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Choosing Where to Live

Selecting an Assisted Living Facility

Senior Living:  Levels of Care

In addition to nursing homes, there are many senior living facilities with multiple levels of care.  The usual categories are independent living, assisted living, and full care.  People in the independent living section normally have their own cottage or apartment.  They have the option to eat meals in their quarters or in a communal dining hall.  While there is often laundry and maid service, those in independent living are responsible for their own personal care and medications.  Many still drive and do their own shopping.  Apartments often have a call button or emergency button in the event medical assistance is required.

Assisted living or residential care is the next level of service.  Residents usually have their own room and may have their own furniture.  They are free to roam the facility and participate in planned activities.  The facility provides meals, laundry service, housekeeping and supervisory care.  The staff dispenses medications and makes sure residents are fed.  Most residents can bathe and dress themselves, but help is available when required.

The most intense level of care is full time care or nursing home care.  In a nursing home setting, the resident is closely supervised, and staff assists with bathing, dressing, feeding, and medications as needed. 

Choosing the Right Facility for Yourself or Your Loved One

Many seniors opt to move into a senior community or multilevel facility at some point.  Some opt for a senior community without services or additional levels of care.  Others opt for a multilevel community where they will have the ability to move to a higher level of care when it becomes prudent.  Yet, the majority of seniors remain in their homes until necessity forces their move to assisted living.  

When someone in your family needs assisted living, it is vitally important to spend the time and effort to find a place that is a quality facility that fits your loved one’s needs.  

Before You Commit, Know Your Needs.

Far too often, people sign a contract and put a parent or spouse in a facility without researching the options.  First, know what level of care your loved one needs.  Talk to the doctor.  Find out if dad forgets to take his medications; if he has frequent falls; if he has memory issues.  Of course, if you live near dad or see him on a regular basis, you may know the answer to these questions from your own observations.  The point is this, before you contact or tour any facilities, make sure you know what you are looking for.  If dad is in the early stages of dementia, he may be fine in assisted living now, but, at some point, he may require care in a “memory unit.”  The ideal solution is to find a place that has both assisted living and full, dementia care.  That way, dad can easily move to full care if his dementia worsens in the future.

Second, make sure you know exactly what services are offered.  Is there a registered nurse on site? What recreational activities are offered and how frequently do they occur?  Are there exercise programs for residents?  Are there pleasant and easy to access outdoor areas for residents to enjoy?  Check with www.medicare.gov to make sure the retirement home you are considering complies with Medicare regulations.  The Medicare website lists all the local facilities that are Medicare compliant.  Arizona Department of Health Services licenses assisted living facilities.  You can check with the state to find out if the place you are considering is in good standing with the state and if there have been any violations of state regulations.

Take a Tour of the Retirement Home and Talk to Residents

Never commit to a home for mom or dad unless you have toured the place, had a chance to speak to staff and to some of the residents.  When you tour the facility, be observant.  Check the level of cleanliness.  Look past the furnishings.  Just because a place has fancy furniture and plush carpeting doesn’t mean it is a well-kept facility.  Look in the corners, at the baseboards and windows.  Is there accumulated grime in the forgotten corners?  How does the place smell?  Your nose can tell you a lot.  Bad smells may mean a lack of cleanliness.  If the smell is confined to a single space, it probably means a recent accident, but if there is a pervasive odor, that signals a larger problem.  Talk to the manager about the smell and don’t be fobbed off with a glib reply.  Do the residents seem busy and happy, or are they all sitting lifelessly, doing nothing?  Talk to the residents.  Ask them how they spend their day.  Ask about activities and outings.  If possible, arrange to observe some resident activities.  Is there a craft club, card groups, bingo, movies, and other activities?  Do most residents participate in activities?  How often are movies and activities scheduled?  Don’t be shy about asking questions.  If you are committing your loved one to live here, you have a right to all the facts.  

Take careful note of the staff’s attitude.  Do they seem friendly and helpful?  Do they seem to listen to residents?  Do they make eye contact?  If the staff seems sullen and prone to brush off resident questions, beware.  An unhappy staff means the residents are also unhappy.  Also, look at the resident to staff ratio.  Find out how many staff members are actually participating in resident care, and how many staff members are on each shift.  Talk to the management staff and feel free to ask lots of questions.  Management’s attitude can tell you a great deal about the facility.  

Make sure that you ask security and safety questions.  Are there security guards and security protocols?  Seniors can be easy targets, so adequate, on-site security is essential.  Are the bathrooms handicapped accessible with raised toilets and grab bars?  Is there an easy and convenient way for residents to call staff in an emergency?  Who is on-site to assist in a night-time emergency?  

Your tour should include resident rooms and apartments, common rooms, recreational and exercise facilities, dining rooms and outdoor areas.  The grounds should be pleasant and well maintained.  The residents should have restful, attractive outdoor areas to visit with family and socialize.  Make sure the outdoor areas residents use are not the same places staff go for their smoke breaks.  As you tour the facility, trust your instincts.  Can you envision yourself or a loved one living here?  Do you feel comfortable and at ease?  If the place gives you that queasy, antsy feeling, this is not right for your family.

Have a meal in the Dining Hall.

Don’t underestimate the importance of food.  Make sure you eat either lunch or dinner in the dining hall.  Is the atmosphere attractive and pleasant?  Is the dining hall clean and comfortable?  You are looking for nutritious, tasty, cooked meals.  Is there a variety of food for the residents to choose from?  Are the vegetables soggy and over cooked?  Are there good quality choices of meats, vegetables, and fruits?  If the food tastes like bland, over cooked, hospital food, you won’t like it and neither will your loved one.  Make sure you ask about the hours when meals are served and what happens if a resident misses a meal.  Are there options for serving a resident in his room if he can’t make it to the dining hall?

Don’t Be Rushed Over the Financial Details.

Be wary of a sales pitch that rushes over financial details.  You need to have a clear understanding of all the financials before committing.  Ask what services are included in the monthly charge.  Are meals, housekeeping and laundry extra charges?  What are the move out conditions?  Is there a 30-day notice required?  Think ahead to future possibilities like dementia, Parkinson’s or diabetes.  Can the facility accommodate special dietary needs?  Do special diets mean additional cost?  What are the projected costs to move to an advanced level of care?  You also should inquire whether the facility participates in ALTCS (Arizona Long Term Care Services) or Medicaid.  If it does, there is a greater likelihood that your loved one can remain a resident even if he runs out of money.  Ask what happens if the money runs out.

Avoid these Common Pitfalls in Choosing a Facility

Choosing an assisted living facility for a loved one is a very difficult and emotional choice.  You may be battling a family member who resists all your efforts, stubbornly clinging to the idea of remaining in a home that no longer meets his needs.  Keep your cool, do your homework, and avoid these common mistakes:

  • Being unrealistic about your loved one’s needs: don’t be tempted to an inappropriate placement because mom’s or dad’s dementia is mild, and you hope it will stay that way.  Talk to the doctor about current and future needs to make an informed decision.
  • Being seduced by a luxurious appearance.  If you take all the steps discussed earlier, you will avoid this pitfall.  When we toured facilities for my mother, we saw one place that was gorgeous.  The common areas and individual rooms were beautiful.  However, we noticed that the residents didn’t really socialize or use the common areas.  We noted there were few activities other than a weekly movie.  My mom was a very social person, so we rejected that facility rather quickly. 
  • Think about what would appeal to mom or dad, not about what appeals to you.
  • Don’t choose the first senior community you visit without taking the time to shop around.
  • Failing to read the fine print is a common pitfall when people feel rushed to find a placement.  As discussed earlier, it is vital to know all the financial details before committing to a facility.  As the saying goes, the devil is in the details.  Make sure you understand the financial terms.
  • Trying to do it all alone can be overwhelming.  There are agencies that offer assistance with assisted living placement.  Talk to a senior advocate or elder care advisor to help you with your decision.  If you need help, contact an agency for assistance and advice.

Federal Nursing Home Regulations, Section 483.15 states: “A facility must care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident’s quality of life.”   The regulation goes on to say that each resident has the right to dignity and to choose his or her activities.  The regulation embodies the goal for assisted living facilities.  The goal is to help each resident enjoy a fulfilling life of activities and social interaction that will enhance health and quality of life.

Resources

www.caregiverlist.com/AssistedLiving.aspx

www.gpo.gov/fdsys/pkg/CFR-2011-title42-vol5/pdf/CFR-2011-title42-vol5-part483.pdf

www.eldercare.gov

 

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This website has been prepared for general information purposes only. The information on this website is not legal advice. Legal advice is dependent upon the specific circumstances of each situation. Also, the law may vary from state-to-state or county-to-county, so that some information in this website may not be correct for your situation. Finally, the information contained on this website is not guaranteed to be up to date. Therefore, the information contained in this website cannot replace the advice of competent legal counsel licensed in your jurisdiction.

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