Choosing a long-term care facility may be one of the most difficult decisions you may ever make for yourself or a loved one. As our population continues to age and live longer, the need for continuous health care for an extended period has risen dramatically. Unfortunately, most people find themselves in the middle of a crisis when looking for a long-term care facility. The family may be in emotional turmoil while being faced with finding an appropriate long-term care facility, and at the same time trying to understand how long-term care services are provided and funded.

Be assured that today's long-term care facilities help residents live life to its fullest- mentally, physically and emotionally. These facilities exist to provide highly specialized and sophisticated services for the young and the old alike. Rehabilitation services are offered if appropriate, enabling many residents to return to their prior living arrangements.

Finding a facility that will provide the right kind of care for the unique needs of the individual is the most important consideration. In many facilities, nursing care is being provided in long-term care facilities that would have only been provided in hospitals a few years ago.

There are numerous options available. Your family physician, hospital social worker or the Illinois Health Care Association can help you become better informed to make the best selection to meet your needs.

This Guide discusses what to look for when choosing a long-term care facility, and provides a "Checklist to Choosing a Long-Term Care Facility," as well as a directory of Illinois Health Care Association members to aid in your search for the best long-term care facility for you or your loved one.

The key to effective cost control must begin with selecting the proper level of care, and avoiding higher levels of service than needed. Any nursing facility you are considering should conduct an assessment to help you make this determination and to explain the individual facility's rate structure.

The payment sources for any given patient might include personal income, assets, or insurance. Many veteran's groups, trade unions, fraternal organizations and private insurance carriers offer plans with applicable benefits. There are local public assistance entities that may provide aid in cases of proven need.

Medicare, a federal insurance program for people age 65 and over, will pay for care under certain limited conditions. The resident must meet eligibility requirements and the nursing facility must be licensed as a skilled nursing facility in order to be certified in the Medicare program. To qualify for Medicare, check with the Social Security Administration for current criteria. The continuing need for this level of care is monitored carefully by government officials, and payment may be terminated if skilled care is no longer justified on a daily basis.

Medicaid is a combination federal-state program to assist low-income people of all ages. Illinois guidelines allow payment for skilled and intermediate care, provided the facility participates in the program. The requirements for Medicaid eligibility can be complex. The nursing facility staff or the local office of the Illinois Department of Public Aid can assist you in obtaining the necessary information. Not all facilities are certified for Medicare or Medicaid. If you believe that one of these programs may be a source of payment, discuss this with the facility.

No matter who is responsible for the payment of long-term care services, it is important to familiarize yourself with the procedures, finalize all the arrangements in advance, and to secure copies of all financial details. Make certain to determine what services are included in the basic rate. Secure a list of all services and charges which are not included in the basic rate and ask whether advance deposits are required. The State of Illinois requires certain safeguards for resident funds that facilities manage on behalf of the resident. You may want to confer with the facility on the way they handle resident funds.

The condition of the person seeking nursing care is the key factor in your choice of a long-term care facility. All skilled/intermediate care nursing facilities provide personal care and residential services including room, meals, planned activities and programming to meet social and spiritual needs. The levels of nursing and therapy services offered vary quite widely, and these should be carefully matched to the individual's needs. The resident's physician is involved regularly in the direction of a resident's care. The nursing staff works with and keeps the resident's physician updated on any changes in the resident.

One nursing need to consider is the availability of rehabilitation therapy services. Some people may require a few weeks of therapy because they aren't quite ready to go home after a stay in the hospital. Others may face serious medical problems and still others may require a different kind of care, such as care required for Alzheimer's disease or other related dementia. Does the facility you are considering meet your special needs? It is very important to ask the admissions representative and nursing staff those questions. Many facilities specialize and are better equipped to handle different kinds of nursing needs. The facility will also work with residents and their families to set up advanced directives for health care for the resident. Competent adults have the right to make decisions regarding their health care. This right should not be lost when a person becomes incompetent. These rights include the right to accept or refuse any medical treatment, including life-sustaining treatment. Residents have the right to be adequately informed about their condition, treatment alternatives, likely risks and benefits of the alternative and possible consequences. The advance directive helps to assure that wishes are carried out even if one is no longer capable of making decisions. For more information on advanced directives, ask the admissions representative for assistance.

The following is a description of the types of licensed facilities in Illinois and the different kinds of care each provide:

Skilled Nursing Facilities (SNF): provide continuous 24-hour nursing care for convalescent and/or critically or chronically ill patients. Registered Nurses (RN), Licensed Practical Nurses (LPN), and Certified Nurse Assistants (CNA) provide care and services prescribed by physicians with heavy emphasis on medical nursing care. Social services are provided to meet the resident's social needs, as well as physical, occupational and other therapies. This type of facility may be certified to participate in the Medicare and/or Medicaid program. Check with each facility.

Intermediate Care Facilities (ICF): provide less intensive care than that which is found in a skilled nursing facility. However, services still include 24-hour nursing care by licensed nurses as prescribed by a physician, along with rehabilitative programs, social services and daily activities for persons not capable of full independent living, such as convalescent or persons with chronic conditions which are not critical. Physical, occupational and other therapies are provided. This type of facility may be certified for Medicaid. Check with each facility.

Sheltered Care Facilities (SC): emphasize the social needs of the individual rather than the medical needs. Residents include people who are functionally independent but need some assistance in daily living. Dietary and housekeeping services, medication monitoring, and leisure activities are primary functions of these facilities.

The following types of facilities are also members of the Illinois Health Care Association, but are not listed in this Guide. If you are considering this type of long-term care service, contact the Illinois Health Care Association for additional information and facility listings in your area.

Skilled Pediatric Facilities (SNF/PED): provide for long-term care needs of chronically ill children, with close staff, parent and child relationships. Specialized nursing, therapy, social and educational services are provided under medical supervision.

Intermediate Care Facilities for the Developmentally Disabled (ICF/DD): provide care and training for adults and children who suffer from physical and mental disabilities.

Intermediate Care Facilities for the Mentally Impaired (ICF/MI): provide the nursing care of an intermediate care facility, but with special attention to the active treatment/psycho-social needs of the mentally impaired or disturbed resident. Community Integrated Living Arrangements (CILAs): provide an array of direct services to individuals with developmental disabilities so they can meet their physiological, medical and social needs. They reside under supervision in the local community in units developed for no more than eight individuals.

Another area to consider before making a choice is geographic location. Is the facility close to home where family and friends can visit regularly and attend facility functions with the resident? This often makes for a happier, healthier resident. Maintenance of the building and grounds is important, too. Are the hedges trimmed? Is the paint peeling? If the exterior is well maintained, it is a good sign that the facility pays attention to details. But remember that a fancy building doesn't always mean high quality care. Quality care on the inside is the most important criterion.

Staff's Attitude

The staff's attitude is an important consideration. This is what makes a nursing facility into a home. The way the residents are treated and the friendships they develop are important. The resident may have a short stay or an extended one. Whatever the length, it should be as comfortable as possible. Some signs to look for are pleasant conversation among the staff and residents, openness and friendliness of the staff and respect of resident's privacy and rights. If you think the staff views you or your family member as a threat or a burden, cross that facility off your list!

Management is the key to a good facility. If the management treats its staff fairly it can have an affect on the quality of care given. Be sure there is enough staff to meet all of the resident's needs. In licensed skilled and intermediate care, there must be a Director of Nursing (DON) who manages the nursing staff and there must be a Registered Nurse (RN) or a Licensed Practical Nurse (LPN) on duty at all times. Much of the actual hands-on care is provided by Certified Nursing Assistants (CNAs). Are there enough on staff to address the residents' needs? Are the residents clean, well groomed and dressed for the day? The CNAs may be able to spot physical changes more readily since they provide the routine daily care.

During your tour of a facility, talk with residents, their family members and their friends to help determine the quality of care given. Ask the Administrator about the facility's policy on chemical or physical restraints. They should be used only when medically necessary and not for staff convenience. Is information about resident rights posted with the nursing home hotline telephone number and nursing home ombudsman's telephone number? Spend some time at the nursing station. Observe how quickly nurses and aides respond to a resident call light.

Social service departments in a long-term care facility provide staff who are designated to be a liaison between the resident, family and facility. Social service staff offer a resident and family emotional support through the admissions process adjustment period. They are helpful in assisting with financial issues and referrals to community resources for discharge planning. Check to see if there are support groups available in the facility. Does the facility offer a private place where you can meet with the social service staff?

Activities are therapeutic and fun! They are purposeful and are designed to help keep residents cognitively alert. A good activity program should meet the appropriate needs of each individual resident, bringing him/her to the highest practicable level of functioning. Review the activity calendar posted in the facility and look for a balance between physical and intellectual programs, arts and crafts, religious programs and community outings.

Does the facility have an active volunteer program? When you see volunteers, it's a good sign that the facility has significant community support and involvement. Volunteer programs help to meet the goal of the facility to bring the resident to the highest practicable level of functioning and provide an extra dimension of stimulation to the daily care environment.

Check with the facility to be sure the resident can bring items from home to give the room warmth and comfort. Is there a phone in the room or is there a public phone accessible for residents' use? Unless you pay extra for a private room, count on having a roommate. Be sure to ask questions about changing roommates in the event the first match doesn't work.

When choosing a long-term care facility, schedule a visit to coincide with mealtime. Look to see if the residents are coming to the dining room to eat their meals and talking with one another. Does the food look and smell appetizing? Does it taste good? Ask if a professional dietitian plans the menus and supervises meal preparation, and do the meals meet the residents' nutritional and dietary requirements?

Are the menus posted and do they match what is being served? Do they cater to the likes and dislikes of the resident? Are choices given? Are snacks provided? Do the residents receive assistance in eating, if required?

Meal time is an important social time for most residents. Are men and women eating together? This encourages everyone to be well groomed and sociable. Are the tables attractive and not too large? Ask to eat with the residents and offer to pay for your meal.

On a regular basis, the Illinois Department of Public Health makes an unannounced inspection of all facilities to see if the facility is doing its job. Some of the areas the State surveyors look for are outcome - has the resident achieved his/her "highest practicable level of functioning." If there are problems with outcome, surveyors will review staffing levels, the health status and hygiene of each resident, food service and nutrition, monitor medical records and documentation. These survey reports are public records, so you can ask to read the facility's latest survey. This may provide answers to many questions. Feel free to talk to the Administrator or admissions representative about the survey and to review the facility's response. Just remember these reports should not be the only thing on which you base your decision. A poorly run facility may get a good report. You want to use the reports for determining if there are any patterns of problems over a period of time. If a facility is certified to participate in the Medicaid program, the Department of Public Aid will also survey the facility annually. All of the facilities listed in this directory have been licensed by the Illinois Department of Public Health.

There is a source to aid you in identifying a quality long-term care facility. This is a process of accreditation, much like what you would use to select a good college. Facilities that seek this accreditation are willing to open their doors for review by their peers; a fact that you should use in your choice of a long-term care facility.

The Illinois Health Care Association provides a significant peer review and evaluation program which leads to accreditation and the facility receiving our Seal of Approval. More than 400 Illinois long-term care facilities belong to this professional association and have, therefore, achieved this standard. These facilities provide nearly 33,000 long-term care beds and display the IHCA Seal of Approval in a prominent place.

If you are considering a facility in Illinois and don't see evidence of the Illinois Health Care Association's Seal of Approval, you may wish to ask the Administrator about it.

Upon admission, or shortly thereafter, a resident assessment is completed. The resident assessment process evaluates the resident's physical, mental and emotional needs. The resident's plan of care is developed at an interdisciplinary team meeting based on the resident assessment process. A plan of care considers the resident's likes, dislikes and personal preferences. What kind of food does he/she like or dislike? Does he/she like to stay up late or take a nap during the day? All these areas need to be considered to make the resident's stay comfortable and as normal as possible. Care plan meetings are to be scheduled on a regular basis and are to include the resident (if able) and the family if they are to be involved in any decisions regarding care. The care plan team evaluates what changes are made in the resident's condition, which may require major or minor changes in the resident's plan of care.