar decisions. Ask friends, family members,
co-workers, or your clergy about their experiences with facilities. Personal recommendations
can provide valuable perspectives and may help guide your decision-making process.
Transitioning into a long-term care facility is a significant change, both for the individual and their
family. Even when everyone agrees that it’s necessary, it can still be an emotional and challenging
process. Expect a period of adjustment for both your loved one and your family members.
Before making the move, ensure your loved one has the appropriate estate planning and advance
directives in place. This includes a will, durable power of attorney, health care power of attorney,
living will, and HIPAA authorization for the release of protected health information. These documents
are crucial for ensuring your loved one’s wishes are honored.
Once your loved one is settled in, it’s important to maintain regular visits at different times of day and
night. This will help you stay informed about their well-being and the quality of care they are
receiving. If you notice any signs of abuse or neglect, take immediate action by contacting the
county’s Department of Social Services or Adult Protective Services. Read for more information on
recognizing signs of abuse and neglect.
Need to learn more? Contact an elder law attorney at Brinkley Walser Stoner today to schedule an
appointment.