Questions to Ask Before Moving a Parent to Elder Care

Questions to Ask Yourself First

Before you tour facilities or research programs, answer these honestly:

What triggered this search? A fall? A hospital discharge? A slow accumulation of daily struggles you can no longer manage? The trigger determines urgency. A hospital discharge with a 48-hour placement deadline requires a different approach than a proactive search prompted by gradual decline. Name the trigger so you can calibrate the timeline.

What level of care does your parent actually need right now? There is a difference between needing help with meals and housekeeping (personal care level) and needing wound care, IV medications, or 24-hour nursing supervision (skilled nursing level). Pennsylvania's licensing framework distinguishes between Personal Care Homes (Chapter 2600), Assisted Living Residences (Chapter 2800), and Skilled Nursing Facilities (28 Pa. Code Ch. 201-211). The clinical need determines which license type is appropriate.

How long can current resources sustain the situation? If you are the primary caregiver and your own health is declining, "as long as it takes" is not a realistic answer. If your parent is paying privately for home care at $34 per hour for 40 hours a week, that is roughly $70,700 per year. How many years of that can the savings cover? Honest financial math prevents crises.

Is legal authority in place? Do you have a signed durable power of attorney (financial, under Chapter 56) and a healthcare power of attorney (under Chapter 54)? Without these documents, you cannot sign facility admission contracts, access financial records for Medicaid applications, or make medical decisions. If your parent still has cognitive capacity, getting these documents executed is the most urgent pre-move step.

Questions to Ask Your Parent

What matters most to you about where you live? This sounds obvious, but families often skip it. Some seniors prioritize proximity to their church or community center. Others care most about having a private room. Some want to be near a specific family member. Knowing the non-negotiable preferences before you start searching eliminates facilities that would never work.

What are you most afraid of? The fear behind resistance to a care transition is usually specific: losing independence, being forgotten, having strangers provide intimate personal care, leaving the house where they raised their children. Naming the fear makes it addressable. "I'm afraid I'll be alone" can be solved with a facility that has robust social programming. "I'm afraid of losing my house" can be addressed with the Medicaid home equity exemption rules.

Are there things you are struggling with that you have not told me? Many seniors minimize their difficulties to avoid burdening their children. They eat cereal for dinner because cooking is unsafe. They skip medications because they cannot open the bottles. They do not mention falls because they were able to get up. A direct, specific question sometimes opens a conversation that a general "how are you doing?" never will.

Questions to Ask the Facility

What is your license type — Chapter 2600 or Chapter 2800? If the answer is Chapter 2600 (Personal Care Home), ask: under what conditions would you issue a discharge notice? The legal discharge triggers under Chapter 2600 — becoming permanently bedfast, needing 24-hour skilled nursing, or developing advanced pressure ulcers that the home cannot manage within its regulatory license — determine whether this facility can be a long-term home or a temporary stop.

What is your overnight staffing ratio? Daytime staffing is visible during tours. Overnight staffing is where care often breaks down. Ask for the specific aide-to-resident ratio on the overnight shift, not just the number of staff in the building.

What is your process for handling medical emergencies after hours? Does the facility have a nurse on call? Is there a physician on call who can assess and provide orders? Or do all after-hours medical events result in an ambulance call? The answer tells you how capable the facility is of managing clinical situations without defaulting to emergency room visits.

Can I see your most recent inspection report? If the facility hesitates or deflects, that is information. Facilities with clean records are usually happy to show them. For nursing homes, you can pull inspection reports independently from the DOH Nursing Care Facility Locator. For personal care homes, check the DHS Human Services Provider Directory; if a record is not posted, contact the DHS Bureau of Human Services Licensing.

What are the all-in monthly costs? The base rate is the starting point, not the final number. Ask for a written list of all additional charges: laundry, personal supplies, medication management fees, beauty/barber services, specialized activities, transportation to medical appointments. The gap between the quoted rate and the actual monthly bill can be $500 to $1,000 or more.

Before You Decide

A care transition does not have to be permanent on day one. Pennsylvania has multiple intermediate options — adult day services, home care through the OPTIONS program, respite care through the Caregiver Support Program — that can buy time for a more deliberate decision. A family that is making a placement decision under crisis pressure is more likely to accept the first available bed rather than the best available fit.

The Choosing Care in Pennsylvania guide provides a structured framework for working through these questions, including a care-setting comparison worksheet, a facility tour checklist, and a financial planning tool that maps costs against resources and program eligibility.

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