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 each choice in residential living geared to seniors or others who may need support to manage everyday living activities. 

 

Continuing Care Retirement Community

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, assisted, memory, skilled nursing.

Usually a substantial upfront investment is required, plus ongoing  monthly fees to  cover housing, residential services, personal assistance, and nursing care

Residents must usually be independent when they move in, and when they do,  residents may be reqired to enter into a long-term contract which can be complex. 

 

Assisted Living

 

Features, services? Who best suited for?

 

 

Memory Support

Features, services? Who best suited for?

 

 

 

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

Such residences offer 24/7  skilled care by licensed medial professionals and aids for medical needs, for those needing such care on a long-term basis or while in recovery or treatment for a serious illness. Examples of support include: 

  • Rehabilitation following surgery or illness
  • Injected medication through, often through an IV tube and bag system 
  • Nutrition via a feeding tube
  • Urinary catheter care 

Costs may be covered by Medicare or Medicaid. 

In some states, these group residences are licensed by state departments of public health and  subject to an annual audit by Medicare to maintain their certifications.  

Tips/Resources  (Linda Beck/Others)

Many of thes options require contracts, which can be  are complex financial and real estate transactions and should be reviewed by an attorney familiar with them.

Ask for notices for move-out? 

Who is responsible for loved one’s bill? Is there a “co-signer” requirement? If so, what are there responsibilities? 

Document services actually received.

Are you thinking just in terms of present/best-case scenario? What happens if additional services are needed down the road?

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 serices that you/loved one may be need long term?

Think like a match-maker! 

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

 

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

 

What’s important to my loved one?

 

 

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?

 

 

 

 

Travel/Outings

Do you like to travel?  If so, how far do you like to go?  Drivable?  Flights ok?

Do you like to go on outings with groups of people?  Locally, in the country, internationally?

Do you like to participate in community planned day trips or outings?

Do you have a car?  Do like to drive distances either as the driver or as a passenger?  Is night driving ok with you?

Visitors

Would you be interested in using a community room for family gatherings or similar celebrations?

What would be the ideal situation for family members and friends coming to spend time with you?

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?

Would you be agreeable to signing in and out if you leave the community, along with providing staff information regarding where you are going and with whom?

City vs. Suburban vs. Rural

Do you prefer to be in or near a city 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 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 or social work 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?  Insurance, Long-Term Care, Family Resources, Medicaid or other state funded program?

For extra expenses, will you plan to pay out of pocket?  What are your preferences for payment?

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?

Dining 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?

Personal thoughts and Perceptions: Various Options

What type of facility do you need?  Is it time to enter senior living? 

What are my needs  ADL?, medical?

How much will it cost?

Where is it located?

What activities and amenities are available?

How is health care delivered?

How open is the community to questions from would-be residents and family?

What differentiates this facility from all others?

 

  • Independent Living

 

  1. Are you independent and healthy and require no assistance for daily living and medical needs?
  2. Do you want amenities such as a golf course, exercise classes, nature trails, social activities?
  3. Do you want to cook or in house dining?
  4. Do you drive or need transportation?
  5. Is safety a concern – neighborhood

 

 

  • Assisted Living
  1. Do you require assistance with activities of daily living including bathing and dressing?
  2. Do you need assistance with medication management?
  3. Do you need assistance with cooking?
  4. Do you need transportation?
  5. Do you wish to reside in a small apartment

 

  • Memory Care Units
  1. Are your cognitive disabilities worse than your physical abilities?
  2. Do you need constant supervision?
  3. Are there trained dementia care partners?

 

  • Continuing Care Retirement Communities (CCRC)
  1. You need to qualify for independent living to live at a CCRC
  2. Do you want one place you can transition from independent living to assisted living and or memory care? – Age in place?

 

 

 

 

Tips/Resources

 

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.

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
  • Staffing ratios greater than approx. 8:1. (8 residents for every staff person)
  • 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

 

  • What is the ratio to patient/staff?
  • How long have employees been employed?
  • How long has the director been there?
  • Is there an administrator on site or when are they present
  • (For assisted living, memory and any other care centers staffed by nursing) How often does the adminstrator round on nursing statioins
  • Staff turnover (how long have you been the director, how long has ___ been here)
  • Longest tenure in staff
  • RNs vs. LPN’s — ratio
  • Any certifications on staff?  
  • Orientation and staff training – ongoing
Amenities

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Licenses

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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?

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How are medical emergencies handled?

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Provisions for Visits

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Criteria for Acceptance to Community

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Availability? Waiting list?

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Current make-up/demographics of residents

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How are new residents welcomed and acclimated?

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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?
(To be sorted)
  1. Property:
    1. Who owns the property?
    2. Who is the contact person for admission and nursing?
    3. Is transportation available?
    4. Are meals provided? Can you eat in the room?  How many meals per day are offered?  Do I always have to go the dining room?  Is there a care on site for a la carte items?
    5. Levels of care: What are the levels of care?
    6. How many residents/beds does the facility have?
    7. What activities/amenities do you offer?
    8. What size are the bedrooms/apartments?
    9. What kinds of patients are currently living in the facility?
    10. What makes you stand out from other facilities in the community?
    11. Do you welcome visitors?
    12. Can you tour the facility at different times of the day or evening?
    13. Do you allow pets?

 

     

    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!

     

    Sharing is Caring ❤

    Share these tips with your family and friends.