The variety of senior care alternatives is far greater than it was even just a generation ago. As people age, they are likely to require an increasing level of help with daily activities. For a time, this need may be met by an in-home provider. When remaining at home becomes impractical, moving to an assisted living facility is usually the next step.
Assisted living communities range from a few dozen to several hundred residents, but many are built for occupancy of 40-50 persons. Most of these moderate to larger size facilities provide residents their own apartment with meals served in a community dining room. Residents bring their own furniture and personal belongings. Choosing a facility can appear challenging. With costs averaging about $4,000 a month for a one-bedroom apartment, it is essential to be sure the facility will meet the needs of the person making this community his or her new home.
Take a guided tour.
Most facilities will offer a guided tour of the grounds and a few apartments. If a tour is not offered, that’s a red flag, and you probably should consider other alternatives. Use the tour to examine if the grounds are kept in good repair and appear attractive. Check to see if there is a common outdoor area where residents and guests can sit and visit quietly on a sunny day. Be sure hallways have adequate lighting, that elevators are operating and stairways have railings for safety. Apartments should have standard safety features including grab bars in the bathroom and shower and easily accessible call buttons for emergencies. Once you are generally satisfied with the grounds and apartment options, there are a variety of ways to look beyond the surface appeal. Never hesitate to ask questions of both staff and residents. This is a life-changing decision, and a review of the complex should be thorough. These suggested tips apply to moderate and larger sized facilities.
Ask if you may attend a lunch or dinner as a guest. This gives everyone an opportunity to check out a typical menu and sample the cuisine. Determine if available meals offer sufficient variety. Often, two different entrees will be offered with a selection of several side dishes. Check to see if there is an a la carte option as well which would allow a person to simply choose a sandwich or soup if the entrée offerings are unappealing. Find out if meals can be taken back to the room and whether staff will serve meals in the room if, for example, a resident has a cold and wants to avoid exposing other residents to any sickness. Ask whether friends and family members can be invited to meals as guests and at what cost.
Talk to the residents.
Attending a meal also offers the opportunity to view how staff and residents interact and to speak directly with residents sitting at or near your table. Realize that the staff is trying to sell you on the facility and will put the best face on everything. Talking to the residents and their family members, when possible, can offer important insight into daily life. Try to learn if residents feel satisfied with the attention and care received. Ask how long it takes staff to respond if the emergency call button in an apartment is activated. Are routine maintenance requests handled quickly? Are residents content with the number and variety of activities offered both for socializing and to get out in the community? Residents who appear well-groomed, happy, and friendly are a good sign.
Understand payment options.
Assisted living is not inexpensive. Even for people with a home to sell and a modest amount of savings in the bank, financial resources may become depleted faster than anticipated. If two persons are moving to assisted living, and will share an apartment, ask if both will be charged equally. For example, if renting an apartment for one person costs $4000 a month, perhaps only an additional $1000 more would be charged for a spouse. A second person would increase food costs, but since both share the same living space and it is unlikely any added staff will be required, the spouse should not be charged the same as a single resident.
Conversion to Medicaid.
Many complexes will not accept Medicaid. Some may set aside a limited number of rooms for Medicaid residents. Facilities typically receive less per room for Medicaid residents than they charge to private pay residents. Some complexes will allow residents to convert to Medicaid once they have lived there for one or two years. Allowing conversion to Medicaid for residents who have exhausted their financial resources demonstrates an extra level of compassion and commitment to residents. This practice is a sign that management is in this business for more than just the money and will not abandon residents once resources have been depleted.
Aging in place.
Residents are typically screened during an application process to determine if their assistance needs can be met by the facility and staff. At some point, if the need for assistance increases, residents can be required to move to another facility such as an adult home or a skilled nursing facility. Increased loss of mobility or a decline in memory and cognitive functioning may result in exceeding the level of care the assisted living facility is designed to provide. Moving is stressful at any age. Peace of mind comes from knowing one can age in place at a chosen residence. Larger facilities sometimes offer progressive levels of care, including basic assisted living, memory care, and even nursing care. This spectrum of care allows a person to remain in the complex by moving to a new location within the facility. In choosing a facility, it is important to know what levels of care are provided, and at what point a resident would be asked to leave if assistance needs increase. Inquire about the possibility of hiring private aides if additional assistance becomes necessary. Find out how long the facility will hold a room, assuming rent continues to be paid, if a long-term visit to the hospital is required and whether the rent may be reduced during a prolonged absence.
Activities and transportation.
Most medium and larger facilities offer a range of weekly activities including shuttles to local shopping areas and restaurants, short sightseeing excursions and in-house game and exercise sessions. Moving to assisted living does not mean giving up socializing and community involvement. The best facilities often maintain their own bus and driver to provide ample opportunities for residents to leave the facility. A top-notch facility will also provide transportation to attend local doctor appointments if scheduled during specific times.
Small dogs, cats, and other creatures have proven their worth and benefits as companions to seniors. Many assisted living facilities welcome pets, but find out how many are allowed and whether any special requirements or costs apply.
A weekly housekeeping visit from staff is fairly routine. This typically includes cleaning the bathroom, vacuuming, and changing the bedding. Verify this service is provided. Locate the laundry rooms and ask whether assistance will be provided if required.
Inquire about the level of training required of staff. Staff turnover can be rather high at senior care facilities. Ask other residents if the same people have been attending to them for a substantial amount of time. Check with your state’s licensing department to learn if any complaints have been filed regarding the facility.
The number of assisted living facilities has been rising as the general population ages. There is increasing competition to attract seniors to these communities, and some companies may offer a variety of incentives to make the move more convenient or less costly. Discounts may be offered for the first month’s rent, or a resident may be rewarded with a free month’s rent after living in the community for a specific time. Free cable TV service for several months is a frequent incentive. Some facilities may offer a substantial credit toward moving costs if you use a recommended moving company. Incentives should not drive the decision to move-in, but they should not be overlooked.
Signing the contract.
Take the proposed contract home and have other family members review it. They may think of new questions to ask. Be sure all concerns have been addressed before committing. Don’t simply rely on marketing materials. The contract should lay out very specific provisions on costs, level of care, services provided, and discharge criteria. If in doubt about any provision, get written clarification in the contract. An assisted living facility should meet the needs of both the person moving in and family members who want to ensure the comfort and safety of their loved ones. Seniors facing a move from home may often put up some resistance. Taking the time to help them visit the intended complex, view the grounds, and meet the staff and residents can significantly ease the anxiety and make the move a positive experience for all concerned.
- The following service packages are available at assisted living facilties for residents with Medicaid:
- Residents have private apartments to support their independence and choice.
- These senior living facilities provide nursing services as needed.
- Staff assists with personal care and administering medication.
Adult Residential Care (ARC)
- Residents receive assistance with medication and personal care.
- Limited supervision is provided as needed.
Enhanced Adult Residential Care (EARC)
- Rooms are shared by no more than two people.
- Intermittent nursing care is provided.
- Residents receive help with medication and personal care.
- Specialized dementia care is sometimes provided.
For Medicaid residents in Washington State, the Department of Social and Health Services uses a need-focused system for residents. The system is adjusted according to the geographic location and is based on 17 levels of care. Assisted living facilities determine their rates for private pay residents separately, and the rates may differ.
Laws and Guidelines for Assisted Living Facilities
As assisted living facilities must meet certain guidelines, and staff must have appropriate qualifications. All AFL staff must be certified as home care aides. They must have completed 75 hours of training and must participate in continuing education for 12 hours per year.
Assisted living facilities are inspected every 18 months at a minimum. If complaints have been filed, inspections may happen more frequently. Homes that are not in compliance with licensing requirements may accrue civil fines, have their licenses revoked, or have criminal allegations reported to law enforcement.