7 Considerations for Choosing the Right Assisted Living Facility
The Benefits of Assisted Living
Assisted living facilities provide a bridge of care between independent living and nursing facilities for seniors. Independent living is an appropriate option for many seniors that are still able to drive safely, cook, and manage their medications. Nursing home facilities provide skilled nursing care for those with medical conditions that require constant medical intervention and oversight or with physical limitations that require hands-on assistance for daily living necessities. If your loved one is not quite appropriate for the nursing home but cannot safely live on their own, consider an assisted living facility.
Like nursing homes, assisted living facilities are governed by state rules and regulations that vary by state and dictate standards for care and admission and retention requirements. Depending on the state, assisted living facilities may not be able to provide skilled nursing services, but they can assist with many tasks that provide safety for their residents. For instance, an assisted living facility may be unable to treat wounds for more than 90 days because a long-term wound becomes a skilled nursing need, but they may bring outside services in, such as Home Health agencies, to treat a skin tear that heals within a few weeks. They may not provide daily, on-site physical therapy, but they may bring in Home Health agencies to provide the service a few times a week. The key to assisted living is the word "assist"; residents must be able to assist with or direct their care. For instance, some regulations dictate that a resident must be able to stand and transfer with assistance from staff; in other words, a resident that requires a lift, cannot physically assist with transferring, or cannot propel themselves in a wheelchair may not be appropriate for an assisted living, depending on state regulations and licensing.
Residents are provided care and assistance with activities of daily living. Facilities may provide three nutritionist-approved meals a day as well as snacks around the clock. Residents can get assistance through housekeeping and laundry services. They are also provided activities throughout the day. Residents that need hands-on assistance may have staff assist them with medication, bathing, toileting, grooming, dressing, and transferring. By providing 24-hour staffing, daily assistance with activities of daily living, and oversight of medical care, assisted living facilities allow seniors to maintain some of their independence while providing their families the knowledge that they are safe and well-cared for in a home-like environment.
For seniors that fall in between for the type of care they need, this type of facility deserves consideration. After working five years in an assisted living facility and visiting many others during my time working in the healthcare industry, there are seven areas that I recommend paying close attention to during your visit. When you visit the facility and speak to the staff, evaluate each of the following things; they will help you make the right decision for your family member.
The staff of the assisted living facility can provide a good glimpse into facility life. First, the staff should always be friendly and accommodating toward visitors such as yourself. Do they take the time to shake your hand and introduce themselves (unless busy attending to a resident, of course)? First impressions are everything, and that includes when finding a place for your loved one. If a staff member is rude to you, don't be afraid to think they'll be the same with residents. This does not mean that all staff in the facility should be judged on one person, but if this happens, pay close attention to the rest of the staff.
I believe you can tell a lot about the staff of a facility by watching them with the residents. Make it a point to be attentive to how the staff interact with the residents. How do they respond to resident questions or needs? Staff that have a good relationship with residents will frequently be involved in friendly conversation, and you'll often find them sharing a good laugh. The best staff are always positive and compassionate in what they say and do, and they take the time to spend time with the residents even on a busy day.
Sometimes you will visit at a hectic time. It may be lunch time and the staff is busy serving meals, there may be an emergency, or a resident may be ill. If you don't get to see much of the staff, don't worry; there may be a very good reason that they are scarce.
If you get a chance, chat with some of the residents. Don't be afraid to ask residents a question or two; they will usually be honest about their thoughts. It may be that during your visit you recognize someone you know, went to church with, or whose children you know. Make use of those connections to find out what you can about the facility. Also, keep an eye on how the residents act with the staff. Do they seem to have a good relationship? Do they seem to know the staff well? Body language can be a clue. Also, if the residents start little conversations with the staff, that's a good sign.
Another important thing to notice is the quality of the care for the residents. Do they appear disheveled? You want to see that the staff take care of the appearance of the residents, so look for "bed head" and dirty clothes. It takes less than a minute to comb someone's hair; the staff should take the time for small things such as this. Take note of how the staff respects a resident's privacy. You may be witness to an "embarrassing moment" for a resident, and you want to make sure that the staff takes care of it as privately as possible out of respect for the resident. Speaking loudly in front of others about an issue or calling out loud for a resident to come with them to the bathroom are inappropriate. Private moments should always be private, at least as best they can be.
How the facility takes care of its physical appearance can give a good clue as to how it takes care of its residents. Don't be picky: not everything is going to be sparkling clean all of the time. A few leaves on the porch on a windy day is not a sign of an unclean property. On the other hand, there are many other things to look at when touring the property:
- Is the dining room dirty two hours after lunch?
- Is there dirt or dust on the walls or décor?
- Did the staff walk by without picking up that napkin from the floor?
- How do the empty rooms look and smell?
Also, pay attention to any open, occupied rooms you may pass. Is the carpet dirty? Does the room look messy and unkempt? Staff should always take care to make sure a resident's room is tidy and ready for visitors. Some residents are naturally messy, so see if you see a pattern in the rooms you pass. You don't want to be ridiculously picky, but you know what you expect a clean home to look like. The same concept applies here.
One note about smells: don't automatically dismiss a place due to smell. You may have the unfortunate timing to pass a room with an unfortunate smell. With this population, smells happen. I can promise you that the staff you're with are just as embarrassed and uncomfortable as you are, so give them the benefit of the doubt unless it is something you notice throughout the facility.
The Activity Program
Seniors need activities that will benefit them mentally, socially, and spiritually. While some people naturally prefer to spend time alone in their rooms, all residents need stimulation and social interaction to prevent anxiety and depression. Busy seniors complain less and focus less on their ailments. By keeping seniors active, facilities have busy, happy residents, allowing you to have a content, happy family member. For this reason, activities should be high on your list of priorities when assessing facilities.
Every assisted living facility should have a comprehensive activities program that contains a little something for everyone: live entertainment, group socials, birthday and holiday celebrations, religious services and studies, arts and crafts, mental and physical exercise, and more. One of the biggest questions I would ask when looking at an assisted living facility is if they have an activities director. Not another employee who has activities planning added to their long list of to-dos. A true activities director. The answer to this question will tell you what importance they place on activities for their residents. I'm not saying not to consider a facility if they do not have a full-time activities director, but I can tell you from experience that to have a regular, solid activity program full of variety and many activities a day, a facility needs someone devoted to activities.
One of the top reasons people seek placement for their loved ones is due to safety. Whether they've fallen, they've not taken their medications, or they've become ill, there is some reason that they cannot live on their own and need 24 supervision to keep them safe and sound. Assisted living facilities provide for this need by providing caregivers around the clock, staff assistance and oversight of activities of daily living, and staff assistance with medications.
When visiting a facility, find out how their emergency alert system works. Do the residents have emergency pull cords? Do they use more advanced technology such as a bracelet or a necklace? Also, if the system provides audible alarms that you can hear, pay attention to how long it takes for those calls to be answered. Yes, the staff may be tending to other residents; however, they should still respond in a reasonable amount of time. Find out the number of staff on site at any given time for assistance. Some assisted living facilities work with minimum staff, such as one caregiver for 16 residents. While that may be fine according to state regulations, be sure to consider how this might influence your loved one's care.
Assisted living facilities often have rules and regulations for things that may seem small to you but are meant to keep residents safe. For instance, they may require prescriptions and labels for all medications, including over the counter medications. Depending on the license and type of facility, they may not allow cleaning chemicals in resident rooms or require everything labeled "keep away from children" to be locked away. Inquire about any of these rules that will be applicable in the facility, but remember they are to ensure the safety of all residents no matter how silly they may seem for your loved one.
Costs and Contracts
When discussing the cost of the facility, be sure to get the answers to the following questions:
- Is cable/telephone/internet included?
- If there are extra charges for other certain services, what are they and when do they apply?
- What maintenance services are included and which ones are at an extra cost?
- If my loved one is ill and needs a sitter, do you provide one-on-one services? What's the cost? Can we use outside services or privately hired sitters?
- Are there ever extra costs for activities?
- If my loved one's care increases, does the cost increase?
- If yes: how is that calculated and what's the maximum it could be?
- How often do you assess their care and cost?
- Do you ever have increases for cost of living?
- How often do you raise rates for cable, telephone, levels of care, guest meals, etc.?
- For couples: do you provide discount rates for couples in the same apartment?
- How long are we financially obligated if my loved one gets sick and has to move? Passes away? Decides to move elsewhere?
- Is there a security deposit? Is it refundable?
- Are there charges for rehabbing the room when we leave and what might they be?
Various assisted living facilities do things differently. Some require a full 30-day financial responsibility after giving a notice to vacate, even at death. Others allow the financial agreement to terminate after a death once the furniture is removed. At some point, your loved one may have multiple falls or become ill and need a temporary sitter for safety. Some facilities only allow you to use their own staff for a high cost. Others allow you to hire an outside agency that may or may not be approved by them and is typically much cheaper than using their own staff. Find out about these things so you are prepared when they happen.
No question is too silly! You want to get as clear of a picture as you can on any possible costs, so there are no surprises. Don't be afraid to ask how they determine that they need to replace the carpet when you move out and what that cost might be. Get detailed! You don't want any uncertainties because when it is time to sign the contract, there is a lot of information to digest and you just might miss something important you should have asked before signing on the dotted line.
Why Are You Considering Assisted Living?
State Survey Results
Check the facility for its last state survey summary and see what violations were found. There should be a place in the facility where such information is posted. You can contact the state's regulatory agency to request or view the latest information. Many agencies also have reports available on their websites for easy viewing. These results can give you further information and even provide you with important questions to ask before making a decision.
When reviewing violations, look for red flags on medications and resident care. Carefully consider the violations and how they would relate to the care of the residents and your loved one. An emergency exit light being out happens, but a resident not getting their medication or an emergency call light not being answered for a significant amount of time is a big deal. There is a whole range of possibilities for why these things happened, so see if you can find information on previous surveys. Are these repeat offenses? If the results are recent, don't be afraid to ask the facility how they corrected the violations to prevent them in the future.
The Assisted Living Option
When your loved one cannot safely live on his or her own, hiring private sitters, living with family, or choosing a nursing home are not the only answers. Assisted living facilities give seniors and their families the option of 24-hour care in a homelike setting. With three nutritional meals a day, quality activity programs, and constant health oversight, you can rest assured that your loved one will have the care that they need most.
There are many assisted living facilities to choose from, so be sure to do your research. Read online reviews and state reports. Visit the facility, pay attention, and ask questions. Do not be afraid to pepper them with even the most trivial questions; it is their job to sell you on their facility, and part of that is making sure you have all of the information you need to make the right decision.
In the end, if it turns out that your loved one is more appropriate for a skilled nursing facility, use your assisted living facility contact as a resource. Often they have frequent contact and experience with local nursing homes and can point you in a direction that best fits your family member or at least get you in contact with someone with the right answers. A good facility will be happy to help you, whether assisted living is right for you or not.
- Assisted Living: National Institute of Health MedlinePlus
Information on assisted living with links to helpful resources.
- Senior Assisted Living Guides: Find Senior Care A Place for Mom
A free resource helping seniors, families, moms and dads find assisted living facilities, dementia care, Alzheimer's memory care, and nursing homes.
- Assisted Living Information from ALFA
Resources and information from the Assisted Living Federation of America.