Whether you’re researching assisted living facilities for yourself or someone else, it can be a confusing and stressful process. Depending on the area where you’d like to find assisted living, there may be many assisted living options near you and you may be completely lost as to how to choose the best one for your or your loved one’s needs. There are common sense issues of physical needs, but emotions can also affect this process. It’s a good idea to arm yourself with questions to ask each assisted living facility to make sure that you can objectively assess and compare facilities.
Before visiting facilities, it’s important to know what the new resident needs medically and personally to function and be comfortable. This will determine if it is an assisted living facility needed, or actually a nursing home that is required (see our comparison of assisted living to nursing homes). This can be discussed with a primary physician who can advise what is currently needed and likely needed in the future. Finding a long term care facility that meets current and future needs can avoid extra fees associated with entrance fees and moving costs, not to mention less disruption for the senior who is moving. When touring assisted living communities, there are certain questions you should be asking each facility that will help you determine whether it is the right one for you or your loved one. They are as follows:
An assisted living facility is not a nursing home. It’s important to distinguish the difference. This distinction determines the type of care and services that are provided and can also determine insurance coverage. A resident of an assisted living facility is no longer able to live independently and needs daily help with personal care. This resident usually needs bathing, dressing, eating and taking medication, but otherwise does not need daily medical care. Residents of a nursing home require daily professional medical care. The primary concern then is to find a facility that effectively meets the resident’s needs.
The discussion with your healthcare provider should give you the minimum basis of what services you are looking for. What assistive services are offered at the facility? Are there services that are specifically not available? Some states specify the difference in types of facilities based on services which impacts Medicaid coverage. Sometimes facilities offer specialized care (such as memory care) or are licensed for a specific purpose. This might mean that the facility is not right for you. For instance, are there special care units for dementia and Alzheimer’s?
Don’t make assumptions about what is available. Ask about the basics of daily personal care like bathing, eating and dressing. Often these are things that a resident can no longer do for themselves and might be embarrassed to ask about. These are basic services, but they are important for personal hygiene and emotional wellbeing. Some facilities offer basic assistive service for new residents and offer additional more advanced services if needed in the future based on the aging or health of the resident.
Questions about staff
It is OK to ask the staff-to-resident ratio. Also, how many trained staff are on duty per shift? Are there doctors “onsite” or “available” 24 hours a day? Group homes tend to have staff “available” 24 hours because staff usually lives in the home with residents, though this wouldn’t necessarily mean that the staff is not sleeping. Larger assisted living facilities are more likely to have someone awake and on duty at a main desk. Staff of larger facilities typically do not live at the facility and are there on a shift basis. Ask about shift coverage.
Questions about case file
A resident enters an assisted living facility due to a current condition that prevents them from living independently. How does the facility monitor a resident’s needs for change in care? A written case file is often not mandatory by individual state laws, but a case file is usually kept to monitor a resident’s condition. Who is responsible for that case file at this facility and how often is it assessed?
Questions about medication
Residents of assisted living facilities often take several types of medication. How does the facility monitor and administer these individual medication schedules? Are medications kept centrally or are residents allowed to keep medication in personal units?
Questions in case hospital stay is needed
Residents of assisted living facilities might be mobile and functioning but may also be in gradual declining health. What is the process if staff determines that a resident must be transferred to a hospital? Will staff discuss care with primary physician or specialist or decide independently?
Questions about meals
What is the meal plan and what is the schedule? Can meals be eaten anywhere or in designated areas only? How flexible is this schedule? How does the facility handle special dietary requirements? Does the staff monitor to see that a resident is eating the appropriate food? Some medications warn about side effects if specific foods are eaten.
Questions about non-medical services
Are there non-medical services available onsite? Sometimes there are dental and optical services available on either a scheduled or permanent basis. Some facilities, especially the luxury retirement facilities, offer hair salon or barber services. If these are not offered, is transportation available to access these services or attend doctor appointments?
Residents of assisted living facilities need daily assistive care, but they are still functioning adults. Studies have shown that keeping the brain stimulated and active helps slow declining health. Quality assisted living facilities should offer some sort of personal enrichment program, however extensive. This might be in the form of informative classes or creative outlets for residents to learn or maintain stimulated interest in things around them. Ask what social interaction and physical activity programs are available.
Assisted living residents often need help with cleaning and laundry. What are the policies for these services?
Assisted living facilities are owned and operated by many organizations. Some might be religiously based. Does the facility accept all faiths? What worship services are available and what religious holidays are observed?
There are also assisted living facilities that allow pets. If you or your loved one plans to bring a pet, make sure to ask about the facility’s pet policies. Some facilities will charge an additional monthly fee for a pet, while others simply will not allow pets at the facility.
There are many senior living options these days and they come in a variety of shapes and sizes. Some facilities are community based with multiple buildings that are assembled as a campus and some are individual buildings with apartment type units for senior citizens. Some apartment type buildings offer units as condo or apartments as monthly rent.
What are the types and sizes of available units? Do these units have a full kitchen and bathroom? Are there specific units available to meet your needs, such as wheelchair/walker accessible or dementia care units? Residents with dementia and Alzheimer’s often are placed in units without ovens or stoves due to safety issues.
Are there private or roommate units available? Sometimes residents benefit from having someone around to prevent feeling isolated. Roommates can also lower the cost.
Do all units have TV cable and internet access? Some facilities only offer these in common areas to encourage movement and socialization.
Studies show that being outdoors improves human physical as well as emotional wellbeing. Are there outside grounds for residents to enjoy the outdoors? Are residents allowed to plant or garden? Are there activities specifically prohibited on the outdoor grounds?
This assisted living facility will be a home and it’s important that a resident feels at home in the environment. What is the policy on decorating units or bringing personal items or personal furniture? Is there a safe for valuables such as jewelry or documents? Is there a policy on storing food in resident units?
What is the security policy of the facility? Can residents come and go at will or is there a check-in/check-out process? Do visitors request access or sign in or can they go directly to the resident’s unit? How does the facility monitor the residents’ whereabouts? Dementia Alzheimer’s patients have been known to wander. This requires higher security and oversight for safety.
What is the facility’s emergency process in case of fire, natural disaster or medical emergency? There are fire and safety mandates required by law, but does the facility practice evacuation or practice and prepare for possible events? What happens if the facility must be evacuated? Where would residents go?
An assisted living facility is most often not considered a medical facility. Therefore, they are not subject to federal Medicare requirements. Assisted living facilities are regulated under individual state laws and guidelines. Individual states affect the operation and management of a facility. Another layer is if the facility is owned and operated as part of a larger national organization with multiple locations or individually owned and operated.
Some states specify what services or not allowed in an assisted living facility. Some states use that specification to distinguish between assisted living facilities and nursing homes, or between larger assisted living facilities and smaller facilities such as adult care homes homes or board and care homes. This distinction impacts what services can be provided and by what level of care provider.
The level of care provided is impacted by the knowledge of the care provider. What are the training requirements for staff positions? What are staffing levels across the different shifts in a day? Some facilities might have one highly trained staff, but multiple lesser trained staff performing the majority of services. Staff experience and training greatly affects the level of care provided.
Residents move to an assisted living facility and hopefully feel comfortable and at home. The facility is also hopefully creating a sense of community and is welcoming to new and existing residents. What are the rights of residents? What if the resident has a complaint or request? Are there reasons why a resident be asked to leave? Is there an appeal process?
If a resident is hospitalized, is the unit reserved? How long can a resident be gone before the unit is considered available to another resident?
Unfortunately, costs can impact decisions. The facility might check every box on your wish list, but there are costs involved in offering assisted living services. There are a variety of issues to cover in how administration and billing are covered.
A big issue to cover is the billing process and how payments are handled. You want to make sure that you are not overpaying and that you are making use of the services that are paid for. What are the monthly fees? What is included in that monthly fee? Often, facilities offer tiered or a la carte pricing based on services provided. Are there programs available to help cover these costs? Medicare and Medicaid cover specific medical services and have specific billing process. Does the facility itemize billing to effectively meet these requirements? What does Medicare or Medicaid cover? Do they accept long-term care insurance? You want to make sure that you understand this billing issue. The facility expects to be paid from someone, whether that’s Medicare, private insurance, or directly from your pocket. Is lack of payment a reason for eviction?
Aside from monthly fees, there is usually an entrance fee when becoming a new resident. There is a wide range in this fee. It’s primarily based on geography, type of facility and services provided, but can also be based on reputation of the facility and its level of quality. Is this refundable at any point? Some facilities refund all or some portion when the resident is no longer a resident.
Just like an apartment or buying a house, there is usually a security deposit. What is that amount and is it refundable at any point?
Is there a waiting list? What affects positions on that list? Is it need-based or strictly first come, first served? How much time is allowed to move in before giving the opening to someone else?
The idea of moving to an assisted living facility can be overwhelming, because it’s an important decision and there are so many variables involved. If you’re making this decision for someone else, you want to feel good about your decision. You undoubtedly want the resident to be happy with the result of your research and effort.
Logical, sound, good decisions are based on facts. A good comparison of facilities and asking the right questions help gather those facts. Comparing facilities also gives a comparison of the environment. Where did it feel most like home where people cared?
The most important outcome of this process is that the resident is comfortable in a new home and receives the necessary care. Everyone involved, including the care providers, should appreciate that residents of assisted living facilities need help in meeting their daily personal needs. Quality assisted living facilities will provide for those needs in a friendly and capable environment that maintains resident dignity and emotional stability.