Updated November 03, 2014.

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

The decision to move a loved one into a nursing home (i.e., care home, long term care, skilled nursing facility- a rose by any other name is still a rose) can be a difficult one. I've had loved ones in facilities and worked in the industry for twenty years, and I've never heard anyone say, "Oh, I hope I need lots of care and get to move into a nursing home!" (Fortunately, I have heard many times, "Mom said if she ever needed care, this is the place she wanted to be.")

Read more: How Do You Know if Your Loved One Needs a Nursing Home?

Understanding  what's realistic and appropriate to expect from nursing home care may be helpful in guiding your decision of whether to proceed with admission to a facility or not, and hopefully assist in the transition if you do.

On that note, here's my list of what you should not expect from a nursing home. (And let me clarify- my list below refers to facilities that overall, are good nursing homes.)

Read more: How to Research and Choose a Good Nursing Home

8 Things NOT to Expect

• Don't Expect that the Staff Members Don't Care

If you judge every nursing facility by the media reports on a few, you will approach this decision with much terror, apprehension and guilt, and understandably so. Yes, there are some people working in facilities who don't do a good job and don't care, but the majority are there because they do. The nurse aides have, what I would argue, one of the most difficult jobs around, and they possess a wealth of knowledge about those for whom they care.

Many of them could get an "easier" job somewhere else making a similar amount of money, but have concluded that this is where they want to be.

What Should You Expect? In a good facility, people typically are going to try their best to meet the needs of the residents. Starting out with the assumption that the staff care about the residents (but balancing this with a watchful eye to ensure they do)  is more helpful to you and the staff than beginning this venture with only negative expectations.

• Don't Expect One-on-One Staffing

This may seem obvious, but nursing home care is not one caregiver providing care to one resident. You may need to be a little patient with waiting for your loved one's call light to be answered, or for the nurse to make rounds to your loved one.

What Should You Expect? You SHOULD expect needs to be met and generally, for call lights to be answered without a long delay. You should also expect an individualized approach to your loved one's needs, rather than a "One-Size-Fits-All" approach.

Read more: What Does Person-Centered Care Look Like?

• Don't Expect Guarantees that She Won't Fall

Long term care homes can't promise that your loved one won't fall when getting out of bed or suddenly lose her balance and go down while walking. They can't restrain her by never allowing her to get out of her chair, or use full-length, double bed rails to try to keep her in bed. If your only reason for placing your mom in a facility is so that she won't fall, you may want to reconsider this decision.

Read more: I Don't Want My Mom to Fall. What's the Problem with Restraints When They're Used for Her Safety?

What Should You Expect? Most residents benefit from regular exercise to try to strengthen them, and they may have specific individualized interventions to try to decrease the likelihood of falls. Some residents might benefit from alarms that alert staff when they need assistance, or low beds to reduce the chance of injury if they do fall when getting out of bed.

Read More: What Are Some Causes of Falls in Dementia?

Read More: Different Kinds of Alarms to Reduce Falls

• Don't Expect Perfection

Here's another obvious but important one. Is everything going to be perfect? No.

What Should You Expect? You and your loved one have the right to be treated with dignity and respect, and to privacy to the extent that it's feasible. It's reasonable to expect good care for your loved one and best efforts from staff. You have the right to, and should, express any concerns about your loved one's care and preferences. It's far better to respectfully express your concerns than to go home without saying something for fear of "rocking the boat." This denies the staff the opportunity to improve on how they provide care and hinders them from better understanding and meeting your loved one's needs.

Read more: How to Effectively Advocate for Your Loved One

• Don't Expect a Lack of Decline in Dementia

It's not realistic to expect that if you change the environment and routine of someone who has Alzheimer's or another kind of dementia, this won't affect him. It's not uncommon to see an initial decline and increased confusion after the move to a nursing home. It takes time to adjust.

Read more: 5 Ways to Help Your Loved One with Dementia Adjust to a Facility

What Should You Expect? From my clinical experience, It typically takes anywhere from a few days to a month or two for someone with dementia to adjust. Often, after this adjustment, their memory and other cognitive abilities may bounce back close to the approximate level of functioning prior to admission. If you're not seeing this rebound and there aren't other reasons that explain it (such as a urinary tract infection or another illness), talk to the facility staff and also consider if your loved one may be depressed.

Read more: Recognizing Signs of Depression in Dementia

• Don't Expect Things to Be the Same as They Were at Home

It's not realistic to expect that nothing will change in your family member's daily routine, the specific methods of providing care you used at home or her treatment regimen.

What Should You Expect? You can expect reasonable efforts at implementing the preferences of your loved one. Your loved one's routine may need to be adjusted to allow for the care of several persons, rather than just one person. You might also see changes in your loved one's medications, among others areas. Nursing homes have strict regulations about the need to decrease psychoactive medications- specifically antipsychotic medications- and try non-drug approaches for any behavioral challenges present in dementia.

Read more: Should Your Loved One Really Be Taking an Antipsychotic Medication?

• Don't Expect Facility Staff to Be Mind-Readers

They don't always know what you're thinking or what you want. Please tell them.

What Should you Expect? Ask for, and expect, the staff to communicate with you about concerns that develop. For example, you should be informed about significant changes in condition, falls and notable behavior challenges. If, however, your expectation is that you'll be informed about a different specific issue, you should let the facility know ahead of time of your request.

• Don't Expect that Your Loved One Will Hate It There for Sure

As I mentioned above, it may be a universally agreed-upon sentiment that facility care is not something we hope to need, but not every resident hates living in a nursing home. I've seen many people have very full lives while living in a facility. Sometimes, their loved ones just weren't able to meet their needs at home, and now, hopefully they're getting their physical, social and emotional needs more fully met.

Read More: How Can You Improve Quality of Life for Someone Who Has Dementia?

What Should You Expect? A good facility will care about your loved one and work to meet his needs- for physical care but also for social interaction, emotional concerns and spiritual needs. Adjustment to, and contentment in, a nursing home are not a guarantee, but neither are they an impossibility.

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