Question: My 84-year-old mother came to live with my husband and me 10 years ago when Dad died. Her physical health has deteriorated due to diabetes, high blood pressure, heart palpitations, and most recently, a leg muscle damaged in a fall making it difficult for her walk. She has also become increasingly forgetful, which her doctor believes is dementia. So we’ve started looking for a facility that will be an appropriate fit. We live in a medium-sized city in Pennsylvania, but are confused, to say the least, about which place to choose. Is there a way of gauging these facilities independently before we sign on the dotted line for Mom?

Answer: It’s little wonder that we have received dozens of e-mails and letters from readers who are having the same problem. As America’s aging population grows, there are literally tens of thousands of nursing homes, assisted living facilities, and adult day care providers across the country that would like to provide care to loved ones. Choosing the best one for your loved one can be a daunting task.

One solution is to hire an experienced professional geriatric care manager to help you decide how to best care for your mother. First, they assess your loved one’s particular situation – finances, medical and mental health, family dynamics, etc. - and then recommend resources for either in-home care or the best facility in your local area. Kaaren Boothroyd, executive director of the National Association of Professional Geriatric Care Managers (NAPGCM - www.caremanager.org) tells us that it is a “huge advantage” to retain an experienced geriatric care manager who knows the resources in your area and can help you decide how to best take care of your loved one.

While hiring a geriatric care manager is not inexpensive -- between $80 and $200 an hour depending on where you live, the scope of services you need, and so on -- Boothroyd tells us that by looking at the “big picture,” you will save by avoiding unnecessary time and travel, not to mention having peace of mind. NAPGCM has been around since 1985, and we highly recommend them.

We also heard from Boothroyd and others about another great resource: The Gilbert Guide (www.gilbertguide.com). Founded in 2003 by the Gilbert family of California, Gilbert Guide is perhaps the most comprehensive information resource we have seen about long-term care facilities and services in the United States.
Gilbert Guide doesn’t accept advertising (“to ensure unbiased content,” according to the Website), and it covers the complete spectrum of long-term care options, including residential facilities, continuing care retirement communities, nursing homes, in-home care, adult daycare programs, and specialized senior help services.

And unlike assessments made every 9-15 months by the federal government’s Centers for Medicare and Medicaid Services, most of which are self-reported, the Gilbert Guide sends independent experts on site for their assessments. These experts include nursing home administrators with at least five years experience; nurses who have worked in nursing homes or geriatric offices; geriatric care managers; or licensed clinical social workers familiar with senior care. “People deserve to be educated on their best choices,” Gilbert Guide CEO Jill Gilbert told NextSteps in a recent interview.

Gilbert began the San Francisco-based Gilbert Guide four years ago when she couldn’t find what she considered good publications on long-term care services in her area. She started small, first publishing a guidebook for caregivers in San Joaquin County, California. She ended up using her Guide to find care for her own grandmother

Now the Gilbert Guide has been expanded to cover six territories: the San Francisco Bay Area, the East Bay Area (which is also in California), Los Angeles, Dallas-Fort Worth, five boroughs of New York City, and Philadelphia. Gilbert hopes eventually to expand her Guide to cover the entire country. The cost to consumers is $19.95 for six months of unlimited access to 1,440-plus reviews of the top-ranked facilities in those six territories.

When asked to tell us the most important elements people should look for when they’re checking out facilities for their loved ones, Gilbert named three: (1) Is there enough well-qualified staff, and how much are they involved in the facility’s day-to-day activities? (2) Are there enough socialization activities for the residents? (3) Is the facility clean? For nursing homes, Gilbert adds a fourth element: Is there a high-level quality of care? You can test this, she says, by noticing how staff and administrators interact with residents (for example, does staff respond quickly to call lights from residents?), and by determining staff training and turnover rates.

After an initial visit to the facility, Gilbert suggests doing a second visit when the staff doesn’t know you’re coming. “It’s not to be sneaky,” she says, “but you care about where you or your loved one is going to live. You don’t want any surprises.”