When it’s time for you or a loved one to consider moving into an assisted living facility, you’ll have to weigh many factors and concerns.
The American Health Care Association/National Center for Assisted Living, a nonprofit that serves the needs of the assisted living community through national advocacy, education, networking and other initiatives, reports that there are about 28,900 assisted living facilities across the United States. Each one has its own atmosphere, strengths and weaknesses.
“Assisted living is part of the continuum of senior living options and is best suited for older adults who do not require complex medical care but would benefit from support with bathing, dressing, medication reminders, memory care and the provision of meals,” says Brian Doherty. He serves as president and CEO of the Massachusetts Assisted Living Association, a not-for-profit association dedicated to professionally operated assisted living residences in Massachusetts that provide housing and services for individuals with varied needs and income levels.
“Assisted living was founded on the values of independence, dignity and choice. Each assisted living community is different and offers its own unique amenities, services and activities,” Doherty adds.
However, Dr. Michael Tehrani, a geriatric physician with Brand New Day, a California Medicare Advantage plan, says, “most assisted living homes offer similar services.” Differentiating among the various options available can be a lengthy, bewildering and overwhelming process.
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Use This 14-Point Checklist
This 14-point assisted living checklist can help you break down this process to make sure you’re not leaving anything to chance or leaving any question unasked:
— Think about your preferences and location requirements.
— Contact the facilities that look most appealing.
— Book a tour of the facility.
— Speak with as many people in the facility as you can.
— Check state safety records.
— Get the details about fees and services.
— Find out about policies.
— Ask about staffing levels.
— Check on the health care options.
— Ask about activities and resident enrichment opportunities.
— Talk about transportation.
— Try the food.
— Don’t forget about social and spiritual needs.
— Make a selection.
Think about your preferences and location requirements
Amie Clark, co-founder and senior editor of TheSeniorList, a Clackamas, Oregon–based website that connects seniors and caregivers with resources, products and services, says that “when looking at assisted living communities, one of the first things I urge people to consider is the lifestyle and personality of the person who will be living there.”
For example, “some communities are quite large, offer extensive activity schedules and put an emphasis on resident involvement. Other communities are smaller and more intimate and may be more suitable for someone who keeps to themselves or prefers smaller groups.”
If you’ve ever looked up “assisted living facilities near me,” then you know that location is a prime consideration. “Proximity to involved friends and family, as well as proximity to current physicians and other personal services” are all important aspects to consider, Clark says.
Contact the facilities that look most appealing
Once you’ve narrowed down your list of possible sites, it’s time to reach out and learn a little more. Most facilities are all too happy to send you information. Request it, and have a thorough review. Look for amenities you know you want, such as a pool or other outdoor spaces, library or computer rooms, hair and nail salon or barbershop on site, dining options, medical support on site, emergency services and other elements that you think are important. Ask a trusted friend or family member to review the information with you, and ask what their impression of the facility is based on this information.
Book a tour of the facility
The only real way to get a sense of a community is to visit. Find out when you can visit and plan to stay a while to see everything that’s on offer. While you’re there, consider the atmosphere.
— Is the facility bright, clean and odor-free?
— Are there obvious safety features, such as call buttons or hand rails?
— Do residents seem happy and engaged?
— How do staff and residents interact?
— How are the grounds and buildings maintained?
— What types of rooms, apartments or units are available? How do they compare in price and comfort?
— How does the place make you feel?
“Because of the individuality and uniqueness of each assisted living community, we strongly encourage that prospective residents and their families visit communities they’re interested in,” Doherty says.
Speak with as many people in the community as you can
Many facilities want you to speak primarily with their sales team, naturally, but you should also push to speak with other staff members, such as health care professionals, and residents to get a less varnished insight into what life will really be like in that community.
“An excellent way to interact with and observe the staff is to ask to have lunch” at the community, Clark says. Many facilities offer lunch with a tour, and “it’s amazing the things you can learn by chatting with the people who interact with the residents every day.”
Doherty also recommends that “prospective residents and family members meet with the community marketing professional, as well as staff responsible for resident care and direct care to get a clear understanding of how staff interact with residents and their families, how they may handle emergency situations and how responsive and welcoming staff are to any unscheduled needs.”
Check state safety records
While the federal government regulates nursing homes, states regulate assisted living facilities, so there’s currently no national database you can check to see about a facility’s performance. But you can contact your state health department of social services office to find out about the track record of an individual facility in the state.
Assisted living facilities also need to be licensed to operate, and state agencies inspect or survey these communities at regular intervals and investigate if a complaint is filed. These surveys can turn up information about violations or citations, and that information is publicly available.
These surveys “should be easily accessible to anyone who requests them,” Clark says. “If a facility will not share with you the most current survey results, run away. Far, far away.” This is a huge red flag that the community isn’t transparent about issues or concerns.
Get the details about fees and services
While most assisted living facilities offer similar services, that doesn’t mean they’re all the same, and that variation extends to the price. Tehrani says it’s important to “make sure that the assisted living home you chose goes above and beyond the basic needs.” Think the difference between a Motel 6 and the Ritz Carlton; “both serve the purpose of a livable place and have room service, but you know the difference,” he says.
You should also make sure you understand fully what you’re getting for your money and what hidden costs might crop up later, whether you’re opting for a less expensive community or the priciest.
“Before signing a contract, make sure you ask about any additional deposits and fees or move-in or move-out costs,” Clark says. “Also, make sure you understand your obligations in the event of needing to move out,” whether that’s to move to a different community or in the event of a hospitalization or rehab stay.
For example, you should ask:
— If the resident is hospitalized, what are your options for payment while no one is staying in the apartment?
— What services are included in the monthly rental fee?
— Are utilities included?
— Are deposits refundable?
— How much do services cost, and how are they billed?
All of this is important information that will help inform whether this is the right community for your needs.
In addition, determining your budget, especially over the long term, is crucial. According to Genworth Financial’s 2021 Cost of Care Survey, the monthly median cost of an assisted living facility is $4,500, or $54,000 per year.
Find out about policies
Each assisted living community has its own set of policies and rules, and there can be wide variation among them. It’s best to get a sense of all of these before you sign a contract.
For example, if you do need to move out, how much notice does the facility require and will there be a cost penalty?
“What if your loved one needs a higher level of care and there is little to no notice given?” Clark asks. “How much notice will be given if those fees are increased or care charges are increased due to the resident’s increased needs?”
Other policy questions you should ask include:
— Can residents come and go at will?
— Can you bring your own furniture or pets?
— When and how are visitors permitted?
— What happens if the resident runs out of money?
Clark adds that you should “always ask for a copy of the contract in advance so that you and/or your attorney have time to review it.”
Ask about staffing levels
Staffing at assisted living facilities has long been a challenge, as there’s a lot of turnover among employees across the industry. But for many communities, staffing concerns were exacerbated by the COVID-19 pandemic.
According to Patrick Crump, president and CEO of Morningside Ministries Senior Living in San Antonio, Texas, the staffing pressures on nursing homes, assisted living communities and other long-term care facilities grew during the COVID-19 pandemic as staffers tested positive for the illness regularly.
Such issues, which are still ongoing in some communities, create a huge challenge for operators of these communities as they scramble to ensure that they’ve got enough qualified staff on site to assist and care for residents as needed. The situation and solutions vary from location to location; as the pandemic has dragged on, some of these issues have eased. But the virus and the many other pressures it unleashed linger.
If you’re looking to enter a new community or find a placement for your loved one, ask how the facility has dealt with COVID-19 and what protocols are in place for when a staff member tests positive. Ask how the community has been ensuring that residents are adequately cared for at all times.
Check on the health care options
Beyond COVID-19 concerns, consider how other ailments are handled and what sort of health care is available on site.
— What medical personnel and services are available on campus?
— How much do on-site services cost?
— Are those fees part of the whole package or charged a la carte as needed?
— Are services tiered so that an aging resident can stay in the community as health needs change?
— What policies are in place around medications, and is there a prescribing doctor on site?
— Can you meet any/all medical staff working there?
All of this information can help you determine if a specific community is the right choice longer term as health needs change.
Ask about activities and resident enrichment opportunities
Amenities are a very specific way that individual communities can distinguish themselves, so think about what you or your loved one would most want to do for fun. Some communities are focused on certain activities, and there’s a lot of variation.
— Does the community have a dedicated activities director?
— How often are activities available, and are they of interest to the prospective resident?
— Is there a resident council, and are residents encouraged to get involved?
— Can residents share their expertise and knowledge by teaching others?
In addition, Tehrani says it’s important to consider who else is living in the community. “Make sure the current residents are people who share similar interests as you. (When you move) into assisted living, a lot of those other residents are going to be the friends you will be around, so you want to make sure you share the same interests.”
For example, if you’re a big sports fan, look for an assisted living community that supports sports with events and outings and that attracts other residents who also have a passion for sports. “A real-life scenario is a patient who moved into assisted living with a heavy focus on arts and crafts, and he was bored out of his mind and nearly depressed,” Tehrani says. The man moved into a different community that had a heavier focus on sports, which he loves. He’s now happy in his new home.
Talk about transportation
Transportation options can vary widely. If the community is based in a more remote or rural location, consider how your loved one will get around.
— How will your loved one get to a doctor’s appointment off-site or to other events and locations off campus?
— Are there extra fees involved with accessing transportation?
Try the food
is life, after all, so think about what, when, where and how you or your loved one will be eating.
— When and where are meals served, and what sort of variety is available?
— Can residents cook for themselves in their rooms or units?
— Can the community cater to special dietary preferences or needs?
— Is the food good, and do residents seems well-fed and happy with the food options?
— How nutritious are the meals, and who’s doing the meal planning for residents?
Don’t forget about social and spiritual needs
Combating loneliness and providing a social outlet for seniors is a key reason many people move into an assisted living community.
Loneliness is detrimental to physical and mental health.
Julie Thorson, president and CEO of Friendship Haven, a life plan community offering independent and assisted living, skilled nursing and memory care in Fort Dodge, Iowa, also noted that during the pandemic, her community added some new staff positions to help residents cope.
“We’re hiring companions because our residents are socially isolated,” she said, adding that the new position was designed to help residents from feeling too isolated while the community restricted visits from family members. Find out what the community you’re considering does to help residents feel less isolated.
For some seniors, finding a spiritual home is just as important as health care and food, so ask about how the community caters to these needs. Ask whether worship services are offered on site or if transportation is provided to nearby churches, temples, mosques or other places of worship.
Make a selection
When all is said and done, Clark urges you to “trust your gut and plan ahead. Many families find themselves searching for assisted living in crisis-mode, but this can be alleviated by starting the search before a move is needed and getting on waiting lists if required.” Don’t leave this important decision to chance or urgency.
“Finding the right assisted living is like finding the right life partner; you have to first know what you are looking for and the important things to you, then you try to find it in the person, or the assisted living (facility), in this case,” Tehrani says.
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Update 11/14/22: This story was previously published at an earlier date and has been updated with new information.