There are many ways to go about choosing a senior care community for a loved one. Checklists abound, you may be overwhelmed with questions to ask: How do I pay? What percentage of the staff is vaccinated? Is the facility for-profit or not-for-profit? The list goes on. If you want to hone in on one thing, consider staffing.

(GETTY IMAGES)
According to a survey published in September by the American Health Care Association, "86% of nursing homes and 77% of assisted living providers said their workforce situation has gotten worse over the last three months."

Nursing homes are experiencing a high level of staffing shortages while assisted living residences are experiencing a moderate level.

Staffing Shortages Affect Quality of Care
Back in 2002, I interviewed then program director for the Volunteer Advocacy Program in the New Jersey Ombudsman's Office for the Institutionalized Elderly Joann Cancel for my book "Who Moved My Dentures?" Here's what she told me then:

"The biggest problem today is staffing and it applies to all states. Years ago, abuse was the biggest problem in long-term care. It still exists but now the bigger issue is neglect because of inadequate staffing and poor work ethics."

That was 19 years ago – what has changed? Well the pandemic brought to light a few things. Trust in long-term care has eroded. With that, consideration of long-term care has dropped in preference to aging in place. That had an impact on census, revenue and budgets.

So, what happens? People are let go. Those who stay are asked to do more and burn out. Add to the post-pandemic reevaluation of work, and you find lower paid but essential employees questioning if this is what they want to do for a living every day.

[ READ: Antipsychotic Use in Nursing Homes. ]
Get Help With Your Decision
Still for many, an organized community of care (continuing care retirement community, assisted living, independent living, skilled nursing) is sometimes a necessary and important consideration when no other care options are available, especially if the older person is isolated from friends and family.

So, as you consider a community of care, consider first getting some help. A geriatric care manager can help you sort through your options. Then consider a registered nurse who can come with you as you tour a place and help you ask the right questions.

Start With Baseline Guidance
Unfortunately, assisted living is less regulated than nursing homes, so hard and fast data is difficult to come by when evaluating staffing. However, the government's Nursing Home Compare site, weighs staffing when awarding "stars" to facilities. Five stars is considered the highest. This is a good baseline from which to start but not your ending point.

When the Star System was first introduced, staffing was self-reported and the data was unreliable. Places reporting appropriate staffing did not always turn out to be the highest quality places because in reality, the staffing was over-reported. As staffing is probably the single biggest indicator of quality, well, you can see the dilemma.

The Centers for Medicare & Medicaid Services imposed stricter standards for its consumer-facing nursing home ratings in 2019, including new separate ratings for short-term and long-term stays. But U.S. News and World Report recognized the issue one year sooner in its Best Nursing Home ratings.

Finally, research state facility inspection reports too. You can ask to see the state report when you visit a care home.

On July 30, 1965, President Lyndon Johnson signed the laws that created Medicare and Medicaid as part of his Great Society programs to address poverty, inequality, hunger and education issues. Both Medicare and Medicaid offer health care support, but they do so in very different ways and mostly to different constituencies.