How to choose a senior living community
For safe, quality care that fits your loved one’s unique needs
Choosing wisely begins with knowing what you need and want in a senior living community.
Take inventory of needs, wants and wishes. Priorities? Bucket list? Everything counts!
Moving into a senior living community is a BIG decision, and usually an emotional one. Even positive change can be very stressful. For peace of mind about making the right choice for you or your loved one, begin by discussing lifestyle priorities, health care needs, and financial considerations. Take good notes and listen carefully with an open heart and mind.
Which type of senior living community fits best?
There are four basic options to consider for senior living based on level and amount of daily assistance needed. Once you determine the living option that seems best, it’s time for more questions.
- You can get some answers by viewing facilities online.
- Before you spend time touring, call and ask more questions.
- Once choices are narrowed, take all the time needed for a thorough tour.
Independent/Continuing Care
Assisted Living
Memory Support
Long-Term Care
Continuing Care Retirement Community (CCRC)
Offers independent living plus varying levels of support as needs change.
Continuing Care Communities market to prospective residents based on the facilities and amenities offered in Independent Living.
It’s important to think ahead to a time when you may need more support for daily living. Though you enter through Independent Living, be sure to take a close look at the Assisted Living residences and services (Memory Care, too, if offered.)
Is there consistency of quality and safety for every phase of life in the community?
Sometimes called “55+ communities,” these offer apartment-style or small townhouse-type homes plus a range of services, sometimes on an ala carte basis. These include meals in a central dining area, housecleaning, transportation for shopping, doctor appointments, or community social activities organized “off campus.”
These communities also provide varying levels of care and support to accomodate residents’ needs as they change: independent living (IL), assisted living (AL), memory support, skilled nursing or long-term care (LTC).
Usually a substantial upfront investment is required, plus ongoing monthly fees to cover housing, residential services, personal assistance, and nursing care which may be needed after a hospital stay or for longer term care.
Usually, residents must qualify for independent living when they move in.
A long-term contract may be required, which can be complex.
Memory Support Community
A memory care community is usually the best option if your loved one is suffering from Alzheimer’s or another form of dementia and can no longer be cared for safely at home.
If your loved one diagnosed with dementia is experiencing injuries, wandering outside the home, or otherwise putting themselves in dangerous situations, it’s probably time to consider a memory care community.
Geared to residents diagnosed with Alzheimer’s or dementia, small studio-type apartments are set up to offer a simple and (ideally) safe environment for those with impaired daily living skills.
- Typically a “memory unit” is segregated from other types of senior residences (assisted and independent) and exterior doors are locked for residents’ safety.
- Residents in memory care eat their meals communally; for safety reasons, residents’ units don’t have kitchens.
- Medication administration is always handled by staff.
- Ideally a well-trained staff is on hand 24-7 to help as needed with showering, dressing, eating and toileting.
- Expect costs to be higher for memory care than for other types of senior residential options.
Assisted Living Community (AL)
An excellent option for seniors needing extra help due to a decline in their physical abilities and/or memory.
Assisted living residences offer compact apartments equipped with small kitchens and small appliances (no ovens or dishwashers). Conveniences and support offered include:
- Dining room meals with menu options
- Housekeeping and laundry services
- Medications administration (always by staff)
Showering, dressing and other support services for daily needs are available as well, depending on whether the AL is staffed appropriately. Generally, these services are offered for an extra fee.
AL residences may offer these services based on a “tiered” system, (for example, levels 1 – 4) with each level geared to the amount or complexity of assistance needed for daily living activities.
Costs vary widely.
“If I were placing my parent in assisted living, I certainly would be looking not just at staffing ratios but the actual training of staff,” said Robyn Stone, senior vice president of research at LeadingAge and co-director of its long-term services and supports center at the University of Massachusetts-Boston.
The above quote is taken from an article on assisted living by Judy Graham for Kaiser Health News. A must-read for anyone vetting assisted living facilities! Follow Judy on FB.
Long-Term Care Community
Long-term care (LTC) is also referred to as a skilled nursing facility (SNF) or nursing home.
Licensed medical professionals offer 24/7 skilled care for residents with significant medical needs, often after a hospital stay, for a long-term recovery, or treatment for a serious illness.
- Rehabilitation following surgery or illness
- Medication therapy, often through an IV tube and bag system, or by injection
- Nutrition via a feeding tube
- Urinary catheter care
Some long-term care facilities also offer palliative and hospice care as needed. These services may be “captive,” offered by a company under contract, or you may choose your own.
Costs may be covered by Medicare or Medicaid.
Determine your priorities for a senior living community
Good topics to cover and keep in mind when evaluating all residential living options.
Think like a match-maker!
Together with your loved one, create a summary of their unique needs, wants (and “don’t wants”) — everything from health care to favorite social activities and finances.
Click on a topic below for a checklist of questions to help explore your loved one’s wants and “don’t wants” for a potiential move to a senior community.
Be sure to take good notes! The process of discussing living options likely will not be completed in one sitting.
It’s important to listen to your loved one’s considerations and concerns about moving to a senior community.
Too often we hear something like… “I’m putting my mom in Assisted Living.” Consider this: does aging equate to giving up personal agency in such important decisions?
Personal Preferences to Discuss
- Is it time to enter a senior community now, or sometime in the future?
- Is aging in place an option?
- What type of community do you feel you need— continuing care, assisted, memory?
- What kinds of help would you like to have for your daily living needs?
- What kinds of help would you like to have for your medical needs— for example, remembering to take medicines, getting to doctor appointments, getting prescriptions filled, other?
- What else is important?
What is NOT wanted is as important as what is wanted in a senior living community. Be sure to ask about any worries or concerns, and listen without judgement or interrupting. Take careful notes so you can address worries in the facility screening/touring process.
Support for Everyday Activities
Does your loved one need some help with any day-day activities or “chores?”
Personal Care
- Getting dressed in the morning
- Getting ready for bed in the evening
- Washing hair, combing hair
- Bathing or showering
- Toileting
- Arranging for haircuts and other personal care
Home Care
- Making the bed
- Tidying room
- Doing laundry
- Folding and hanging clothes, putting them away
- Wiping off countertops
- Cleaning out refrigerator as needed
Wellness and Safety
- Getting back and forth to the dining room for meals (on own? with a walker, cane or wheelchair? with someone at their side?)
- Making meal choices on a menu, either verbally or by marking on a menu
- Eating, cutting food into smaller portions
- Using a scale to weigh themselves as needed (important for some medical conditions)
- Using personal medical devices (if any), such as blood pressure cuff, pulse oximeter
Managing Communication and Entertainment Devices
- Re-charging phone or other electronics
- Changing batteries in TV remote
- Using TV remote to change sound and channels
- Setting up computer
- Using email or other favorite “apps”
- Trouble-shooting TV, Ipad, computer if glitches occur
Meal & Food Preferences
- Enjoy eating with others, or would you rather dine by yourself?
- Have dietary restrictions and/or preferences? (i.e, diabetic, vegetarian, vegan, gluten- or lactose-free)
- Like to have access to food/snacks all day and evening?
- Tend to eat between meals?
- Enjoy going out to restaurants to eat? Enjoy trying new ones?
- Like to cook or bake?
Medical Care Support
About how often do you meet with your doctors? (average per week or month)
Would you like help with:
- Making appointments with your doctors?
- Transportation back and forth to meetings with your doctor?
- Having someone with you at doctor meetings to help you by taking notes and covering your questions and concerns?
- Getting your prescriptions filled?
- Ordering any medical equipment you may need?
- Helping you arrange any tests or other follow-up care your doctor recommends?
- Finding any other doctors you may want to see as medical needs arise?
- Managing and paying your medical bills?
- Making decisions about your health insurance coverages every year (during the Medicare re-enrollment period, Oct. 15 – Dec. 7)?
Favorite Hobbies
- Favorite pastimes and hobbies? Any supplies needed for these?
- Enjoy exercise activities such as yoga, pilates, martial arts, swimming, walking/running, dancing?
- Weather permitting, like to be outdoors? If so, favorite activities and sports.
- Enjoy board games, card games, online games, or other types of games?
- Are they technologically savvy? If so, what technology do you enjoy using?
- Like to take classes?
- Enjoy teaching others?
- Are they a history buff and/or do like the fine arts?
- Enjoy music? Listening or performing? What types of music or instruments?
Travel & Outings
Interest in planned outings that may be offered in a new community?
- What would they want to see, do, or learn?
- Would they like to help plan outings?
Desire for a car? How important? What uses? Is night driving comfortable?
Interest in travel?
- If so, kinds of trips? Where?
- Interested in seeing? Experiencing or learning? Bucket list?
- Driving trips? Cruises? Comfortable with flying? How about navigating airports?
- Want to travel alone, with a companion, or in a tour group?
Visiting your loved ones is good for them and lets you keep tabs on their care.
Visiting Arrangements
- Would you be interested in using a community room for family gatherings or holiday celebrations?
- Would you like the option to host overnight visits with you, either in your room or in a suite on-site? (Which family members/friends?)
- Would you like friends, family to drop in on you any time or do you prefer pre-arranged visits?
- How do you prefer to make arrangements with family friends? Phone or text? Through a relative or friend? Or, through staff at new residence?
- Do you have a service animal or pet who will be living with you? Would you enjoy visits from other pets/animals?
- Do you have concerns regarding visitor restrictions, health screening, and/or age limitations?
- If you want to leave the community with a family member or friend (for a restaurant meal, for example), would you be agreeable to signing in and out and providing staff with information regarding where you are going and with whom?
Location Preference
- Do you prefer to be in or near a city, in the suburbs, or out in the country? Would you like to be in a community that has nearby nature and/or walking trails?
- Is it important to you to be able to walk to a local store, bank, pharmacy, or any other store of convenience?
- Do you want to bring your bike? Would you like to have access to a bike path?
- Do you like to go out in the evenings to shows or performances? Is it important to you to have theaters, restaurants, and other places of entertainment close by?
- Do you prefer to have many choices when it comes to health care providers nearby? Or is it ok to have just a few that are known and serve the community where you live?
Pets can help your loved one in many ways: reduce stress, lower blood pressure, increase social interaction and physical activity.
Pet Considerations
- Do you have any pets of your own that you will live with you?
- If you have a dog, are there dog friendly walking paths / areas?
- Are dogs, cats, or any other pets allowed in common areas?
- Do you have any pet allergies? If so, what are they?
- Do you have dislikes of any animals others may have (cats, dogs, etc)?
Financial Considerations
- How do you plan to pay for your care? Budget in mind?
- Insurance for Long-Term Care
- Family Resources, personal savings
- Medicaid or other state funded program?
- For extra expenses, will you plan to pay out of pocket? What are your preferences for payment?
Create a spreadsheet of all assets and income. Research other potential sources such as Medicaid, life insurance policies, pension benefits. Consider hiring a specialist to help analyze assets and all potential current and future expenses. If an option, include aging-in-place scenarios.
Check out the licensing granted to each facility you are considering: What does their license cover? What does it not cover? Does the license cover services that you/loved one may need long-term?
Many senior communities require contracts
Thesc can be complex financial and real estate transactions, usually with a large company that owns the residential community. Consider reviewing any contract – or even a simple agreement – with an attorney familiar with senior care.
Some things you and your attorney may want to look for or write into the agreement:
- Does the contract require notice to move-out? Length of notice? Any costs? Penalties?
- Who is responsible for your loved one’s bill? Is there a “co-signer” requirement? If so, what are their responsibilities?
- Add to the contract all services verbally promised in discussions with representatives. (Then, of course, keep track of the services actually received.) Use our checklists to help you!
Ask your attorney about these topics and how they might be addressed in the contract:
- What happens if the facility loses its license or accredidation, or the license is changed and no longer covers the services needed by your loved one?
- What happens if your loved one needs additional services down the road, how does the contract cover potential transitions needed?
- If a portion of your loved one’s expenses are covered by insurance, Medicare or Medicaid, what happens if the facility changes or loses its standing to take these forms of payment?
- (In a continuing care community) If your loved one is moving in through independent living, who makes the decision to transition to assisted living or memory care if your loved one declines? Your loved one? The person with their medical power of attorney, or the company?
Critical screening questions to cover in a phone “interview” with any potential senior residence
Phone first!
Save yourself a lot of time: use our checklist of questions to identify the best prospects for an in-person tour later.
Click on a topic below for questions to cover in a phone call.
The answers will help you decide which communities are worth a tour.
Be on the alert for these red flags that may signal poor quality, risky care, and other concerns.
- Pressure for you to come in for a visit instead of spending time with you on the phone/short answers/person doesn’t know answers
- Unsafe staffing ratios
- Inadequate licensing
- Lack of Registered Nurses
- High staff turnover
- Poor supervision (no/infrequent rounding by senior adminstration)
- Not doing any in-person tours
- High turnover in staff
More Tips & Resources
- Ask about Teepa Snow or Adria Thompson training (for dementia care) among staff and administration. (How recent, how often, depth of training: one video vs. Teepa Snow or Adria Thompson onsite workshop for example.)
- After assessment, what if not covered by license. What is plan B? Or even, Plan C?
- Monitor levels of care! What actually getting vs. paying for, especially as levels of care may change or even step down (i.e. after recovery from a hospital stay).
Question everything! The more questions you ask, the more peace of mind you’ll have when you make your decision.
Questions to Ask About Staffing
The following questions don’t apply to Independent Living. However, if you are considering entering a Continuing Care Community through Independent Living, chances are that Assisted Living, Memory Care or Long-term Care will be needed at some point. Be sure to evaluate all care options before making your final selection. And cover these topics for every phase of care offered in a community. You could save yourself from any unhappy future surprises.
Daily Staffing: credentials, quality, consistency, reliability?
- What is the staff:resident ratio?
- What is the clinical staff:resident ratio?
- RNs vs. LPN’s vs CNAs—number and ratio
- Staff turnover: how long has the director worked there? What about the prior director?
- Longest tenure on staff
- When is an administrator on site? (working hours)
- How often does the administrator round on nursing stations or care units?
- Who is the Chief Nursing officer? (Look up on LinkedIn)
- Any other certifications on staff?
- How many shifts in a day?
- How is oral/dental care provided?
- Staff Training (culture of continous improvement?)
- Orientation and staff training: how are new employees onboarded and what are provisions for ongoing training
What amenities are offered?
Following is a list of common amenities offered in senior residential communities. Some may be important to your loved one, while they may have additional interests and needs worth mentioning to any community you’re considering. Refer to your notes for guidance on what’s important to your loved one!
Activities: Type & Frequency
(ask for a calendar of past and upcoming activities)
- Arts, painting, drawing, crafts
- Classes
- Trips (local and otherwise)
- Card and game groups (bridge, bingo, chess, more)
- Book club
- Hobby clubs (geneology, gardening, more)
- Trivia
- Guest speakers
- Movie theater
- Sports events, teams (bocce, paddle, tennis, golf, more)
- Transportation provided to shopping, appointments (frequency, arrangements, cost)
- Outdoor facilities: bike paths/lanes, walking paths, sport courts, dog park, golf cart paths
- Guest quarters
- Gym, work-out facilities, personal trainers
Services: Personal & Medical
- Physical therapy
- Occupational therapy
- On-site personal services: hair salon, barbershop, manicure, massage, facials, more?
- On site services: banking/ATM, post office, UPS, car wash
- On site lab for blood tests ordered by doctor
- On site clinic, staffed by doctor, RN, Physician Assistant
- Package and mail security (Amazon deliveries)
Licenses
Some states may offer different types of certifications than others for nursing homes, or may use different names for certain certifications, depending on the guidelines and standards by the state’s Department of Health. However, Skilled Nursing Facilities (SNFs) and Nursing Facilities (NFs) are the two main categories of nursing homes for certification that remain the same nationwide.
Any nursing home facility must receive both Medicare certification and separate accreditation performed by a qualified state agency. The differences between an SNF and an NF are primarily based upon the different government programs they serve; an SNF is certified to provide care in rehabilitative services covered by Medicare, while an NF is certified to provide long-term care covered by Medicaid. Offering rehabilitative vs. long-term care is also an important distinction.
Levels of Care
- Independent Living?
- Assisted Living?
- Memory Care?
- Skilled Nursing/Long-Term Care?
- Continuing Care (all of the above)
What are the costs?
- Will the fees increase annually and if so, how much?
- What is included in the fee? Does it change with levels of care?
- Is the fee all-in-one or are there added packages?
- Can you permit outside agencies to assist with care (home health, nurses aide, sitters)?
- Do you require in-house pharmacy, or can I use my own?
- Are there any upfront fees such as a one-time move-in fee?
Accomodations layout?
- Hotel-style with private room and bath only?
- Apartment with small kitchen?
- Apartments for couples?
How are medical emergencies handled?
- Where are POLST and DNR forms stored, handled?
- How are these forms shared with emergency personnel?
- Which hospital would EMTs go to? (Check out the hospital’s rating.)
- Would someone from the staff go to the hospital with my loved one in an emergency?
- How would family be notified?
Visiting Arrangements
- Is there a community room for family gatherings or holiday celebrations?
- Is there an option to host overnight visits, either in your room or in a suite on-site?
- Can friends, family to drop in any time or must visits be pre-arranged?
- Are there visitor restrictions, health screening, and/or age limitations?
- Are pets allowed to visit?
Criteria for acceptance into the community?
- Physical, mental and financial criteria?
- Interview required?
- Medical records?
- Financial resources required?
Availability? Waiting List?
If there is a waiting list:
- How many are on the list now?
- Is a deposit required?
How are new residents welcomed and acclimated?
- Are new residents matched with another resident or group of new potential friends?
- Is there a general acclimation plan you follow for each new resident?
- Do you gather info about a new resident’s personality, abilities, interests, etc. as part of your acclimation plan?
Medical Care Questions
- Can I continue with my primary care physician or other specialists or required to use the one in the community?
- Do you have home health services and if they are out of my network, can I use my own?
- How are medications dispensed and managed? Does my level of care change with medications?
- Is there nursing care available 24/7? If so, what type of nurse? RN, LVN, NP?
- How do you handle special diets or diet modifications?
- What happens at night if I have a medical problem or how will going to the ER be handled? Does anyone accompany?
- What is your fall prevention program?
- Do you have palliative, end-of-life, or hospice care options available?
- If admitted into the hospital, what is the policy for returning? Who brings back? Who accompanies for discharge conversation? How is family involved? Who reviews discharge instructions, and how soon after return?
- If I’m in the hospital for a partial month, do I still have to pay the full monthly rate?
How are life and care transitions handled?
- When decline occurs, how is care staged and who decides?
- How does the care change?
- Costs involved?
- What is the scope of care offered under their license?
Assessment
Medical Criteria
- An interview is necessary.
- Medical records will be reviewed.
Financial Criteria
- Be prepared to share your entire financial picture.
- Ask about resources needed to qualify.
- Ask about annual cost increases and possible extra fees for things like transportation, hair salon, food delivery, extra assistance, and more.
- Regarding cost increases and extra fees, it’s good to review these with someone experienced with having a loved one in a senior community, as well as your lawyer, accountant, financial planner, and other family members.
- Ask about financial assistance.
Property & Management
Property management:
- Ownership (Look up on LinkedIn)
- Administrative staff names (Look up on LinkedIn)
Physical configuration of property:
- Number of current residents and maximum capacity of residents allowed according to their license
- Number of units and how configured (rooms, studios, apartments)
- Sizes of each type of unit
- Availability of private and shared living arrangements?
Meal service for residents:
- Transportation services available?
- Number of meals provided daily/monthly (is there a meal plan?)
- Where are meals served? Dining room? In-room dining available?
Tour each prospective community with your loved one.
TOUR WITH YOUR FIVE SENSES: Sights, sounds, smells — they all matter — providing important clues to the quality of care.
While you tour with your loved ones:
Make small talk with residents, their visitors, and any staff you may come across. Introduce yourself and your loved one, and ask questions (tailor them to your loved ones’ needs and interests):
- How do you like living/working here?
- How long have you lived/worked here?
- How have things changed (for better or worse) during that time?
- Are you happy with your decision to move in/take the job?
- What do you like most?
- What would you like to see improved?
- How responsive is management to your concerns?
Critical details to observe during your tours of senior living communities:
More questions to ask residents:
- Do you feel staffing is adequate?
- Were you satisfied with management’s handling of COVID?
- Are you satisfied with the:
- Food
- Activities
- Support
- Maintenance
- Atmosphere
Be on the alert for these red flags that may signal poor quality, risky care, and other concerns.
- What you see doesn’t line up with what you were told when you called.
- Residents appear unkempt
- You don’t hear any happy voices! Staff is grumpy, sour, unfriendly and residents appear somber, bored, sad or listless.
- You see staff on personal phones! You see staff sitting around, just doing nothing.
- Odd smells, bad smells come from residents, their rooms or public areas
- Unclean public bathrooms
- Unclean residents’ bathrooms
- Unpleasant interactions with residents
- Poor quality of food, nutritional content
More Tips & Resources
- Instead of asking for references from the facility (which may not be a fair sampling) pop in for a few unexpected visits at different times of the day and week.
- Check out how former staff has rated them on Indeed and Glass Door. Look at their job postings, too. Any hint of high turnover, management problems, training deficiencies, poor morale?
- Yelp reviews can be helpful, but bear in mind, discontented customers are more likely to post than happy customers so reviews may not be representative.
- Pop in for meals.
- Ask friends and family: do you have a loved one living here? Word-of-mouth!
Question everything! The more questions you ask, the more peace of mind you’ll have when you make your decision.
Sights: what to look for.
- Do the residents seem generally happy and engaged?
- Does the staff seem professional and caring?
- Cleanliness of facility in communal and personal areas.
- Attractiveness of facility and surrounding grounds.
- Appearance and grooming of residents.
Taste: food and drink!
- Tour at meal time and take a look at the food presentation.
- Review the menus.
- Ask if it’s possible for you to provide favorite foods to be incorporated into your loved one’s food plan.
- Ask if bringing in occasional outside meals is allowed.
Eat at least one meal in the dining area with your loved one.
- Pay close attention to the other residents as well as your loved one.
- How are the food quality, quantity, and presentation?
- Are there healthy options?
- Is there enough variety in the weekly menu?
- What is the overall vibe in the room, are residents enjoying themselves.
- Are they positively interacting with each other?
- How are the staff treating the diners? With respect and kindness?
- If there are residents who need assistance, is it being provided in a timely and caring manner?
- Do they seem to be enjoying the food or just pushing it around their plate?
ASK THE SERVERS:
- What are the most popular and unpopular dishes?
- Are unpopular dishes rotated off the menu?
- Do they eat the food themselves?
- If it is not available to them, would they eat it if it was offered?
Sounds: what to listen for.
- Are residents calling out for assistance?
- What tone of voice and voice level is used by staff interacting with residents?
- Is the atmosphere noisy and chaotic, or humming along positively?
Smells: good or bad, odors mean something.
- What do you smell upon entering the building?
- As you walk through the halls?
- In the kitchen?
- In the dining room?
- In resident’s room and bathroom?
- And how do the residents smell?
Nutrition Quality & Special Diets
- Is there a qualified Nutritionist on staff?
- Ask to see a meal menu for a month.
- Discuss availablity of nutritious snacks on site.
- Discuss your loved ones’ special dietary needs.
Confirm the Details!
When touring, take along the notes you made during your screening call so you can confirm all the details of what you heard. As you talk with different communities, it can be easy to confuse details. Taking photos of the community facilities (not the people) is a good way to recall what you saw as you compare different facilities.
What’s the vibe?
In other words, how does it feel to be in this space?
- Is it a healthy, cheerful place?
- Does it make you feel calm and safe?
- Do staff and residents seem generally positive?
Helpful Resources
Memory Care communities who provide Teepa Snow training for their staff are better equipped to provide the special care your loved one needs of they have dementia.
Does your loved one have dementia?
There are many inaccurate beliefs about dementia. Teepa Snow and Adria Thompson are renowned dementia-care education specialists to follow! They train caregivers so that everyone one involved in support or care, of people living with dementia understand the how and why behind changing behaviors, emotions, interactions, and reactions.
Teepa and Adria also help family and friends navigate the confusing, and often exhausting, role of care giver and advocate. We highly recommend their quick videos on Instagram and Facebook – incredibly helpful!
Nervous about potential nursing home problems?
Whether you are a family member or a supportive friend, this guide gives you the tools to identify and resolve common problems that nursing home residents most frequently face. Your caring advocacy can be the difference between average-to-poor nursing home care, and the high quality, person-centered care that residents are promised by federal law.
Overwhelmed? Find a Patient Advocate.
If you’re feeling overwhelmed, reliable independent professional patient advocates are available to help you in your search for a senior linving community that best fits your needs. Independent means not paid by any senior community referral or “finder’s” fee. Senior Care Authority and Care Patrol are examples, not endorsements. Search in your area for these and similar consultants.
website
LinkedIn
Preferred Social Activities