If you were born between 1946 and 1964, you count yourself, of course, as part of the baby boomer generation that is the largest in American history. And boomers age just like everyone else. In…
If you were born between 1946 and 1964, you count yourself, of course, as part of the baby boomer generation that is the largest in American history. And boomers age just like everyone else. In March 2018, the U.S. Census Bureau reported that by 2035, adults aged 65 and older will number more than 78 million. By comparison, kids aged 18 and younger are expected to total just 76.4 million, meaning that in short order, the number of seniors in the country will outnumber children for the first time in American history.
As they continue to age, many people need some help in completing the daily tasks of living. Faced with the decision of how to address these needs, thousands are settling on the option of an assisted living facility.
Definitions of assisted living can vary from state to state and facility to facility, but “we generally define it as another long-term care option for folks that generally don’t need 24/7 skilled nursing care, which is what most long-term nursing homes provide,” says Rachel Reeves, director of communications for the National Center for Assisted Living, a non-profit organization representing about 4,000 assisted living facilities across the country. For many people, assisted living means they need help with some aspects of daily living, such bathing, dressing, toileting, eating or transferring to bed at night. “Assisted living really focuses on supporting individuals with those activities, but then also maximizing independence and socialization in a home-like environment,” Reeves says. Currently, the NCAL reports that there are more than 835,000 Americans residing in assisted living facilities.
For families considering transitioning a loved one to an assisted living facility, the options are seemingly endless — the NCAL reports there are more than 30,000 assisted living facilities across the U.S. — but you should carefully consider several factors when determining which option is best.
Depending on which state you live in, assisted living may go by other names, such as residential care settings or personal care homes. “That may be a little confusing for a consumer,” Reeves says, so she advises you start off your search by doing a little homework about how your state regulates assisted living facilities, which agency is in charge and what the requirements are for facilities in your state..
Care Needs and Offerings
Once you lay that groundwork, it’s time to start looking at individual facilities.The most important factor to consider is what kind of care the person entering the facility needs and whether a facility you’re considering can offer that level of care. These needs will vary significantly from person to person. The care that a particular facility can deliver will also vary depending on state regulations and the focus and expertise of staff.
Because of the highly individual nature of these needs and what might be available locally, “families need to be extremely clear about what the care needs are both now and in the future,” says Jennifer Cook-Buman, owner of Portland Senior Housing in Oregon, a referral agency. She helps families with these placements, saying “in a nutshell, I’m like a real estate agent for senior housing options. I meet with the family and I try to meet with the senior as well — even if they have dementia and it’s a memory care situation — I try to do a brief visit to have eyes on and verify what the family is telling me about them.”
Referral agents like Cook-Buman might be helpful in steering you to the right facility for your situation, but no matter how you tackle the search, she says care needs should always take top priority. Talk to any doctors your loved one sees and the staff at the care facility you’re considering about how care needs may change over time and whether the facility you’re considering can evolve with you. “If the person has a progressive disease like multiple sclerosis, Parkinson’s or ALS, they need to have a good idea of what the care needs are now and going forward. Ideally you want to select a community or living environment that’s going to be able to change as they change,” she says.
This can be challenging. “I think people are very focused on the immediate, needing a solution for mom and dad that’s going to help them, and are looking at where they are at this point in time,” Reeves says. “But I think it’s important for consumers to ask the assisted living facility what happens if their care needs or finances change.”
She also recommends finding out whether your loved one will be able to ” age in place or whether there are limitations in terms of how much care” the facility can provide. “Sometimes consumers are taken aback by the fact that assisted living can’t always take care of them if the needs become more than they can take on. That’s not a sign of a bad assisted living community — it’s potentially part of state regulations to only let them take on so much medical care, and it may be a limitation that the state has set.” But knowing this in advance can help you make a better selection. “It’s important to talk about that. If they need greater assistance, is this something the community can help with or at which point do we need to consider other options?”
Reeves says it’s also important for family members to consider what the person entering a care facility wants and prefers and to try to accommodate as much as is realistic.
Other important factors include how you’ll pay for care. How much of assisted living costs private health insurance or Medicaid will cover varies state to state and Reeves says in the end, “most assisted living is private-pay,” meaning that many families pay out of pocket for this type of care. (Medicare does not cover long-term service and support; Medicaid sometimes covers these costs for qualified patients, and the coverage varies by state.) Costs can run into the thousands of dollars per month depending on the particular facility and the resident’s needs. You may have to cover all or much of this out of pocket, so it’s important to find out what the facility you’re considering costs and how costs are structured. Again, this varies from facility to facility and likely depends on what level of care is provided. Some facilities use an a la carte type of pricing structure, where you’ll only pay for the services you use, whereas other facilities charge a flat rate to all residents. Either can work fine, it’s just important to know what you’re getting into and how the lease or rental agreement will be structured.
Location and Touring
The location of the facility is also important to consider. “It’s going to become harder and harder to visit someone, so it’s a lot easier if they’re located conveniently to whomever is going to be their advocate, whether that’s a spouse or an adult child juggling jobs, kids and now their parents. It’s really important that they’re conveniently located,” Cook-Buman says.
It also makes it easier to tour facilities if you’re looking at ones located close to you. Taking a tour of the facility and meeting the staff and other residents is the best way to get an understanding of what a particular facility is like and whether or not it seems like the right fit for your situation.
Cook-Buman says it’s important to gather as much information as you can when touring a facility, and that means not just listening to the salesperson, but also speaking with residents, staff and other family members you might encounter. “Don’t be afraid to stop and talk to the residents and ask, ‘Hey, how long have you been here? Do you like it here? If you could wave your magic wand to change anything, what would it be?’ Talk to them and if you see other people who seem to be family members, stop and talk to them. You have to remember that it is the salesperson’s job to sell the building,” so seeking unbiased opinions of people who have direct experience with the facility can help you make a better decision.
Complaints and Redress
You may also want to check on whether the facility has had any complaints. Cook-Buman says since July 1, 2018, the state of Oregon has made its database of complaints about assisted living facilities publicly available. Checking whether the facility you’re considering has had complaints and how quickly they were addressed can offer clues to how good it might be. “In Oregon, assisted living facilities get relicensed every two years and they go through a process called survey. I look at their survey results and see whether they were dinged for not doing fire drills, or did they get dinged for having black mold in the dining room and so on. What did they get nailed on, what was the fine and how quickly did they remedy it? In Oregon, they’ve recently added a tab to the file that says whether or not these deficiencies occurred during current management, which is helpful and certainly something to take into consideration,” she says. (The NCAL publishes a free, annually updated report that details regulations for each state, which can help you determine which agency is responsible for licensing and certifying assisted living facilities near you and how to get more information about the performance of a particular facility.)
The length of service of both management and frontline caregivers should also be considered. The caregivers employed by most assisted living facilities don’t make a lot of money, and they’re typically asked to do a lot of hard work. This can lead to rapid turnover of staff. If you find a facility with caregivers who’ve been there longer term, it might mean that’s a better facility that looks after its employees in addition to residents. Cook-Buman says the staffing-to-resident ratio can also be helpful in ascertaining whether your loved one’s needs will be adequately met at a particular facility.
You’ll also want to consider what sort of activities and cultural offerings a particular facility or community offers. Cook-Buman says it’s important to find out not only what sort of activities are available — are we talking books clubs and shuffleboard, or are there a wider variety of options and outings available? — but also when they’re scheduled. “If activities are only offered from 10 a.m. to 3 p.m., not everybody is active then. Some people worked night shifts or they worked swing shifts and they’re up during the evening,” so limited time offerings may mean they’ll miss out on these important socializing and enriching opportunities.
In addition, finding out how the activity coordinator is tapping into what residents want to do is important. “Good activity people really set the tone of a facility,” Cook-Buman says, and if they see that residents aren’t being engaged by a certain program of offerings, they’ll mix it up and try different activities to get more people involved. “Asking how well attended activities are, what outings are offered and how they’re managed,” are all good questions to ask when considering a particular facility. “It’s more than just bingo. The boomer generation is an intelligent and motivated generation and they want to do more.”