When a loved one ended up in physical rehab after a fall, I quickly learned what a bummer nursing homes can be. Although the staff tried to maintain a cheery atmosphere, it was clear that if my relative, Marion, stayed on as a permanent resident, she wouldn’t be having much fun — and she’d be paying more than it would cost to live in the Four Seasons.
This is why so many families look to assisted living as an alternative to a nursing home for elders who can’t live independently but don’t need extensive medical support. Nearly a million Americans now reside in assisted living facilities, and that number has grown substantially in recent years, according to the Centers for Disease Control and Prevention. Assisted living facilities are able to charge less than nursing homes because they need less medical staff, and many offer activities and social opportunities far beyond what residents can find in nursing homes.
As we began our search for a place where Marion could enjoy her final years in comfort and safety, I learned that not all such homes are created equal. Here are some questions to ask as you look.
1. Can the facility provide the level of care needed?
Depending on the number and qualifications of staff, some facilities can help patients transfer from a wheelchair to bed or to the shower, while others can only accept residents who can transfer themselves, or at least help. Some facilities have locked memory care units for patients suffering dementia, but others don’t. Before investigating further, find out whether your loved one could qualify to live there.
The assisted living management may send a representative to evaluate the potential resident. If your loved one doesn’t qualify, ask if there is anything they could do to improve their chances. In our case, Marion was close to the level of self-care needed but was lacking some abilities, so she did additional physical therapy before being re-evaluated.
Beware of facilities that are so anxious to fill rooms that they accept residents they shouldn’t. Make sure you ask exactly what help the residents get and what they don’t. Find out what the staff to resident ratio is, including during the night shift. They may say they can help residents get up at night, but if one staffer is responsible for 100 residents, it’s probably not happening.
If you are in touch with other families who have used the facility, or people in your local medical and nursing community, ask them about outcomes. If the local hospital has admitted a lot of residents from the facility due to falls, for example, that could be a red flag.
On the flip side, if you have a senior relative who needs little to no assistance, an independent living community might be a better option. In such a community, your elderly loved one can enjoy a more independent lifestyle with access to assistance only if they need it.
2. Is the facility licensed and inspected?
These facilities are regulated by state, so check with yours to find out the place’s record. In California, you can look up a facility’s license status, any citations or complaints, and view inspection records online. Other resources to check are the Better Business Bureau and your state’s ombudsman.
3. Can the resident afford it?
Although assisted living facilities can cost a lot less than nursing homes, they don’t come cheap. The average assisted living facility charges $3,750 a month, according to the Genworth Life and Annuity Insurance Company. And Medicare’s not going to cover it. If you haven’t previously been privy to your loved one’s finances, now is the time to sit down and have a talk about assets and income, and determine where they can afford to stay and for how long. If there’s a chance their money could run out in their lifetime, what’s the plan for when that happens? (See also: 6 Things You’ll Encounter When Taking Over a Loved One’s Finances)
4. What activities are offered?
Once she was settled in her assisted living facility, Marion enjoyed wheelchair fitness classes, bingo games, church services, and other activities. Later, she moved to a memory care unit that offered activities with more direction, such as arts and crafts and cooking classes. If your loved one is active, you’ll want to look for a place that offers field trips and maybe even cocktail hours. A more limited person may be content with offerings such as taking some sun on the patio.
5. What is included?
Is the resident responsible for setting up their own phone line and cable TV, or does that come with the rent? Will they eat every meal in the dining room, or cook in their own apartment for some meals? What about laundry service, and supplies such as absorbent pads? Consider the logistics in addition to the costs: Will you be responsible for shopping for supplies and bringing them to the resident? Who will make sure the phone bill gets paid?
6. Can the resident abide by the rules?
Some elders will only consider a facility where they may share an apartment or room with their spouse. Are residents expected to keep their doors open or are they allowed privacy? Can they come and go at will, or do they need to have someone come check them out? Can they invite guests to dine with them? Do they have to go to bed and get up at a set time? These are all questions your loved one needs to consider before agreeing to a facility.
7. What on-site services are provided?
For women of a certain age, a weekly salon visit is a valued part of everyday life. Nail care is also a big plus and can be a morale boost. Transportation service to shopping and doctor visits are also a plus.
8. How does medical care work?
Does the staff dispense medications? How will residents get to their doctor appointments? Is physical therapy available? How long will the room be held if the resident has to be hospitalized?
Some assisted living facilities are part of continuing care communities, meaning that they comprise independent living, assisted living, and rehab or nursing facilities, making movement back and forth easier on residents.
9. How long will they be able to stay?
The resident may qualify for the level of care offered now, but what about if they have a stroke or a fall and can no longer self-transfer or feed themselves? Does the facility have a section that offers a higher level of care, or would you be allowed to hire a nurse to provide additional assistance? Would your loved one have to move to a nursing home? What if your loved one needs hospice care?
It’s important to find out in advance under what conditions the resident could be involuntarily discharged. Sadly, after a hospitalization, Marion was not allowed to return to the assisted living facility she loved because her self-care abilities had declined. Luckily, we were able to place her in another facility with a higher level of care. The new facility was more expensive, but not only was it better equipped to care for her, the management promised — in writing — that under most circumstances she would be able to stay for the rest of her life. When the time came for hospice care, it was provided right in her room, where she felt most comfortable.
10. Does it seem like a nice place?
Everything may look good in writing, but of course you will want to tour the facility your loved one would be living in — if possible, with the future resident. The National Consumer Voice for Quality Long-Term Care offers the following signs of quality care: Residents appear well-groomed; call lights and requests for assistance are answered quickly and kindly; residents are engaged in activities; the place appears clean and smells fresh.
One of the nicer assisted living facilities I have visited had a clean, large bird enclosure that residents loved to watch. Outdoor space and space for congregating and accepting visitors are nice too.
11. Will your loved one fit in?
If your elderly relative is still mentally nimble but needs help with physical needs, it’s important to make sure they’ll have peers in their new home. You can ask management about this, but it’s one of the things you’ll probably notice on a tour. Engage any residents in common areas in conversation to see if they seem willing and able to socialize with your loved one.
12. When could they move in?
The best facilities sometimes have waiting lists. Before either you or your loved one gets too set on a specific place, find out if there is a waiting list for the type of unit they want. If there is a long wait, consider where they will be living in the interim. If at home, is it safe to wait that long? If in a nursing home, consider that the longer someone stays in a situation that isn’t right for them, the more their physical and emotional state can deteriorate.
It’s never easy to watch a loved one lose independence. But when the time comes, asking these questions can go a long way toward smoothing the transition and making sure they are in the right place.