Placing a loved one in a long-term care facility can become an emotional decision, one which is confronted by hundreds of people every day. There are many types of long-term care services available in facilities of all sizes, as well as a variety of support services. Selecting the right one for your situation can be a trying, heart-rendering experience. The emotions involved take many forms, but most stem from the feelings of inadequacy and guilt accompanying the decision to place a parent or relative with a long-term care facility.

To deal with these feelings, make the most rational decision possible. Determine if a nursing or other long-term care facility is needed or if you could better meet the individual's needs in another way. After making your decision, choose a facility to meet the resident's needs, and involve that person in the decision-making process.

By following these simple steps, you should reduce the anxiety and frustration that are felt by most people.

This guide is designed to assist you in making that emotional decision and to aid you in determining which facility is right for your loved one.

The aim is to help a person care for him or herself to the best of their ability, and to return to one's own home and community whenever possible.

Nursing facilities provide skilled nursing care services on a 24-hour basis. These are procedures requiring the professional skills of a registered or a licensed practical nurse, including administering and monitoring medications, injections, catheterizations, and similar procedures ordered by the attending physician. Post-hospital stroke, heart or orthopedic care are available, with related services such as physical, occupational and speech therapy, dental services, dietary consultation, laboratory and x-ray services available. The emphasis in a nursing facility is on rehabilitative nursing car, with restorative, physical, occupational, and other therapies also provided.

Personal care services such as help in walking, getting in and out of bed, bathing, dressing and eating, and the preparation of special diets as prescribed by a physician are also in the scope of nursing facility services.

Many nursing facilities serve special populations, such as patients with Alzheimer's disease, AIDS, or others requiring specialized services.

All nursing facilities in Ohio must be licensed by the state. Participation in the Medicaid and Medicare programs (or certification) is voluntary. Not all, homes which are licensed, are certified for Medicaid or Medicare.

Nursing facility care can be paid by the individual, and may be funded by the Medicaid or Medicare programs or through private long-term care insurance.

Your doctor or social worker usually will be familiar with the area facilities. Other sources of information include the Ohio Health Care Association, and affiliate of the American Health Care Association; local medical societies; hospital discharge planners; local or county aging agencies and ombudsmen; and health or human services departments. Friends and neighbors may offer information if they are acquainted with someone in a nearby facility. Religious organizations also may recommend local facilities. Surveys conducted by the Ohio Department of Health are also available for review.

By telephoning the facilities on your initial list, you usually can narrow the field to two or three facilities offering the specific services and location required. Plan to visit each of these facilities. Utilize the information in this web site and don't be afraid to ask questions!

Still, to families or individuals faced with placing a loved one in a nursing facility, the prospect of substantial costs for this long-term care can be intimidating. It helps, therefore, to understand what costs can be expected, what kind of care and service this money will provide, and what options are available to persons about to enter a nursing facility.

We have stressed selectivity in the type of facility you choose. As your doctor will tell you, you do not need a higher quantity of services than the situation requires. Applying your choice to the needs of the individual will help keep down your health care cost and allow others in greater need of more services to obtain them. Remember that many nursing facilities have waiting list.

When meeting with nursing facility administrators and social service personnel, discuss financial conditions in detail. All financial agreements should be in writing, and you should have a copy of the final arrangements. You may wish to cover the following areas in advance:

• How are payments covered, whether Medicaid, insurance or self-pay?
• How are cash and assets entrusted to the home protected? Is a receipt given to the resident? Are withdrawals noted by signed receipts so that the resident can keep track of his/her account?
• Is the agreed date of admission and the degree of care to be furnished set forth in the written agreement?
• Will the resident receive a refund of advance payments if he/she leaves the facility?

There are many ways to finance nursing facility care. These might include Social Security payments, your own funds, assets in escrow or as an endowment, assistance from Medicare or Medicaid, or from private organizations such as veterans groups, trade unions, fraternal organizations, or health insurance plans.

Some insurers provide nursing home coverage and, in addition, specialized long-term care insurance policies are available. Be sure to check with your agent and /or group insurer to see what your benefits are. The administrators of the homes you visit can help in your financial planning under these methods or under Medicaid and Medicare.

It is difficult for the average person who is not familiar with cost in health care to find parallels to help them understand the value they receive in nursing facilities. Some people compare daily rates for nursing facilities against daily rates in hospitals. While hospitals are obviously capable of providing more intensive care to patients, nursing facilities charges for 24-hour services are usually 15 to 20 percent of those charged by hospitals. In fact, in many instances nursing facilities chare less for 24-hour skilled nursing care that others do for a quality hotel room.

It helps to know what your long-term health care dollar buys.

While every situation is likely to be just a little different because of the type of long-term care facility and the service required for each individual resident, there are certain generalities, which we can draw.

• Forty percent of the long-term care dollar goes for direct medical care: nursing staff, doctors, therapists, dentists, and other health care professionals.
• About 18 percent of your long-term care dollar goes for housing costs: resident rooms, kitchen, dining and activity areas, and specific accessibility requirements imposed by the government.
• About 12 percent of your long-term care dollar goes for dietary services: required nutritional levels and monitoring as well as actual food costs.
• About 12 percent of your long-term care dollar goes toward "quality of life." Activity programs; housekeeping; laundry; maintenance and infection control; chapels, beauty and barbershops, transportation, lounges, and patios.
• Administrative expenses account for 14.5 percent of your long-term care dollar: licensed administrator, record-keeping, and clerical personnel; equipment and supplies.
• About 3.5 percent of your long-term care dollar goes to profit: Seventy-five percent of Ohio's nursing facilities are owned by a private individual or corporation; profit is the reward for the risk involved in making health care services available.

If certain criteria are met, the bill (for covered services only) may be paid by Medicare for the first 20 days in each benefit period. Experts on Medicare determine the amount to be paid, which the nursing facility can accept as full payment. Some of the bill can be paid for covered services for up to an additional 80 days, if the patient qualifies.

The Medicare patient's case is, however, routinely reviewed by the Social Security Administration. When it is determined by these reviewers that the patient no longer requires skilled nursing facility services, Medicare payments are ended.

Medicaid, on the other hand, is a federal-state financed assistance program for certain needy and low-income persons of all ages. States design their own programs within broad federal guidelines. Thus, Medicaid programs will vary from state to state. Medicaid pays only for basic care needs, excluding amenities such as private rooms, etc.

You may need to complete applications for both Medicare and Medicaid. Please discuss this with your social worker, the facility's administrator, or local aging office.

Data on Ohio's regulations are available from the Ohio Department of Human Services, which administers the program in Ohio, and your county aging, ombudsman or Human Services office.

An administrator serves as the top manager of the facility. This person has special education and training in long-term care and must be licensed in the state of Ohio. Each nursing facility is required to have a licensed administrator.

Nursing personnel are available around the clock. The nursing department is headed by a director of nurses. Twenty-four-hour coverage is provided by licensed practical and registered nurses. When you tour a facility, look to see if the nursing staff is interacting with residents, answering call signals quickly, and talking with the residents. If special treatments or nursing measures are needed, ask if they will be available.

Activities are provided in all facilities. Ask to speak with activity coordinator and find out what types of individual and group activities are available. Social services may be provided by the facility staff or through an outside agency. Ask about social services.

The dietary department is under the direction of a food services supervisor or dietitian. A dietitian is available to perform nutritional assessments and design special diets.

Other specialists may also be on staff or available on a consultant basis: medical records technicians, physical therapists, occupational therapists, therapeutic recreators, psychiatric personnel, medical director and consultant pharmacist, podiatrists, and dentist. It is important to find out what specialists you will need and to make sure the facility has them or is able to provide their services.

Nursing facilities also employ environmental, maintenance and housekeeping personnel for sanitation and safety. The most important thing to look for in a nursing facility is the kind of people who care for the residents. People providing services to people is what nursing care is all about.