As your parents age, staying in their long-time home can become challenging due to physical, emotional or financial strains. That is usually when families begin considering moving to a senior living community.
Transitioning a parent out of their home is an emotional journey, so finding a senior living facility that feels safe, comfortable and welcoming is essential. But while most families naturally compare care levels, location and pricing, one critical factor often goes overlooked: community size and total resident population.
“One size doesn’t fit all, especially now that senior living has become more individualized with more choices,” says Matthew Hollinghead, executive director for NewBridge at the Charles in Boston, a Hebrew Senior Life community.
Whether you’re looking for a small residential care or board and care home, a smaller assisted living community or a continuing care retirement community (CCRC) on a large campus, don’t underestimate the importance of size in your decision.
“It’s important to consider size options that align with your parent’s personal preferences and lifestyle and to consider in the process not just what their needs are now, but what they will be as they continue to age,” says Elissa Sherman, president at LeadingAge Massachusetts, a trade association representing nonprofit providers of housing, healthcare and services for older adults.
Decoding Senior Living Sizes: The Bed Size Standards (BSL)
Residential care communities are grouped into three bed-size levels:
| Community Tier | Bed Count | Common Industry Names | Best Suited for Seniors Who: |
| Small | 4-10 beds |
— Residential care homes — Board and care homes — Personal care homes |
— Need personalized care, high supervision and a quiet environment — Value a home-like atmosphere and need a higher staff-to-resident ratio — Dislike institutional settings and are looking for tight bonds |
| Medium | 11-25 beds |
— Boutique assisted living homes — Senior boutique living |
— Want a balance of social life and intimacy as well as more personalized attention — Feel isolated in larger facilities and find it easier to socialize with a smaller number of people — Desire more tailored daily routines |
| Large/extra Large | 26-100+ beds |
— CCRCs — Corporate senior campuses — Retirement villages |
— Are active, extroverted and independent, want to “age in place” and want diverse social activities — Depend on specialized technology such as on-site physical therapy equipment, state-of-the art security and dedicated memory care |
[Read: 11 Signs it’s Time for Senior Care: Expert Advice]
Small Senior Living Communities (4-10 Beds)
The small residential home model is typically a single-family house in a residential neighborhood that’s been adapted to provide care for seniors. These communities are intimate and family-like. The ratio of caregivers to patients is generally higher than at larger facilities, and the daily care and assistance is more personalized, flexible and adaptable to individual residents.
Small residential homes generally provide 24/7 supervision, medication management and help with activities of daily living (ADLs), such as bathing, showering and dressing, in a quiet setting. Residents typically share a dining room, living room and sometimes a bathroom and have either private or semi-private bedrooms.
These communities are best for those who need care but not at the level of skilled nursing care. Because these homes are small and quiet, they may be a good fit for residents with dementia or memory problems who can’t handle overstimulation.
“Small senior homes composed of between four and 10 residents are typically beneficial for those who are anxious in large settings, enjoy the feel of home and sometimes for those who need a lot of hands-on care from a staff at their beck and call,” says Sanela Graziose, chief marketing officer at Atria Senior Living.
Pros of Small Communities:
— High staff-to-resident ratios
— Individualized, intimate and beneficial care for those who need significant help
— Home-like, quiet atmosphere
— Familiar staff and a small number of residents foster close relationships
— Flexible and adaptable to the individual
— Shorter hallways and fewer obstacles make navigation easier while reducing the risk for falls and other accidents
Cons of Small Communities:
— Limited amenities unlike larger communities that offer extensive or luxurious options
— Less privacy and possible shared bedrooms and bathrooms
— Lack of space for residents to escape to if they crave solitude
— No 24/7 on-site doctors or nurses and no complex skilled nursing care
— May be unable to accommodate new or worsening care needs, necessitating a relocation
— Fewer residents, limiting the opportunity to find peers with similar sensibilities
— Potential lack of staff readily available to fill in when others are sick or leave
[READ: What Is Luxury Senior Living? Amenities, Costs and Care Levels]
Medium-Sized Senior Living Communities (11-25 beds)
Boutique senior living communities are smaller independent living, assisted living and memory care communities designed to bridge the gap between small residential homes and larger, more institutional-feeling corporate facilities.
Many of them cater to like-minded residents, and most are designed to feel more like a home. These communities typically emphasize the preservation of dignity, self-direction for residents, personalized care and community-driven social connections.
Cultivating a bed-and-breakfast type atmosphere with a limited number of residents, staff-to-resident ratio is high, with personalized hands-on care being the norm. This approach allows staff to get to know the residents well and generally allows residents to move at their own pace when getting dressed, walking to the dining hall and throughout the day.
Caregivers in these mid-sized communities are typically cross-trained in tasks such as ADLs, basic clinical and wellness support, cognitive or memory impairment care and hospitality. As a result, they often behave more as companions to residents than solely as health-related caregivers. Staff typically get to know residents so well that they can detect subtle changes in health and behavior before they become crises.
When there are sudden spikes in a resident’s medical or memory care needs, these communities will often bring in a third-party Medicare-certified home health agency and outside nurses and other specialists to supplement the daily staff, allowing residents to get 24/7 high acuity care without having to be transferred to a nursing home.
Pros of Medium-Sized Communities:
— High staff-to-resident ratios
— Individualized, relationship-centered care with staff learning personal routines and preferences
— Home-like and cozy with private and public spaces that reduce overstimulation and confusion
— Safe layouts that create a lower risk for falls and confusion, less foot traffic, lower noise level
— Shorter response times to calls for assistance
— Better communication due to its small size and staff familiarity with residents and their families
— Calm environment with predictable staff
— Some allow residents to age in place
Cons of Medium-Sized Communities:
— Varied but less diverse activities than larger communities
— Less anonymity and privacy than in larger facilities
— Staffing disruptions if a staff member is out
— Some not equipped for high acuity care, which means a resident may have to relocate
— Less social diversity than in a large community
[READ: Senior Living Advisors: What They Do, How Much They Cost and How to Choose the Best Consultant]
Large and Extra-Large Senior Living Facilities (26-100+ beds)
Corporate communities and CCRCs are typically located on sprawling, resort-like campuses, some of which contain independent, assisted, memory care and skilled nursing care living. Residents can transition through care levels as their needs progress without having to move.
Well-suited to self-sufficient seniors who want to downsize and no longer want the responsibilities that come with home ownership, these communities typically offer lots of activities, perks, planned social events and dining options.
Independent and assisted living residents generally have their own apartments with bathrooms located in large, multistoried buildings with long corridors, elevators and common areas that may require a lot of walking.
Staff-to-resident ratios tend to be high, with specialized staff members and less personalized care, causing campuses to feel more regimented than in a smaller facility. Residents will likely see many caregivers who can’t spend too much time with them.
Medical staff may be on site for emergencies or brought in from outside to help, and staffing on night shifts may be minimal.
Pros of Large and Extra-Large Communities:
— Extensive amenities, such as beauty salons, swimming pools, dining options and organized events
— On-site services, including pharmacies, physical therapy, concierge service and valets
— Large, diverse population to socialize with
— Private apartments for residents
— Care continuity, especially for residents of CCRCs
Cons of Large and Extra-Large Communities:
— High caregiver-to-resident ratios, often high staff turnover, may have fewer staff during off-peak hours
— Potential long waits for open spots
— Less personalized, more regimented care
— Mobility challenges, including large campuses that require walking to common areas or rooms placed far from elevators
— May have an institutional, impersonal feel
The Matchmaker Matrix: How to Choose the Right Size for Your Parent
Before determining the size of the community your parent would be most comfortable in, it’s important to consider how independent they are. Then, visit the facility more than once at different times of the day, including at meal time, to get a feel for the community and its size and prepare a list of questions to ask.
14 questions to ask on a community tour
1. How many residents live in the community when it’s at full capacity?
2. What kinds of living spaces are there? Are there apartments? Are there single and double rooms? Are living spaces and bathrooms private, or are they shared?
3. How many caregivers are on each shift, and what are their roles on each shift?
4. What is the caregiver-to-resident ratio on all shifts?
5. Is there a nurse on staff, and if so, when are they on duty? What kind of medical support is available in the facility on every shift?
6. How well do staff generally know residents?
7. What is the average length of employment of staff members?
8. How long has the community’s executive director been at the community?
9. What is the response time when a resident needs help?
10. What does the community offer to support independence?
11. How does the physical set-up nurture meaningful connections, encourage social fitness and impact mobility?
12. How far are the dining and activity areas from the living quarters of the residents?
13. When needs increase, can my parent continue to age in the community?
14. What kinds of amenities and activities does the community have?
Bottom Line: Finding the Right Fit for Peace of Mind
When trying to determine what size community would suit your parent the best, focus on their lifestyle, including their level of independence, care needs and whether a small, medium or large community would best suit their personality and sense of security and belonging.
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How to Choose the Right Senior Living Community Size for Your Parent originally appeared on usnews.com
