How to Choose the Right Assisted Living Community for Your Loved One
My mom was looking ahead to plan for the day when she could no longer care for herself. She knew she did not want to be in a house, even with me. She thrives on social interaction and group activities. I knew that, even though we loved each other, it would be challenging for us to live 24/7 in the same house. She asked me to go with her to visit a few assisted living facilities in our area. I was so proud of her for being so intentional about thinking ahead and planning for the days when she could not think and plan well for herself!
As an RN who has worked in assisted living and memory care, I have talked with many families who have to place their loved ones in these types of community-based care because they have come to the end of their ropes and are exhausted and unable to safely care for their loved ones. Often, the elder is resistant to the process and refuses to willingly make this move. The family is torn between trying to defer to the desires of this person they care about so deeply and trying to ensure that their needs are met. This can lead to guilt, frustration, anxiety, anger, and grief.
For this reason, it can be a difficult transition for all involved. Even for those elders who have agreed to this move and feel that it is necessary, it can be emotionally and mentally challenging, simply because change becomes more difficult as we age.
As I went with my mom to visit each assisted living, I began to make a mental checklist of what to ask and what to look for. Every business will do their best to present themselves well. That is the marketer’s job and if they are good at it, you will walk away feeling that you have found the BEST place for your loved one! It is your job to ask the tough questions and “snoop”. You are the investigator and must ask certain questions if you want to know the environment and what kind of care your loved one will receive.
Here are the things I looked for:
Uniform Disclosure Statement (UDS). This is something that should be given to you when you receive the other information about the facility. If it is not in the packet, be sure to ask for it. It will tell you what services the facility has agreed to provide and what they will not provide. Some facilities will admit an elder who is a two-person transfer. Some will only admit up to one-person transfer assistance. Ask what their policy is if, after admission, the needs of the resident exceed what is in the UDS. Get this information and any related questions answered before you leave, as this is vital information.
Health Services audit which every facility must go through regularly to ensure compliance with state regulations. In my state, this is completed every two years. Every state is a little different in regulations and frequency of audits. This is public information and will provide you with the most recent issues with compliance for that particular facility. For example, this information will show the recent status of areas such as kitchen cleanliness and service, resident care, and facility safety. You can find this information on paper in the facility. (Ask for it, if you don’t see it.) You can also find the information online. Usually, this report is quite extensive, so you may want to ask for a copy.
Staff. Watch the staff closely, especially those you meet who are giving direct care such as caregivers, caregiver supervisors, and servers in the dining room. Do they look happy in their job? Are they interacting with the residents with smiles and conversation? If you are not sure which staff are caregivers or work directly with resident care, ask! Look for any and every opportunity to talk with them and find out how they like their job, and how long they have been working there. If you don’t have an opportunity, ask to be introduced to a couple of caregivers. Making conversation in this way will give you a lot of information that you won’t find in the colorful [handouts] you are handed by the one giving the tour.
Staffing Plan. This is an important piece of information. Each assisted living or memory care is required to post this (at least in the state I live in). This is the minimum number of caregivers to residents they are to have each shift. You could also ask how many caregivers are on this shift today to get an idea if they are actually meeting this minimum standard. And you can ask the caregivers if they feel they have enough staff shift to shift.
Ombudsman. This should also be posted in clear view of any person walking through the facility. This is the person appointed as the resident advocate for that facility. Their job is to investigate any resident complaints that come their way. They understand the residents’ legal rights. Ask for the name and number of the ombudsman for the facility if you don’t see it posted. Call and talk to him/her. Ask how many times they have visited or received requests to intervene at this facility. They can’t give you resident-specific information but may be able to give you information about the frequency of calls they get for that facility.
Resident Council. When you are making your appointment to take a tour of the facility, ask if the facility has a Resident Council. This is a legal entity that allows the residents to voice their desires to the management of the facility and work together to problem-solve for the benefit of the residents. If they do, ask if you can meet with one of the council members. They will be an invaluable resource to get the “inside scoop”. If they don’t have this kind of group, you may want to ask why not? If there is no resident group like this, ask to meet with a couple of the residents. Ask them if they would be comfortable telling you what they like best about living there and what their biggest complaint is.
Dining. Often, when you are setting up a tour, you will be offered to have a meal “on the house”. If that is not offered, ask. This is one of the best ways to see what daily food your loved one will receive, what kind of service they will receive, and to sit and take a look at the environment. Sometimes you can coordinate that with meeting some of the residents and having an honest conversation about their experiences.
When my mom and I visited one facility, we had lunch with a few members of the Resident Council. They were very friendly and talkative. They told us so many wonderful stories about the ways they had made improvements in collaboration with management, the activities they enjoyed and helped organize, and the attitudes of and conversations with management. They introduced us to staff and other residents. It was a great experience! Toward the end of the meal, I asked the burning question in my mind, “What is the biggest complaint you have about living here?” They thought for a few minutes and said, “I suppose it would be the food at times, but if you don’t like something there are other things you can order from the menu.” I was floored! THAT was their biggest complaint?? And even that could be easily remedied! Food is often the biggest complaint, but in this case, it was the least of their worries! That is remarkable in my experience!
It will be easy to note the willingness of management and marketing personnel to provide you with the above information or opportunities for conversation with staff. This will tell you a lot right there about their willingness to communicate openly with you and your loved one in the future.
Are they “put out” because you are asking or do they provide the information with a smile and without hesitation?
If they don’t know where the information is, do they follow up after they find the answer for you?
Helping your loved one do this work before making this life-changing move will give you the peace of mind you both need to know that you are going in with eyes wide open. It can give you the time to make a plan ahead of time for the areas you have decided aren’t “deal breakers” but will need greater intervention and collaboration with staff on your part to ensure that your elder will receive the care they need and deserve. All of these facilities rely (or should) on the knowledge you have of your loved one that no one else does. Family and friends are ongoing resources to make this the best experience for all involved!
ABOUT CYNDY McCOLLUM:
Cyndy is an RN in the states of Oregon and California. She has worked in several fields of nursing, but her passion has become senior living. She is currently working in her own business as a health consultant and planning and dreaming toward the future when she can invest in the industry of senior living, making a better place for those who don’t have the luxury of receiving care at home. Cyndy spent approximately 18 years of her adult life in cross-cultural work and loves diversity! She is the proud mother of three daughters. Her youngest daughter, she cared for 24/7 during her 7 years of life, so she has a personal understanding of the roller coaster of in-home care!