context: If you have multiple sclerosis, you know your condition can change a lot over the years. You may reach a point when you need a lot of extra help to take care of yourself and everyday tasks. Depending on your situation, you might be able to get help from loved ones, hire a part-time caregiver, or move into an assisted living facility. But if you need round-the-clock care, a nursing home may be a good choice. Nursing homes usually give two types of care: Basic care includes help with everyday tasks like bathing, eating, and getting around. Skilled care includes help from trained health professionals, like a registered nurse, physical therapists, occupational therapists, and respiratory therapists. That varies from place to place. They often include: Room and board Help with medication Personal care (including dressing, bathing, and using the toilet) 24-hour emergency care Social and recreational activities It takes time to research them and find one you like. So start your search for one long before you'll need to move to a facility. You may have to get on a waiting list, especially if you're using government funding such as Medicaid. Also, if you plan ahead, you can make the transition of moving much easier. Talk with your family and caregivers about the services you'll need. Think about the ones that are important to you before you start calling different nursing homes. Ask yourself: What daily activities do I need help with? How often do I need help? Before you schedule a visit to the nursing homes that interest you, ask about vacancies, admission requirements, the level of care they offer, and if they accept government-funded health insurance options. As you and your family think about your long-term care needs, finances will be a big part of the conversation. There are four main choices: Medicare, Medicaid, private insurance, and personal funds. Not all facilities accept each form of payment, so it's important to ask the staff which options they take when you're researching nursing homes. It's important to know how they're different, too: Medicare. This is a federal health insurance program that offers health care benefits to all Americans 65 and over. It offers insurance protection to cover major hospital care, but it allows only some benefits for nursing home care. Also, the program only pays for skilled care in a nursing facility that has a Medicare license. Medicaid. This is a joint federal/state health insurance program that provides medical care benefits to low-income Americans who qualify. The program covers nursing home care, but eligibility and covered services vary a lot from state to state. Private long-term care insurance. You can purchase this health insurance option to supplement Medicare coverage. Private long-term care insurance policies vary greatly. Each has its own rules for eligibility, restrictions, costs, and benefits. When you're researching and visiting one, take this checklist with you. It can help you and your loved ones remember some important questions to ask the staff -- and yourself. Facility Does the nursing home offer the level of care you need, such as skilled care? Does it meet local or state licensing requirements? Does the administrator have an up-to-date license? What are the visiting hours? What's the policy on insurance and personal property? How does the staff respond to a medical emergency? Admission and Assessment Is there a waiting period to get in? What are the admission requirements? Is there a written care plan for each resident? How does the staff decide the kind of care a resident needs? How often do they assess residents? Fees and Financing Have fees gone up a lot in the past few years? Is the fee structure easy to understand? What are the billing, payment, and credit policies? Are there different costs for different levels or types of service? What services are covered in the quoted fee, and what services are extra? What financing options does the center accept (such as Medicare, Medicaid, Medicare Supplemental Insurance, Supplemental Security Income, and others)? When can the facility terminate a contract? What's the refund policy? Staff Do the nurses, social workers, and administrators have experience working with people with MS? Is the staff willing to work with all of your doctors to make a plan for your care? Often nursing homes assign people to a general doctor who is responsible for their medical care. It's very important for him to work well with the rest of your care team. Are staff members available to meet scheduled and unscheduled needs? Do staff members seem to enjoy working with the residents? Do they treat residents as individuals? Do they call them by their first names? Are there people to help residents who have trouble with memory, confusion, or judgment? Atmosphere Do residents seem happy and comfortable? Are they clean and dressed well? What do residents, other visitors, and volunteers say about the nursing home? Are the rights of residents clearly posted? Facility Design Do you like the look of the building and its surroundings? Is the floor plan easy to follow? Do wheelchairs and walkers fit in doorways, hallways, and rooms? Are there elevators? Handrails? Are shelves easy to reach? Are carpets secured and floors made of a non-skid material? Is the building well-lit? Are the living spaces clean, odor free, and a comfortable temperature? Is there a 24-hour emergency response system in or near each room? Are bathrooms private? Are they big enough for wheelchairs and walkers? Can residents bring their own furnishings? What may they bring? Medication and Health Care What is the policy on storing medication and helping residents take it? Can residents take their meds themselves? Who coordinates visits from physical, occupational, or speech therapists? Does a doctor or nurse visit the resident regularly to give checkups? Social and Recreational Activities Is there an activities program? Is the schedule clearly posted? Do most of the residents at an activity seem to join in? Food Service How often does the center provide meals? What's a typical menu? Are there set meal times? Is the food hot and appetizing? Are snacks available? What if residents need special foods? Is it easy to get to drinking water from anywhere in the facility? Are there group dining areas, or do residents eat meals in their rooms? Are there staff who can assist residents who need help with eating?