RCFE touring checklist: questions to ask and what to watch for

Before you go

Look up each home on the state's Care Facility Search first. Note its license status, capacity, and any citations or complaint findings, so you can ask about them in person. Plan to see several homes.

Write down what your loved one needs and wants: help with daily activities, dementia or hospice care, a layout that works with a walker or wheelchair, and a location near family, friends, or doctors. Every licensed home must provide basic services, but not every home can provide specialized care.

License, reports, and staffing

State rules require enough competent staff at all times to meet residents' needs. Night rules depend on the size of the home.

In homes with fewer than 16 residents, a qualified person must be on call on the premises at night. In homes with 16 to 100 residents, at least one employee must be awake and on duty, with another on call who can respond within ten minutes. Ask what the home actually does, especially if your loved one is up at night.

• Is your license posted? Licensed homes must post it where the public can see it.
• May I see your most recent licensing report? What changed after any citations?
• How many care staff are on duty in the morning, afternoon, and overnight?
• Is a staff member awake all night?
• How are care staff trained, and how often?

Care levels and what triggers a move-out

Before admission, the home must interview the prospective resident and complete an appraisal of their needs. It must update that appraisal when needs change, and at least once every 12 months. In privately operated homes, residents have the right to be told in writing, before or at admission, about any limits on the care the home can provide.

State rules limit the reasons a home can evict a resident, and generally require 30 days' written notice. Reasons include not paying, not following written house rules that are part of the admission agreement, and a new need, confirmed by a reappraisal, that the home cannot meet. An RCFE also cannot keep a resident who needs 24-hour skilled nursing care.

• What care can you provide, and what can't you provide?
• What changes in health, memory, or behavior would mean my parent has to move?
• Do you have a hospice care waiver?
• Can residents receive visits from an outside nurse or home health agency?

Costs and the admission agreement

Ask for a blank copy of the admission agreement and read it at home. The home must provide one on request and may charge only copying or mailing costs. By law, it must be printed in black type of at least 12 points, on one side of plain white paper, in clear and understandable language.

• What does the basic monthly rate include, and what costs extra?
• How are fees set for higher levels of care?
• Is there a preadmission fee, and what are the refund rules?
• How much notice do you give before a rate increase? State rules require at least 60 days' written notice.
• What is your refund policy if my parent moves out or passes away?
• What are the written house rules?

Meals and activities

Every RCFE must make three nutritionally balanced meals and snacks available each day, including low-salt or other diets a doctor orders as medically necessary. Ask to see the menu, and try a meal if the home offers one.

Homes must also offer planned activities, including social time, physical activity, mental stimulation, and free time for residents' own interests. Ask for the activity schedule, and notice whether residents are actually taking part.

Medication handling

RCFE staff may help residents take their own medications, but they may not give injections unless authorized by law. Helping never includes forcing a resident to take medication, or hiding it in food or drink without the resident's knowledge and consent.

• Who helps residents with medications, and what training do they have?
• Where are medications stored, and who keeps the records?
• What happens when a dose is missed or refused?
• Can we keep using our own pharmacy?
• How do you work with my parent's doctors?

Residents' rights and what to observe

Residents keep important rights in every RCFE. These include having visitors, including ombudsman representatives, privately during reasonable hours and without prior notice, and keeping and spending their own money. A future resident also has the right to visit the home before moving in, along with their representatives.

In privately operated homes, residents also have the right to 30 days' written notice of a room change in most cases. They can choose their own doctors and pharmacies, consistent with the admission agreement, and form a resident council.

Every long-term care facility must post the phone number of the local Long-Term Care Ombudsman office and the statewide hotline, 1-800-231-4024. Ombudsman help is free and confidential. Look for the posting during your tour.

• Are indoor and outdoor areas clean, safe, and in good repair?
• How do residents seem: content and engaged, or withdrawn and anxious?
• Do staff speak to residents with respect and patience?
• Are staff easy to find?
• If residents are willing, ask them what they like about the home and what could be better.