Choosing an Assisted Living Facility

For an adult child, it's a decision fraught with questions and guilt. Yet knowing the facts about assisted living care can ease the decision-making process.

The first step in choosing an [assisted living] facility is to be honest and forthright about your aging loved one's physical, financial, and lifestyle needs. If your elder seems like a good candidate for assisted living, your next task is to shop for a facility with well-trained, reliable staff, and quality care. Your elder's hospital discharge planner, physician, case manager, clergy, social worker, financial planner, and friends may be able to recommend area facilities. Or contact the local social services department to find out which assisted living facilities are available in your elder's area.

Put on your walking shoes

Visit as many facilities as you can to get a sense of the kind of choices you will have. Note whether you are greeted warmly by staff and whether the administrator and staff call residents by name as you tour the facility. Ask about staff training and turnover. Find out how the facility will accommodate your elder's current needs and what will happen if the needs increase. Who decides when a resident must leave for health reasons?

Consider convenience

Consider how close you live to the facility. Residents who have frequent visitors tend to get better care, so proximity is a plus. Look at the physical surroundings the presence of handrails, easy reach cupboard space, accessibility to the dining room, color coded hallways. A new trend is to incorporate skylights into the facility design of common areas, such as dining rooms and corridors; this brings in more natural light and creates a friendlier, less "institutional" environment. Ask about special amenities. For example, some assisted living facilities have beauty salons with shampoo bowls that elevate several inches to accommodate people in wheelchairs.

When you have narrowed your selection to the top three, return to the facilities with your elder for a more in-depth look. Visit at different times of the day and on a weekend to observe the routines and activities. Make surprise visits to the places you are seriously considering, and arrange for an overnight stay before making a final decision. Eat a meal at the facility. Is the food tasty? Do the residents socialize and appear happy? Chat with the residents about their experiences. Ask them questions like these:

  • Do you have a choice of main courses? Do you help decide the menu?
  • How long do you have to wait for services?
  • What happens if you have a problem?
  • Does the staff smile and respond to you as individuals?
  • Is there an active residents' council?
  • Are pets allowed?
  • Can residents' grandchildren spend the night?
  • What kinds of things do you do on a typical day?
  • Are you very glad to be living here?
  • What happens if someone dies?
  • What special observances (secular and Christian) are recognized here?

Ask the administrator for a copy of the rules and the contract and read them carefully at home. Then ask a lawyer (preferably one who specializes in elder law) to review the contract for you. If you do not know an elder-law attorney, search for "elder law" on the Internet and you will find dozens of sites including some that have searchable databases of attorneys in your area. Ask to see the facility's licensing inspection report. Your local long-term-care ombudsman can advise you and provide you with a recent listing of complaints.

The Consumer Consortium on Assisted Living (CCAL) has developed a lengthy questionnaire you can take with you when you meet with the director of the assisted-living facility Here are some questions excerpted from the questionnaire:

  • What services are provided in the fee?
  • What happens if funds run out? Is there any financial assistance?
  • Does the contract clearly describe a refund policy in cases of transfers, discharges, changes in ownership, or closing?
  • If a resident displays a difficult behavior, what steps will the facility take?
  • Is there special training for staff about dementia and Alzheimer's disease?
  • Is there a separate area specifically for people with dementia, and if so, how do services differ from services in the rest of the facility?
  • What kind of emergencies are staff expected to handle and how are they trained for them?
  • To what extent will the facility monitor your elder's health?
  • What safeguards are in place to see that your loved one receives his medications on schedule?
  • Is transportation to health appointments available, is it wheelchair accessible, and what are the fees?
  • How are religious/spiritual needs met? Is there transportation to church? Are there arrangements and room for worship programs in the facility?
  • If your elder does not like a meal, what alternatives are there?
  • Are background checks made on all staff?

How to pay for assisted living

Assisted-living residents or their families generally pay the cost of care out of their own funds. Medicare does not pay for assisted-living services. Medicare pays the bills only for a limited number of days when a more intensive form of care, called skilled nursing care, is needed and provided in certified facilities. Some facilities offer subsidies and financial aid on a limited basis, although a waiting list typically exists. A growing number of private insurance companies are beginning to offer assisted-living coverage as part of their insurance package, but services covered under these policies vary widely, and many elderly people do not have long-term-care insurance.

Most facilities accept only private pay, although some states Offer limited assistance through Medicaid or Supplemental Security Income. Thirty-seven states reimburse or plan to reimburse for assisted-living services as a Medicaid service. Check with your state Medicaid office for more information.

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