How to choose a senior living community
For safe, quality care that fits your loved one’s unique needs
So, what are the residential living options for seniors?
Click on the buttons below for fast facts about the main types of housing and care choices.
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 when vetting, and find out what facilities and amenities are available when the time comes (and it will) for more care and support. You cannot assume the amenities and accomodations will be the same.
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 facility 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 facility.
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 offer these services based on a “tiered” system, 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 Facility
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.
What’s important to my loved one?
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” related to senior residential living.
Be sure to take good notes! The process of discussing living options likely will not be completed in one sitting.
It’s important to let your loved one express concerns about a change in residence without judging. They need to feel heard and participate in all decisions.
Personal Preferences to Discuss
- Is it time to enter senior living now or in the near future? Why, why not?
- Is aging in place an option?
- What type of facility do you feel you need?
- What kinds of help would you like to have in your daily living needs?
- What kinds of help would you like to have for your medical needs, For example, remembering to take your medicines, getting to doctor appointments, getting prescriptions filled, other?
- Do you want one place you can transition from independent living to assisted living and or memory care?
What are your loved one’s worries or concerns about senior living options in general, or about specific types?
What are your loved one’s worries or concerns about senior living options in general, or about specific types?What are your worries and concerns about your loved one and senior living options?
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
- Bathing or showering
Wellness and Safety
- Getting back and forth to the dining room for meals (on your own? with a walker, cane or wheelchair?)
- Eating
- Cutting up food into smaller portions
- Weighing yourself on a scale
- Using your personal medical devices (if any), such as blood pressure cuff, pulse oximeter
Managing Your Communication and Entertainment Devices
- Re-charging your phone or other devices (Ipad?)
- Changing batteries in your TV remote
- Using TV remote
- Getting to your favorite shows on TV
- Setting up your computer
- Getting to your email or other favorite “apps”
- Trouble-shooting TV and other devices when glitches occur
- Making your bed
- Folding and hanging clothes to put them away
- Tidying your room
Meal & Food Preferences
- Do you enjoy eating with others, or would you rather dine by yourself?
- Do you have dietary restrictions and/or preferences?
- Do you like to have access to food/snacks all day and evening?
- Do you tend to eat between meals?
- Do you like to go out to restaurants to eat?
- Do you like to cook?
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
- What are your loved one’s favorite hobbies?
- Do they enjoy activities such as yoga, chair exercises (with or without weights), swimming, walking, dancing and/or jogging?
- Do they enjoy hands-on hobbies such as woodworking, knitting, crocheting, painting, sculpting, and/or other arts & crafts?
- Weather permitting, do they like to be outdoors? If so, what are their favorite outdoor activities?
- Do they enjoy board games, card games, online games, or other types of games?
- Are they technologically savvy? If so, what technology do you enjoy using?
- Do they like to take classes?
- Do they enjoy teaching others?
- Are they a history buff and/or do like the fine arts?
- Do they enjoy music? If so, what types of music do they prefer?
Travel & Outings
Are they interested 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?
Do they want to have a car? Is night driving comfortable for them?
Do they want to travel?
- If so, what kinds of trips do they want to take? Where?
- What do they want to see, experience or learn?
- Do they anticipate driving? Are they comfortable with flying? How about navigating airports?
- Would they want to travel alone, with a companion, or in a small 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 be need long term?
Many of these senior living options require contracts…
which 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 help you more successfully screen senior living facilities — before you spend time on 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 (blame on Covid)
- High turnover in staff
More Tips & Resources
- Ask about Teepa Snow training among staff and administration (how recent, how often, depth of training: one video vs. Teepa Snow 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
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Levels of Care
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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?
Are accomodations home-style or hotel-style?
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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?
Provisions for visits?
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Criteria for acceptance into the community?
- Physical, mental and financial criteria?
- Interview required?
- Medical records?
- Financial resources required?
Availability? Waiting List?
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How are new residents welcomed and acclimated?
- Are new residents matched with another resident or group of new potential friends?
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 was Covid handled? Rate of infection?
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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
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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
- 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.
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Taste: food and drink!
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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.
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Smells: good or bad, odors mean something.
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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.
Get confirmation!
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What’s the vibe?
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Preferred Social Activities