How to Choose a Residential Care Facility


Driving by residential care facilities only gives us a glimpse of its environment. Before stepping inside potential custodial care homes, think about the needs of your loved one, and prepare a list of questions and concerns. Since there are no federal standards for these small care homes, it’s vital to thoroughly research each potential residence. States with licensing regulations provide surveys on each residential care home, so start by contacting your state’s department of aging for information, or ask each residential care home for its survey.

Often, people are apt to judge residential care facilities by their outside facades and interior glamour. While ambience is nice, the most important aspect is the caregivers experience and background, says Jerry Graham, a Senior Living Advisor for A Place for Mom. “You’re looking for care with dignity. If the caregivers are smiling and happy, the residents will be happy. Chandeliers and caviar do not mean quality care.” Keep the following in mind:

  • The experience of the owners and each staff member. Ask for references and check them.
  • Ease of communication: Will you be able to effectively communicate with the staff?
  • The staff-to-resident ratio.
  • Are the caregivers live-in or do they work in shifts?
  • Is there an RN on-site at all times? If not, is there an RN advisor or an RN on-site at specific times?

The “right” answers to these questions depend on the care your loved one needs. For example, some residents will need an overnight on-duty staff member to take care of them.

Of course, potential residential care facilities should be clean and tidy. This also translates to the appearance of its current patients. “I also speak to the other residents, take note of their appearance, and also how the staff interacts with the residents,” says Graham. It’s not a good sign if a staff member barges in on a napping resident to show off a room, or if everyone is still in their pajamas at 2 pm, he says.

When touring, ask yourself, “Would my loved one fit in here?” says Charlotte Stackpole, MPA. Try to watch residents in action during an activity time, and look at the home’s activity calendar. Stackpole and Graham recommend asking about the following issues:

  • Pets: Are they allowed?
  • Smoking: Some states don’t allow smoking in-doors. Some allow it outside, but some do not.
  • Transportation: Is there transportation to medical appointments or even outside activities such as church services?
  • Health: How are health issues managed, including the activities of daily living, such as bathing and toileting? Does the staff make doctor’s appointments?
  • Money: Can spending money be managed by the staff?
  • Medications: Are the residents just reminded to take meds, or does the staff administer them? Will prescriptions be filled and picked up by staff?
  • Security: If the residential care home accepts dementia patients, make sure the perimeter is secure, and that doors are alarmed. How does a caregiver know if a resident attempts to exit the home?
  • Meals: Will the home provide different meal options that appeal to your loved ones tastes?
  • Finances: How much is the monthly rate, including all the fees? Does the home accept Medicaid? Do you need to pay out-of-pocket for a period of time before they accept Medicaid? How does billing work, whether residents pay themselves, with long-term care insurance, or by Medicaid?

It’s also essential to visit more than one home before you make your final decision. Graham recommends visiting 5 or 6 residential care facilities. Always schedule an appointment for your first visit, asking the owner or house manager all your questions. “After you’ve toured several properties and narrowed your choices down, then do un-announced visits,” says Graham. “I do think it is important to show up un-announced at different times of the day, but please be respectful of the other people living in the home, not showing up early in the morning or very late at night.”

Before choosing a residential care home, make sure all of your questions are answered. “Don’t be embarrassed to ask anything. These people are now going to be your employees,” says Graham.

Update: January 2018