Elder housing isn’t what it once was, and thank goodness for that.

I worked part-time in a real convalescent hospital when I was in college. I remember walking in the front door of that nursing home, and the first thing that hit you was the smell of urine. Too many patients and too few staff to adequately care for them meant the residents were miserable much of the time. It was dreadful for all concerned, but mostly for the patients who were so dependent on us.

These days, elder care has become a booming industry and most senior facilities have stepped up to meet the demand by providing excellent care. The older I get, the more friends and family members I have that need these various levels of care, from temporary stays in rehabilitation hospitals to independent living to full nursing care.

If you foresee that you or a loved one will soon need some degree of long-term care, it might be a good idea to start looking at the options.

Here’s a breakdown of the major types of facilities.

Independent living

These are best for people who want convenience, don’t have specific medical care needs and can live on their own. Independent living communities offer such niceties as meal preparation, housekeeping and security, and may have on-site beauty parlors and barbers, church services, buses to take residents shopping and transportation to appointments. Residents can make use of all or none of these things.

Assisted living

These are for people who need some medical care. They include everything offered by an independent living facility, but can also provide help with managing medications when needed, and with activities of daily living, such as bathing, dressing and grooming. Some assisted living homes are apartment-like settings, and others are more institutional.

Nursing facilities

Nursing homes are for people who need round-the-clock nursing care and other support services. If this is the level of home you are considering, it’s important to inquire about how emergency care is provided. How available are physicians? Are staff members certified in CPR? What are the qualifications of nurses that provide direct patient care? How does the nursing home deal with family visits? How are patients with Alzheimer’s or Parkinson’s cared for? Your local Area Agency on Aging may have some of this information available.

News of substandard care travels fast in the medical community, so ask the patient’s doctor, nurses and therapists what facilities they would recommend. Also ask social workers, relatives and friends.

What to consider

If possible, let the patients participate in the decision of where they will live—even if their needs for care are far into the future.

If you go facility shopping, here are a few points to pay special attention to:

• Cleanliness. To the extent possible, observe hygiene. It shouldn’t be hard to notice if residents are being neglected.

• Staff. Does the number of staff seem adequate to manage the number of patients? That’s not to say that employees aren’t hopping busy, but the staff-to-patient ratio should be such that all patients get bathed and receive other personal attention they need. The same is true not just for nursing care, but also general maintenance and kitchen staff.

• Services. What are the patient’s special needs? Be sure the facility provides for those needs. For example, a patient may require the use of a lift machine to get in and out of bed. Many will need physical therapy and/or a gym where they can go to strengthen their limbs. How are supplies paid for? If supply costs are added to the patient’s bill, are the costs reasonable? Are there regular increases in costs? Hidden charges? Obviously, meals are a key service. Visit facilities during meal times and observe if meals are served in a relaxed manner and if there’s plenty of food available.

Get the unseen story

Don’t accept any facility without first checking its financial stability, record of legal compliance and quality of management. Facilities aren’t likely to be perfect, but significant problems in any of these areas may lead to trouble finding a sufficient staff of qualified health professionals.

Find out if the facility has current valid state and local licenses, and liability and malpractice insurance.

Ask to review state inspection reports and investigate whether they have lawsuits pending.