Be patient. Ask lots of questions. Have several alternative plans.

Those are among the words of advice from healthcare professionals and families who have experience with Hawai'i's long-term-care system.

Many people wait until a loved one is facing a medical crisis before they even begin to research possible options.

But discussions should start well before that, families and professionals say.

You already should be talking to your parents or elderly relatives about their preferences and what is financially feasible if they become unable to live independently.

"This is something you should do now instead of when you're in crisis mode," said Patty Griffiths, geriatric care manager for Options for Elders. "Then you don't have choices."

Most seniors prefer to remain in their homes as long as possible, but the cost of hiring in-home help — especially if care is needed around the clock — is prohibitive for many.

If care outside the home is the best option, plenty of possibilities exist.

Before you start the search, though, get an assessment from your loved one's physician or a medical specialist about what type of care is needed. The assessment also should include what kind of family support there is.

Hiring a professional placement firm familiar with the complexities and gaps in Hawai'i's long-term-care system can make the selection process go smoother. If you can't afford that option or are inclined to do the navigating yourself, you can get lots of information about nursing homes on the Web.

The federal government operates a site that gives quality-of-care ratings for individual nursing homes across the country, and results can be separated by state. (See www.medicare.gov/NHCompare/Include/DataSection/Questions/ProximitySearch.asp).

For Hawai'i's community-based facilities, virtually no quality-of-care information is readily available. Contact the Department of Human Services, which regulates foster homes, to get results about foster home inspections. The Department of Health regulates all other long-term-care facilities and has inspection results for them. The inspection reports should be just one of many tools used to evaluate facilities.

The state's long-term-care ombudsman's office also has useful consumer information, as do the aging offices for each county.

Once you have a list of possible options, visit each facility to see what they're like. Narrow them down to several preferred choices, just in case some are unavailable when the placement is needed.

One of the key considerations for anyone searching for a long-term care facility is cost. Nursing homes can start at around $7,000 a month, with some topping $10,000. Care and foster homes can cost half that much, but prices also vary.

Here are other things to consider:

• Do the caregivers seem happy on the job? Do the residents seem content? Talk to both, plus contact relatives of the residents.

• Is the facility clean? Is it well organized?

• Do the residents seem engaged in activities or are they just camped in front of televisions? Check the activities calendar to see what events are planned.

• Can you picture your loved one living in the facility? Would he or she be compatible with the other residents? Are their levels of mobility similar? Would the staff be able to accommodate special needs?

• Visit the facility at different times, including during meals, to see how it operates.

• Look at the staff-to-resident ratio to ensure caregivers can provide enough personal attention.

Pearl City resident Grace Sakamoto wasn't able to do any research before her mother, Toshiko Sakamoto, then 88, was admitted to a nursing home in 2007 after fracturing a hip in a fall. Toshiko Sakamoto's nursing home stay was arranged through the hospital where she had surgery following the fall. She died less than a month after moving to the nursing home.

The experience of dealing with Hawai'i's long-term care system convinced Sakamoto that people need to do their homework well before a family member actually needs long-term care.

"I didn't realize how stressful it would be," Sakamoto said. "You really have to be prepared. You really have to talk things through. That will eliminate some of the headaches and tension down the road."