Touring a care home over the holidays: the questions to ask

Many Texas families tour homes between Thanksgiving and New Year's, when siblings are in town and can go together. That is a smart time to look. Homes are decorated, families are visiting, and you can see how the staff handle a busy day.

The trick is to look past the wreath on the door. Here are the questions to ask, grouped so you can split them between family members.

Before you go

• Check the license first. Look the home up in the Texas Senior Care Directory or on the HHSC provider search. Write down the license number, Type A or Type B, and the number of licensed beds. Our license guide shows how.
• Write a one-page snapshot of your parent: what they need help with, their medicines, how they sleep, whether they wander, what they love to do.
• Plan two visits. The Alzheimer's Association suggests visiting several homes, including unannounced visits. A scheduled tour shows you the home at its tidiest. A second visit at a different time shows you a normal day.

Questions about the license and the rules

1. What type of license do you hold, A or B, and how many people may live here under it?
2. Do you hold an Alzheimer's certification? Under the Texas assisted living rules, a home that advertises specialized Alzheimer's care must be certified, and only a Type B home can be. That is my plain-language reading of the rule, not legal advice.
3. May I see your most recent state inspection and how anything cited was fixed?
4. Under what conditions would you ask my parent to move out? The Alzheimer's Association also suggests asking about the discharge policy and whether residents can stay as their needs change.

Questions about the people who give the care

1. How many residents does each caregiver look after during the day, and at night?
2. Is a nurse here every day? Who is on call at 2 in the morning?
3. Are caregivers trained in dementia care, and how do they handle a resident who is upset or confused?
4. How long have your caregivers worked here? Who would know my parent's name and habits?
5. Who will help with medicine, and how are missed doses caught?

Questions about daily life

1. May we stay for a meal? (Taste the food. Watch how residents are helped to eat.)
2. What did residents do this week? Ask to see the real calendar, not the brochure.
3. How do you handle holidays for residents whose families cannot visit?
4. Can my parent bring their own chair, photos and bedding?
5. How do residents get to doctor visits and church?

Questions about money

1. What is the monthly rate, and what does it include?
2. What raises the rate? Ask for the list of care levels or add-on charges in writing.
3. Is there a move-in fee or deposit, and is any of it refundable?
4. How much notice is required before a rate increase?
5. Do you accept Medicaid through STAR+PLUS, or veterans benefits? Medicare.gov is clear that Medicare does not pay for long-term care, so it helps to know early. See our guide to paying for care in Texas.

Get every answer about money in writing before anyone signs.

What to watch while you are there

• Smell and sound. A clean home smells like nothing much. Listen for call lights that ring a long time.
• How staff talk to residents. Do they knock, use names, and kneel to eye level?
• Residents. Are people up, dressed and doing something, or mostly parked in front of a television?
• Your gut. If your parent would not feel like themselves here, keep looking.

After the tour

Compare your notes the same day while they are fresh. If anything worries you, the Texas Long-term Care Ombudsman, a free and confidential advocate for people living in assisted living and nursing homes, answers at 800-252-2412. To report a concern about a home, the HHSC complaint hotline is 1-800-458-9858.

Looking for a quieter way in? Homes and groups can post open houses, resource fairs and caregiver meetings on our events calendar at no cost, so check it for one near your parent.