In previous columns, we discussed in-home care and assisted living facilities, but what happens when your loved one needs long-term continuous care? A nursing home may be the best option.

According to the Centers for Disease Control and Prevention, as of 2014, 1.4 million Americans were living in nursing homes, the majority of them seniors. And as the Family Caregiver Alliance points out, nursing home care becomes more prevalent as we age: In 2010, 13% of those 85 or older (one in eight) and 1% of those 65 to 74 resided in such institutions.

Since people are living longer these days, nursing home admission is a possibility that many adult children will need to consider for their aging parents. Consequently, as a caregiver or caretaker, it is important for you to understand what to look for when considering facilities. Below are nine suggestions to keep in mind as you explore your family’s options:

1. The best time to tour a nursing home is on a Saturday evening. Since administrative and marketing staff are not likely to be around, you can get a more accurate picture of what life is like at the facility.
2.   Make sure to visit when a meal is served. You will get a chance to see the quality and quantity of the food. Observe whether each resident gets enough to eat and whether staff members are available to help those who need it.
3. Find out how often the facility brings in nurses from a staffing agency. It is not unusual or necessarily harmful for a nursing home to occasionally turn to an agency to shore up its staff. After all, you want an adequate number of medical personnel to be on hand at all times. But if the nursing home continuously brings in nurses who are unfamiliar with the facility and its patients, your loved one could receive a lower quality of care.
4. Consider long-term-care insurance. Medicare offers very limited coverage for nursing home stays. That is why many people buy long-term-care insurance or set money aside to pay for extended care out of their own pockets. If you choose the latter option, keep in mind that skilled nursing facilities can be expensive. While figures vary by region, Genworth reports that the national median in 2016 was $6,844 per month for a semiprivate room and $7,698 for a private room. Furthermore, the average nursing home stay is 835 days—or more than two years, or about $200,000, making it unaffordable for many Americans.
5. The consistency of caregivers matters. In some facilities, caregivers may change from day to day, which can be unsettling and confusing for residents. Try to find a nursing home where the same caregiver is assigned to a resident on most days.
6. You should be proactive to ensure that your loved one gets the care they need. It often helps to designate a single family member who will take charge of the care and communicate with the nursing home. Having a single point of contact can make the process much easier.
7. Your loved one probably won’t be able to choose their doctor. Instead, they will be limited to the physicians who work with the nursing home—and those doctors may be responsible for numerous patients. Nursing home doctors often visit a facility once a week to meet with residents—make sure you understand the protocols for the facilities you are considering.
8. Make your family member’s room feels as much like home as possible. Bringing personal objects and pictures to the nursing home can help the place feel more familiar and comforting, especially if your loved one has memory issues or is afraid to be there. Make sure that the facilities you research welcome the steps you are taking to increase your loved one’s feelings of comfort and security.
9. Theft can be a problem. If your loved one owns expensive jewelry or other valuable items, those valuables should be stored in a safe or at least not left out where they can easily disappear. Larger valuable items should be marked with your loved one’s name for easy identification. This eHow article contains other helpful tips on preventing theft in senior facilities.

Paying for Care

Nursing home care can be paid for in a variety of ways. Here are the four most common options:

• Medicare: The federal Medicare program will cover part of the cost of a skilled nursing home for seniors who require special care. However, the facility needs to have been approved by Medicare. Rules and requirements change regularly, so I recommend that you check with Medicare for up-to-date details.
• Medicaid: Medicaid is a joint federal and state program that is intended to help people with low incomes pay for medical costs. Contact your state Medicaid program to see if your loved one qualifies.
• Private pay: Some people pay for long-term care until they exhaust their savings, then apply for assistance from Medicaid. If you think your loved one may need Medicaid at some point, make sure that any nursing home you consider accepts Medicaid payments—not all of them do.
• Long-term-care insurance: Some people buy private long-term-care insurance, which can pay part of the costs for a nursing home or other long-term care. The length of time covered will be stated in the policy. Long-term-care insurance is sold by many companies, and benefits vary widely. I recommend that you look carefully at several policies before making a choice.

When considering expenses, keep in mind that there may be out-of-pocket charges for supplies or personal care services outside of “routine care.” Hair appointments and laundry costs may fall under this category.

In addition, rules and benefits governing nursing home care can change. The National Institute on Aging recommends that you check with Medicare, Medicaid and private insurance providers to find out their rules on long-term-care coverage. Visit www.medicare.gov for information about care options. To learn more about the Medicaid program, see www.medicaid.gov.