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Summary

Once it is determined that an assisted living facility is the proper choice, it is advisable to do some homework to learn about the facility's reputation, costs and to get the idea of what life in the facility is like.  If you are not up to it, ask a family member or friend to do it for you. Choosing the best facility for your needs is too important a decision to leave to chance.

If there isn’t time to do an inspection, be sure the information you receive about each facility under consideration comes from a broad base of sources. Do not rely on any one source in making a decision about an assisted living facility. 

The steps to take to find the best assisted living facility for you are:

Step 1. Locate the facilities in the area you want to live in

Step 2. Call the facility and do a telephone evaluation

Step 3. Contact your state's long-term-care ombudsman

Step 4. Do at least one on site inspection - and preferably more.

Step 5. Ask a lawyer to review the contract.

NOTE: Consider speaking with a geriatric care manager who can make a clinical assessment about a patient's needs and make a recommendation for an appropriate level of care.

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Step 1. Locate the assisted living facilities in the area you want to live in

Available sources for locating an assisted living facility include:

You can also find assisted living facilities through the following sources which may also be able to provide some insight about a particular facility's reputation and what it is like to live there.

  • Your doctor
  • A hospital’s “discharge planner” 
  • Professionals in the long-term care field
  • Local non-profit organizations which relate to life threatening diseases. (Note: Feel free to call non-profit organizations that concern health conditions other than yours.)

Step 2. Call the facility and do an initial evaluation.

To start your own evaluation, call the facility. You may eliminate the need to visit. Some of the key questions to cover on the phone are:

  • Is the location convenient?
  • Is the facility certified for participation in the Medicare or Medicaid programs? (This question is valid even if you are going to pay from private funds or via a long-term-care insurance policy.) 
  • Does the facility accept your means of payment?
  • Does the facility offer the medical and other services you need?
  • What are the facility’s admission requirements for residents? Do you fit them? 
  • What is the typical profile of a resident?  
  • What is the ratio of staff to residents? (number of staff for each patient )
  • Does the facility have vacancies or is there a waiting list?  
  • Is there a website that includes comments from residents and family members about the facility and their satisfaction with it and the care they receive(d) in it?

NOTE: If payment is going to be through Medicare or Medicaid and there are no beds available for such payment methods: consider paying the market rate for several months and then switching to Medicare/Medicaid payment. It is difficult to move people out of a facility once they are in.

Step 3. Contact your state's long-term-care ombudsman

Your state's long-term-care ombudsman will have a record of complaints that have been filed against a facility. The ombudsman should also be able to tell you what happened with the complaints. 

Find your state's ombudsman through the National Long-Term-Care Ombudsman Resource Center: www.ltcombudsman.org offsite link, Tel.: 202.332 2275

Step 4. Do a site inspection

The following suggestions are based on a Consumer Reports article together with the recommendations of the New York State Department of Health. The list is extensive to provide questions to help you focus on things that will be important to you if you become a resident. Add whatever matters are of particular concern to you before you visit any sites so you do not overlook them. Photocopy the list with your additions. Take the list with you or give it to whomever will visit the site for you. Write down your observations for each home visited so you can make a better comparison later.  

Bottom LineForm your own impressions. After you have done all of your research, your final judgment should include your “gut feeling.”

 Inspection Report:

  • Ask for a copy of an inspection report. A good way to do this is to ask for a meeting with the residence administrator. You will also be able to ask about the philosophy behind the facility.
  • Ask how any problems have been corrected.

 Visits:

  • Tour each facility on your own rather than with a staff member. If the facility won’t allow you to tour alone after the first guided visit, take it off your list.
  • Make unannounced visits. 
    • Ideally the visits should be at different times of the day and week to get a complete view of life in the facility. 
    • One of the visits should be during the evening and/or on a weekend when there are usually fewer staff members on duty.

 Physical Appearance:

  • Does the facility allow residents to personalize their rooms?
  • Does each resident have at least one comfortable chair?
  • Does each resident have his or her own dresser and closet space with a locked drawer or other secure compartment?
  • Is there an out-of-doors area where residents can walk and sit and is it used?
  • Does the equipment appear to be in good condition? For example, wheelchairs and assistive devices.
  • Is there a lounge or other area where residents can entertain visitors privately?

Safety:

  • Are the exits clearly marked and unobstructed?
  • Are there features geared toward accident prevention? For example, handrails in the hallways and grab bars in the bathrooms.
  • If you are or could be in a wheelchair, are the hallways wide enough for two wheel chairs to pass? Can they pass freely everywhere or are there obstructions?
  • Are there safety hazards to people who walk unsteadily or with impaired eyesight?
  • Is there good lighting?
  • Telephones: are there any restrictions on mobile phones?
  • Are inside temperatures appropriate? 
  • Are people assisted in walking for the purpose of exercise or retraining?

Cleanliness:

  • If there is a common kitchen, check the kitchen for cleanliness.
  • Check for smells (particularly for urine and feces).
  • Look at the overall cleanliness of the public and activities areas.

 Residents:

  • Look at the quality of the care and concern for residents.
  • Ask residents:
    • What they like about the facility.
    • What they don't like about the facility.
    • What do they do when they need something to be different. 
    • What they like about the staff. 
    • Ask visitors or volunteers the same questions you ask residents.
  • Do the residents appear to be content, enjoying the activities, interacting with each other? 
  • Do staff interact with residents in a warm, friendly manner?
  • Do staff address the residents by name?
  • If possible, speak with family members of the facility’s residents. There may even be a voluntary council of family members with which you can speak. 

Staff:

  • Visit the activities area when in session and notice how staff interacts with residents.  
  • Walk through the corridors and listen to what you hear.
  • Try to get a handle on staff turnover if you can. A high rate of turnover is not good.
  • Find out who to speak with if problems arise, and meet with that person.

Food:

  • If meals are offered by the facility:
    • Try to time a visit for meal time. Taste the food. Is food appetizing and of good quality?
    • What arrangements does the facility have for special diets? 
      • Is there a dietitian? 
      • What effort is made to make special diets taste good?
    • Is the dining room clean and attractive?
    • Is food delivered to residents who are unable or unwilling to eat in the dining room? 
  • Is there sufficient staff and equipment to help residents who canot easily feed themselves? 
  • Are snacks available?

Medical/Nursing Care:

  • Generally, you choose your own doctor, even for emergency care. 
  • Look at the medical services available in case of need. Is there a nurse on premises or on call?
  • An assisted living facility usually has a relationship with a doctor "just in case.". Find out:
    • Who the doctor is 
    • The doctor's qualifications
  • How are medical emergencies handled?
  • If you need more than routine medical care, ask:
    • If a specialist can be called in.
    • If so, how is this done?.
  • If you may need special therapy:
    • Look in the therapy rooms to assess the physical quality.
    • Speak with the staff person in charge to find out if there is any rapport between the two of you.
    • How frequently will the therapy be offered? 
    • How much involvement is there from the doctor with respect to the establishment and oversight of the therapy?

Activities Programs:

  • Ideally, a program should be designed to fit the interests and skills of each person at a variety of times on a daily basis, including weekends.
  • In general, what are the opportunities for socialization?
  • Are residents taken out for events in the community?  
    • If so, how often? 
    • Where do they go?
  • Do people in wheelchairs get to participate?
  • How often are outside events brought in for the entertainment of residents?
  • What activities are provided for bed-bound residents?

Money Issues:

  • Find out what services the facility provides and which ones cost extra.
  • How much does the nursing home charge for: 
    • A daily semi-private or private room if you need one.
    • The “extras”. For example, supplies such as diapers, catheter tubes and for special services like incontinence care. 

NOTE Prescriptions in assisted living facilities often cost double what they would at a local pharmacy. If the drug prices are gouging, demand the right to purchase drugs outside the facility.

Step 5. Have a lawyer review the contract before signing

If the facility uses contracts, have it reviewed by a laywer specializing in elder law.(You can find an elder law attorney through the National Academy of Elder Law Attorneys: www.naela.org offsite link)  Look for terms that are important to you. For instance:

  • Can residents see their own doctor or are they restricted to doctors from the facility?
  • If your health condition gets worse, who makes the determination that it is time to move to a facility that offers more care?
  • If you have to pay money up front:
    • Is it refundable? 
    • If not fully refundable, is there at least a prorated refund in case you’re not happy there? If so, what are the terms?
  • If the contract is for a minimum term, what if you are not happy in the facility after living there for a while?
  • Who is responsible for scheduling and administering medication?
  • If the facility is to help you with your medications:
    • Does it permit you to use your own pharmacy or do you have to use theirs? 
    • Who is responsible for administering and coordinating your medications?
  • The place in which you will live:
    • Does the contract specify a specific unit you will live in? 
    • Can you bring your own furnishings? 
    • Is the same unit guaranteed on your return after a stay in a hospital?
  • Are there limitations on who can come to visit you?
  • Meals
    • Are meals included? 
    • If so, which ones?  
    • During what times?
    • What if you cannot make it to the dining room for a meal?
    • Will the facility provide a special diet if you need one?
  • What does the contract provide about transportation? For example, to and from doctor appointments or for treatments.