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By Attorney, David Inabinett

Placing a loved one in a long-term care facility is often one of the hardest decisions a family must make. As our population has aged, the number and type of these facilities have increased to accommodate the need. There are active adult communities, assisted living facilities, special care units (memory care, palliative care, and others), program of all-inclusive care for the elderly (PACE) facilities, and traditional residential skilled nursing care facilities. Also available are progressive care campuses or continuing care retirement communities (CCRT’s) that offer residents a continuum from independent living through full nursing care.


The search to find the “best” or “right” facility can be confusing and stressful. The challenges are compounded when a sudden health issue requires a quick decision. Not all long-term care facilities are created equal, and you want your loved one to have the best care possible. Here are some things to consider and some resources available here in North Carolina to help you make your decision:

  1. 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
  2. Look at Medicaid’s nursing home comparison tool located at You can choose up to three facilities to compare. Note: Medicare is implementing a new star rating system. You can find a thorough explanation of the new rating system and how to review the facilities in comparison to the current star system.
  3. Tour the facility at least once, preferably more than once, and at different times of the day and different days of the week. Look, listen and smell as you go through the facility. Ask to see copies of inspection reports for the last year. If you can speak with workers, residents, family members of residents, or other visitors about the facility they may provide some unique input. A list of adult care homes in North Carolina can be found at
  4. Check with the county Department of Social Services where the facility is located and ask them to detail the services provided and give you information about any complaints within the last three years.
  5. North Carolina also has Regional Long-Term Care Ombudsmen who are responsible for advocating on behalf of facility residents. They are a good source of information on the quality of facilities in the state.
  6. (Gulp!) Google the facility or read comments (if allowed) on its Facebook or other social media page(s), but don’t believe everything you read online. Look for trends, themes, or recent news or reviews about the facility.
  7. Check out some of the rating websites like A Place for Mom or Senior Advisor.
  8. Ask your loved one’s doctor(s) or a local elder law attorney, both of whom probably have numerous patients and clients in area facilities. Many doctors and attorneys who handle a lot of elderly patients and clients will know which facilities are the best in the area.
  9. Not all long-term care facilities accept Medicaid patients and those that do may have limited beds, especially if your loved one is entering directly from home rather than remaining after a Medicare-covered stay for purposes of rehabilitation after a hospital discharge. If Medicaid eligibility is critical to your decision, ask upfront so you don’t waste time. If funds are short and your loved one may transition from private pay to Medicaid within the near future, also ask if your loved one would be guaranteed a bed at that time or what is the process to be considered at a later time. If not, you may end up having to move your loved one to a different facility – possibly a less desirable facility – with an available Medicaid bed, resulting in more stress for both of you.
  10. Ask questions about payment options. Most continuing care facilities require you to “buy-in” to the facility. You may wish to have an elder law attorney or financial advisor look over the terms of the agreement before you sign anything, as some agreements contain prohibitions against making transfers of assets to family or from doing anything related to “asset protection planning.” Many have large deposits that are not refundable or which may be partially refundable on a sliding scale depending upon how long the resident remains there independently before moving into a higher level of assisted living, memory, or skilled care. Be cautious about the capacity in which you sign on behalf of a loved one to be the “financially responsible person” concerning the resident’s cost of care. If you are signing as “attorney-in-fact” make sure that is clear from the manner in which you sign any documents.  Facilities are not supposed to require such guarantees but it does occur.
  11. Check the Better Business Bureau or Chamber of Commerce in the city where the facility is located. Not all are listed, but many are.  Visit adult daycare facilities and ask if they have knowledge of recommended long-term care facilities as many of their day residents have probably transitioned to long-term care.  In fact, consider if an adult day-care facility is an alternative to long-term care placement.
  12. Consider a facility that offers a full continuum of care through skilled nursing care so that as your loved one’s needs change, they are not required to move to another unfamiliar facility, potentially further away, to obtain the level of care they may need.
  13. If you anticipate your loved one may require placement into a long-term care facility following a hospital stay, be sure that the patient is identified as an “inpatient” and not “outpatient for observation” at the hospital and, if possible, that their stay is at least 3 days before discharge. These are the prerequisites for Medicare coverage for a nursing home placement following discharge from a hospital for rehabilitation purposes. Have this discussion with the hospital upon admittance.

Finally, we recommend talking to other people you know who may have faced the same decision and get their opinion of the facility where their loved one receives (or received) care. Ask friends, co-workers, your clergy person, or members of other regional groups to which you belong.

Moving into a long-term care facility can be a difficult transition for the individual and for family members, even in situations where everyone agrees ahead of time that it’s necessary. Expect an adjustment period on both sides.  Make sure your loved one has executed the proper estate planning and advanced directive planning documents, such as a last will, durable power of attorney, health care power of attorney, living will and HIPAA authorization for release of protected health information. We also recommend you visit as often as possible and at different times of day and night, and continue to monitor the quality of care your loved one receives. If you see any signs of abuse, act immediately and notify your county’s Department of Social Services, Adult Protective Services. Visit the U.S. Administration on Aging for a listing of signs of abuse and neglect.

Need to learn more? Contact an elder law attorney at Brinkley Walser Stoner today to schedule an appointment.