Your loved one has been in a hospital recuperating from a fall, a stroke or heart attack. The nursing home discharge planner informs you that they will be discharging him/her to a nursing home within a few days. What do you do?

Most likely, the discharge planner will have found a specific placement for your loved one and you feel that you have no choices … but you do!

The first question you must ask yourself is, do you want your loved one to go to a nursing home or return home? The reason a nursing home is often the first option is because additional care is needed. Usually after an acute episode, such as a hip fracture, heart attack or stroke, gradual rehabilitation is necessary to get that person’s strength, coordination, balance and nutrition back.

However, rehabilitation can be done in a nursing home as well as at home. Nursing homes, however, have the capability of providing full-time 'round the clock care, which may not be available at home. You should consider your loved one’s preferences as well as safety issues ,and the ability of the family and caregivers to provide the needed full-time care before making the decision to bring someone home.

If you decide that the nursing home is the appropriate placement, do you have to take the nursing home that the discharge planner has located? No, you don’t. In any case, you should visit the recommended facility as well as additional facilities before choosing one.

Also, look up each facility's report card to see how the health department has rated the facility, and whether they have had any citations issued for care violations. Nursing Home report cards can be found at http://www.medicare.gov/NHCompare. This is one way to compare nursing home violations and get information on any Medicare or Medicaid certified facility in the U.S. Consider the report card as well as the visual inspection you make.

When visiting the facility, look at the residents; see how they are being treated and how they look. Are they lined up in wheelchairs in the hallway? Are they being engaged in activities in the dining room? Talk to the director of nursing as well as the admissions director to see what your loved one’s expected course of treatment and rehabilitation will be. Be aware of how the facility smells. Does it smell of urine? Does it smell of antiseptic cleaner to try and mask a urine smell? Also, consider how convenient the facility is for the loved one's visitors. Patients who have consistent visitors usually get attended to first.

Many patients and family members are unaware of how the nursing home stay will be paid for. In most cases with an elderly patient who has been in a hospital, the stay will be paid for by Medicare. Medicare will pay the first 20 days of authorized care for free. Additional authorized days have a hefty co-payment ($128 per day). If the patient’s Medicare is with an HMO or if the patient has a Medicare Supplement, that will pay for the co-payment. Being in an HMO may also limit the choice of nursing homes to those that are within the provider network, so be sure that the nursing homes you visit are within that network.

Also, find out whether the patient’s primary care physician visits the nursing home, or whether another physician will be taking over the patient’s care. It may be very distressing to find out that the physician does not visit a particular nursing home where a patient may be placed. Ask your physician if he/she visits nursing homes, and if so, which ones.

There are many additional resources to find out how to find a good nursing home, and how to advocate for good patient care. If you think your loved one is not getting the care he/she needs in a nursing home or have an issue or dispute that needs to be resolved, contact the long-term care ombudsman program in your locality.

You can also consult the Nursing Home Companion by Bet Tzedek Legal Services to get additional information about nursing home care.

Janet Morris is a practicing attorney in the area of elder law with Bet Tzedek Legal Services, The House of Justice, in Los Angeles. Through her Family Caregiver Project she assists elders and their caregivers with a variety of legal issues. Janet is an executive board member of the California Coalition of Caregivers and sits on the board of the Alzheimer’s Association, California Southland Chapter. She has co-authored numerous publications including the “Caregiver Companion.” Fluent in English and Spanish, Janet has given hundreds of speeches in both languages. In 2005, she received the Caregiver of the Year Award from AARP and KCET. In 2007 she received an award from MetLife for her contributions to the area of caregiving. Send your questions to Janet@smartnow.com.