How to choose a senior living community 

For safe, quality care that fits your loved one’s unique needs

 

 

Residential Options

Fast facts to help you understand the differences between residential living options tailored to seniors.

 

Continuing Care Retirement Community (CCRC)

Sometimes called “55+ communities”,  these offer  apartment-style or small townhouse-type homes that generally offer a range of services, sometimes  on an ala carte basis.  These include meals at 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. 

 

Assisted Living (AL)

 

When physical abilities and memory changes cause seniors to feel the need for help, assisted living residences offer compact  apartments equipped with small kitchens with small appliances (no ovens or dishwashers.)   Conveniences 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. 

Memory Support

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.

 

 

 

 

Long-term Care (LTC, “skilled nursing, “SNF, “nursing home” care)

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.

Examples of support sevices provided in long-term care in these nursing facilities include: 

  • 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. 

Tips/Resources 

Right DiagnosisMany 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?

Right DiagnosisCheck 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?

 

Right DiagnosisContinuing Care Communities market to prospective residents based on the facilities and amenities offered in Independent Living. ALWAYS evaluate their services and amenities for Assisted Living (AL), Memory Care and Long Term Care. These living options may be needed in the future.

 

Right Diagnosis

Finally, don’t miss this article on assisted living by Judy Graham for Kaiser Health News. Follow her on FB.

 

Think like a match-maker! 

Create a summary of your loved one’s unique needs and wants: everything from health care to favorite social activities and finances.

 

What are your loved one’s worries or concerns about senior living options in general, or for specific types?

What are your worries and concerns?

Is aging-in-place an option?  

 

What’s important to my loved one?

Good topics to cover and keep in mind when evaluating all options.

 

Personal Thoughts and Preferences

Is it time to enter senior living now or in the near future? Why, why not?

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?

 

Support for "Everyday" Activities

Would you like to have 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

Support for Medical Care

About how often do you meet with your doctors? (avergage 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, October 15-December 7)?

 

Meal and 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?

Social Preferences

Are you an early riser or do you like to sleep in?

Do you consider yourself a social butterfly, a more private person, or something in between?

Do you like activities such as movie nights, barbeques, singalongs, and group outings?

Do you like Happy Hours, birthday parties, and holiday gatherings?

Do you anticipate going on day outings with family or friends outside of the community?

Are you a reader and/or do you like going to the library?

Do you enjoy phone calls and/or video calls with family and friends?

 

 

 

 

Favorite Hobbies

What are your favorite hobbies?

Do you enjoy activities such as yoga, chair exercises with or without weights, swimming, walking, dancing and/or jogging ?

Do you enjoy hands-on hobbies such as woodworking, knitting, crocheting, painting, sculpting, and/or other arts & crafts?

Weather permitting, do you like to be outdoors?  If so, what are your favorite outdoor activities?

Do you enjoy board games, card games, online games, or other types of games?

Are you technologically savvy?  If so, what technology do you enjoy using?

Do you like to take classes?

Do you enjoy teaching others?

Are you a history buff and/or do like the fine arts?

Do you enjoy music? If so, what types of music do you prefer?

Travel/Outings

Do you want to travel? 

(If so) What kinds of trips to you want to take?  Where?

What do you want to see, experience or learn?

Do you anticipate driving? Comfortable with flying?  How about navigating airports?

Would  you want to travel alone, with a companion, or in a small tour group?

Are you interested in planned outings that may be offered in a new community? 

What would you want to see, do or learn?

Would you like to help plan outings? 

Do you want to have a car?  Is night driving comfortable for you?

 

Visitors
  • 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: City vs. Suburban vs. Rural

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

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)?

Finances and Financial Preferences

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?

Tips/Resources

 

Right DiagnosisCreate 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.

Phone first. 

Save yourself a lot of time: use this checklist of questions to identify the best prospects for a tour later.

 

Be on the alert for these red flags that may signal poor quality, risky care, 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

Critical screening questions to cover in a phone “interview”

Staffing

These questions don’t apply to Independent Living, however if you are considering a Continuing Care Community, entering through Independent Living, chances are that Assisted Living, Memory Care or Long-term care may be needed at some point. Be sure to evaluate all care options and cover these topics for every phase of care offered in a community.

Daily staffing: credentials, quality, consistency, reliability

  • What is the staff:resident ratio?
  • What is the clinical staff:resident ratio?
  • How long have employees been employed?
  • How long has the director been there?
  • When is an administrator on site? (Working hours)
  • How often does the adminstrator round on nursing stations or care units
  • Who is the Chief Nursing officer? (Look up on Linked In)
  • Staff turnover: how long has the director worked there? What about the prior director?
  • Longest tenure on staff
  • RNs vs. LPN’s vs CNAs: number and ratio
  • Any other certifications on staff?

Staff Training (Culture of continous improvement?)

  • Orientation and staff training: how are new employees onboarded and what are provisions for ongoing training
  • How is oral/dental care provided?
  • How many shifts in a day

Emergencies

  • How are medical emergencies handled?
  • Where are POLST and DNR forms stored, handled?
  • How are these forms shared with emergency personell
  • 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?

 

Amenities

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 and frequency (ask for a calendar of past and upcoming), for example:

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

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

Movie theater

Guest quarters 

Gym, work-out facilities, personal trainers

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
Levels of Care
Costs, ALL costs!

 

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 is there added packages?

Can you permit outside agencies to assist with care (home health, nurses aid, 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?

Physical layout? Home style or hotel style?
How are medical emergencies handled?

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Provisions for Visits

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Criteria for Acceptance to Community

What are criteria for acceptance into community?

Physical, mental and financial criteria? 

Interview required?

Medical records?

Financial resources required?

 

Availability? Waiting list?

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Current make-up/demographics of residents

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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
  • 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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Life and care transitions

– When decline occurs, how is care staged and who decides? How does the care change? Costs involved?  (Again, what is the scope of care offered under their license?)

 

Assesment?
Property and Management

Property Management

Ownership (Look up 

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? 

Levels of care offered

Pet policy?

When are tours offered? (Drop-in visits accomodated?) 

Activities 

Amenities

     

       

      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 assement, what if not covered by license. What is plan B? Or even, Plan C?
      • Monitor levels of care! What actually getting vs. paying for, esp. as levels of care may change or even step down (i.e. after recovery from a hospital stay)

      Tour with your 5 Senses. 

      Details to watch for during your visit. Sights, sounds, smells – they all matter.

       

      Be on the alert for these red flags that may signal poor quality, risky care, 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

      Smells, odor

      Poor quality of food, nutritinal content

      Critical details to observe during tours of senior living communities

       

      Sights: what to look for

      Activities calendar 

      Sounds: What to listen for

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      Smells: Good odors and bad, they meant something

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      Get confirmation!

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      Taste: Food and Drink!

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      What's the vibe?

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      Food quality, nutrition, variety, appeal

      Nutritionist on staff? 

      Can I have a few meals beforhand 

      May I see meal memu for a month 

      Availaiblity of snacks on site? 

       

       

      • 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?
        • For residents, are you satisfied with:
          • Food
          • Activities
          • Support
          • Maintenance
          • Atmosphere
        • Do you feel staffing is adequate?
        • Were you satisfied with management’s handling of COVID?

       

      • Eat at least one meal in the dining area with your loved one. Pay close attention to the other residents.
        • 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

      Tips/Resources  

      • Instead of asking for references from the facility (which may not be a fair sampling)  pop in for a few 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 turnouver, managment 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!