Looking for a Long-Term Care Facility for a Family Member with Dementia

Key issues/concerns that the Ombudsman Program receives calls about from consumers regarding quality of care and quality of life in long-term care facilities for their loved ones

  • Basic care:
    • Resident hygiene
    • Feeding issues
    • Medication errors
    • Falls and injuries
    • Bathing methods & schedules 
  • Lack of training:
    • Communication problems – limited ability and understanding
    • Need for specialized training on
      • Dementia care
      • Difficult behaviors
      • Transferring residents
      • Feeding
      • Medications 
  • Lack of individualized or personalized care:
    • Food that is not appetizing to the resident or not individualized to their tastes
    • Activities that are not tailored to the individual or to person’s with dementia
    • Resident schedules not tailored to their life long life style
    • Staff not spending time to treat the resident in a humanistic way 
  • Facility management / corporation:
    • Staffing ratios – not enough staff to provide the supervision and care
    • Billing issues - overcharges
    • Internal grievance procedures
    • Fear of retaliation for complaints 

Questions consumers could ask when looking for long-term care for someone with dementia

  • What is the philosophy of this facility? Does the facility have a person-centered philosophy? Individualized care?
  • Concerning the Dementia Unit
    • Does the facility have a special dementia unit?
    • What are the criteria for admission to the dementia unit?
    • Is there an increased cost for the dementia unit?
    • Does staff on this unit have additional specialized training?
    • What is the number of staff on each shift: Morning, evening, night?
    • What is a “normal” day for resident on this unit?
    • What happens if the resident doesn’t sleep all night?
    • Do the residents have any opportunities to go outside of the unit for walks or events?
    • Are visitors allowed access to a secure care unit after hours? 
  • Caregivers
    • What is the ratio of caregivers to residents for this facility? For each shift – morning, evening, night?
    • What is the ratio of caregivers to residents for the dementia unit? For each shift – morning, evening, night?
    • Does the facility have consistent assignments for caregivers?
    • Is there a nurse available or on call at all times? (Assisted Living) What if that person is unavailable?
    • Does the caregiver speak and understand the native language of the resident?
    • Does the caregiver speak and read English?
    • What amount of supervision do you provide?
    • Does staff have any special training on mental health issues or handling difficult behaviors? 
  • Medications
    • What type of training does the medication staff receive?
    • Are medications required to be packaged in any special way?
    • Are residents required to buy their medications from the facility “preferred” pharmacy?
    • What is the medication error rate? 
  • Activities of Daily Living (Bathing, Eating, Dressing, Eating Transferring, Walking)
    • What is the bathing schedule handled?
    • What does the shower room look like? 
  • Activities
    • Are there specialized activities for the dementia unit?
    • Who coordinates them?
    • Are there a variety?
    • Are activities tailored to the resident? 
  • Dietary
    • Does the menu have variety?
    • Do they offer individual preferences for meals?
    • Does the facility offer an alternative meal?
    • Does the staff offer assistance to the residents?
    • Is there an assigned activities staff person for the dementia unit?
    • How does the staff ensure that residents are hydrated? 
  • Transportation
    • Does the facility provide transportation for appointments?
    • Does a staff member accompany the resident if they are out of the facility? 
  • Contact with staff
    • When will there be care plan meetings? When is the first meeting?
    • Who should the family contact for concerns in the facility? For all issues?
    • Is there a social worker? Who is assigned to my family member?
    • How long has the administrator been at this facility?
    • How many administrators have worked at this facility in the past 5 years?
    • Is the administrator on site and available? 
  • Advocacy
    • Is there a Resident Council?
    • Is there a Family Council?
    • Is there a Volunteer Long-Term Care Ombudsman at the facility?
    • Is the latest survey by the licensing agency out and available for you to see? 
  • Grievance Procedure
    • What is the grievance procedure?
    • Is there a procedure manual for the family/resident to have?
    • What reasons would someone be transferred or discharged from this facility? 
  • Billing Issues
    • Get a copy of the contract, take it home, and read it. Review it with someone if you need help understanding it.
    • How is a billing dispute handled?
    • Are there levels of care and are there charges associated with them?
    • What is the procedure for assessment of the level of care needed?
    • Is there an appeal process for an assessment of an increase in the level of care?
    • Is there a time limit before the level can be increased?
    • Are the charges for supplies included? Automatically charged? Can the family bring in supplies?

When touring a long-term care facility what issues would be of concern?

  • Observation of current residents:
    • Resident personal care does not appear appropriate
      • Hair
      • Teeth
      • Nails
      • Facial hair
      • Clothing is soiled or not appropriate for climate
    • Are residents being assisted with their needs?
    • Are the staff including the residents while giving care or treating them as an object?
    • Are residents eating their food and does it look appealing? 
  • Environment
    • Check if the home is clean and pleasant?
    • What types of conversations are going on?
    • What is the atmosphere like during meals?
    • Is there a lot of noise, traffic? Is it hectic? 
  • Licensing agency survey (inspection)
    • What was the last survey result? Have they made corrections or changes?
    • Is the facility unwilling to discuss the survey results or let you see them.
    • Admissions
    • Any rush to sign the contract before reading it or understanding it. 

What special considerations/issues are there for Alzheimer’s units when choosing a nursing home?

  •  Staff of the Alzheimer’s unit:
    • Staff should have specialized training.
    • Staff numbers should be adequate in any shift to handle residents that may be awake.
    • Does the facility have staff that is awake during all 24 hours?
  • Specialized services for dementia care:
    • Are there special activities for the dementia unit?
    • Does staff use appropriate communication styles for this type of unit - use short sentences, concrete statements, or other methods when words aren’t understood anymore?
    • Is staff body language friendly and non-threatening?
    • Does staff know how to redirect inappropriate behavior?
    • Are residents still treated with dignity and respect?
    • Are drinks offered often?
  • Safety issues:
    • Is there an alert system that tells staff when a resident leaves the unit?
    • Does staff react when the alarm goes off or just turn it off?
    • How often does staff check on residents?
    • Is lighting appropriate? Not too harsh and night lights in rooms and halls?


What suggestions would you give in choosing a long-term care facility?

 When looking for a facility, research it!  Don’t just go to one that is closest.

  • Call the Long-Term Care Ombudsman Program.
  • Research – on the internet. Narrow it down to a few facilities to do detailed research on and visit.
  • Talk to others about their experience with facilities.
  • Know your family member’s needs and history. Know what additional needs may come along with the progression of the disease.
  • What type of payment sources does the facility take? Private pay only? Medicaid? Medicare? Grants?
  • What services are included in the fee given up front and what additional cost of fees resident will have to pay and for what service?
  • What happens if a resident’s money runs out? Does the resident have to move? Will the facility help to apply for Medicaid if appropriate?
  • Is the facility certified? By what agency and what does that mean? Medicare and/or Medicaid?
  • Look at past surveys (inspections) by the licensing agency.
  • Talk to more staff than just the marketing or admissions person.
  • If possible, take the potential resident for a visit and get their input.
  • Don’t be fooled by expensive décor. This does not equate to mean better care.
  • Look at all sizes of facilities. Sometimes the smaller (4-8 bed) facilities are more appropriate for a resident.
  • Visit more than once –
    • Different times of the day
    • Different days of the week – at least once on a weekend day
    • Visit at least once unannounced and tour the facility unaccompanied by staff
    • Are activity schedules posted and are they appropriate activities that are actually happening during your visit?
    • Visit during meal time
  • Use all of your senses:
    • Do residents look clean and attended to? Are they clean? Groomed?
    • Is it a comfortable temperature for the resident?
    • Is it a comfortable temperature for the resident? Are surfaces clean or sticky?
    • Are there odors – either pleasant or unpleasant?
    • Is it noisy? Is music appropriate for the residents? Are staffing talking with residents?
    • Are staff talking to each other in a different language that the resident can’t understand? Are staff talking about residents where others can hear?
    • If possible – eat a meal there. Is it appealing? Appropriate? Are staff assisting the residents – to open items and/or to eat? Are the residents served food or are they sitting and waiting for a long time? Does one resident get their food long before another at the same table?
  • Read the contract before signing. Ask for a copy to take home and review. Make sure you understand it or take it to someone that can help you understand it.
  • Get a copy of the Resident’s Rights and know them.
  • Find the regulations for this type of facility on-line or call the licensing agency to get a copy.
  • Review them and keep a copy for future reference.
  • Ask about the staff of the facility
    • Who owns this facility
    • Ask about the administrator – background and how long they have been with this facility
    • What is the amount of staff turnover?
    • What is the caregiver staff to resident ratio?
    • Are staff consistently assigned to a resident?
    • What type of training does staff have?
    • Does staff have specialized training for the dementia unit? What is it?
  • Does the facility provide the services that the resident needs?
  • Ask if there is a Family Council – ask to speak with the Family Council Chair.
  • Ask if there is a Residents Council – ask to speak with the Resident Council Chair which should be a resident, not a staff member.


Once you have selected a long-term care facility

  • Know all staff possible – the administrator, head of nursing services, social worker, direct caregivers
  • Ask if they are not satisfied with the care or have a problem, how should this be handled? Who in the facility do they go to?
  • Know if there is a Volunteer Ombudsman and how to contact them.
  • Know the Licensing agency for the facility, that contact person and their number.
  • Get a copy of the resident’s basic information sheet to ensure all the emergency contact information is correct. Review this at least quarterly.
  • Make sure that know who the main contact person is and who should be contacted if that person is not available.
  • Visit often and stay active in the resident’s life.


 Northern Virginia
Long-Term Care
Ombudsman Program

12011 Government Center Parkway
Suite 708

Fairfax, VA 22035 

 Intake Line: 703-324-5861
 To request reasonable accommodations,
call TTY 711 or 703-449-1186;
Fax 703-653-1796

8 a.m. to 4:30 p.m.

E-mail: NVLTCOP@FairfaxCounty.Gov


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