January 17, 2008
Research and references are the key to selecting assisted living facility
The following advice can help you find the right assisted-living facility to meet your individual needs and to empower you to make sure that what is required by law and promised by the assisted-living facility is, in fact, delivered.
Differences Between Facilities
It is said that if you've seen one assisted living facility, you've seen one assisted-living facility.
An assisted-living unit may be as grand as a small apartment with a tiny kitchen in a large complex or as modest as a shared room with little more than a bed and dresser for each resident. One can find an assisted-living facility housing 100 residents and providing onsite nursing care two blocks away from another facility that houses six residents and employs a staff with no health care expertise at all.
Such disparities exist because assisted-living law in most states is loosely regulated. In an atmosphere of looseness, many assisted-living owners are only inclined to provide high-quality care under pressure.
Locate the Place That's Right for You
Matching an individual's specific needs (physical, emotional and social) to an appropriate assisted-living setting is a tricky endeavor, because there are so many differences between facilities. There are no shortcuts to finding the most suitable facility, but the following tips have helped others in their search for the right place:
Gather Personal Recommendations
Seeking a referral from any of the following sources make for a good first step:
- Friends, co-workers and acquaintances.
- A social worker or geriatric care manager.
- A physician who specializes in geriatrics.
- Home health caregivers or hospice workers whose clients live in assisted-living facilities
- A hospital discharge planner (be aware that their recommendations may not always be based on the patient's best interests, because in many hospitals, discharge planners are pressured to get patients out the door as soon as possible, which may distort their advice.)
Take the Formal Tour
When your initial research narrows the candidates to a handful of facilities, it's time for onsite visits. Above all, trust your senses and intuition. Does the assisted-living facility feel good, smell good and appear clean and bright? When you visit, remember to do the following:
- Talk to facility employees. Questions can be addressed to the admissions coordinator or administrator, as well as employees more directly involved in resident care. Potential residents or family members should ask questions that matter to them, with as much specificity as possible. For example, the potential resident who has concerns about falling should ask about the amount of available hands-on assistance, as well as the facility's fall prevention policies.
The tone of the answers is as important as the content. It's a bad sign if employees seem resistant or evasive when asked to consider a potential resident's individual concerns.
- Talk to residents and family members. Current residents and their family members and other visitors know a facility's strengths and weaknesses better than anyone. Conversations with residents and their loved ones should take place without a staff member present. This is another opportunity to gauge a facility's attitude. If the facility staff seems perfectly comfortable with private conversations between current and potential residents, the facility is more likely to be a good place to live.
Consider the Location
The best assisted-living facility in the world isn't much good if it's too far away for family and friends to drop by or too difficult to get to because of traffic patterns or lack of public transportation.
- Older adults, whose friends and relatives visit frequently, tend to keep their spirits up and feel less lonely.
- Family members who visit often tend to develop a relationship with various staff members, which benefits everyone, including relatives, staff members and residents.
Look Out for Yourself or Your Loved One
The following situations are common in assisted-living facilities. Asking the suggested questions will help you to determine whether the facility is the right one to meet you or your loved one's current and future needs:
- It's unclear how much control residents have over their day-to-day life in the facility. Are there meal choices? Is there a range of daily activities to choose from? Are residents free to wake up and go to bed whenever they wish? Are there any restrictions on a resident's right to see visitors (e.g., time and place)? Are rooms private or shared? Once a resident is settled in, does the room become permanent, or can he or she be forced to move to a different room?
- A staff member tells you that residents' care is planned, but you don't know what that means. What kind of care and level of supervision is provided? Is the facility licensed? (Most states require a license, which means that specific regulations set the minimal standard of care that must be provided.)
- You are uncertain of the cost. What exactly is included? How many meals? Are the bedrooms and bathrooms cleaned or just the community areas? How often? Does the cost vary with the amount of care required by the resident? If so, how? How frequently has the cost been increased in the past?
(Be aware that Medicare doesn't pay for assisted-living arrangements. Most tenants pay out of their own pockets. Even when long-term-care insurance policies pay, they may allow only a specified amount of money to cover assisted living, after which no insurance funds are left should nursing home care be necessary.)
- You worry about whether or not there will be someone on duty if you or your loved one needs assistance. What is the ratio of direct-care staff to residents during the day? During the evening and overnight? How many staff members are on duty at night? What is the staff's health care expertise? Are the services of a nurse available?
- It is unclear how medication is administered. Who administers medication? How much training does that person have?
- You worry that care needs may become too much for the facility to handle. What would happen if the resident got increasingly weaker and needed a two-person assist to get out of bed or required insulin injections for diabetes?
(Be aware that the Americans with Disabilities Act prohibits a business from discriminating based on a person's medical condition and requires a business to modify its procedures reasonably to accommodate a person with a disability.)
- You don't know whether your loved one's safety is a priority. Are residents regularly checked on? How frequently during the day, in the evening and through the night are they checked? Does the facility have a sprinkler system to prevent fires?
- You don't know whether residents with Alzheimer's disease or dementia-related symptoms receive special services. What procedures and policies does the facility follow for residents suffering from Alzheimer's disease or other dementing illnesses? Does the facility have a system to prevent confused residents from wandering away?
Dr. Rachelle Zukerman is professor emeritus of social welfare at UCLA, a gerontologist and author of the book, "Eldercare for Dummies." She can be reached at email@example.com.