What do consumers want to know about assisted living facilities?
I was recently asked to participate in a project aimed at answering that question. So, I asked some residents of facilities and their families, as well as people who are considering whether to move in. I thought their questions were interesting, so, I’ll share them and try to provide a few answers of my own:
What is assisted living? In general, it is a residential care facility that provides some services but is not licensed as a skilled nursing facility. But that covers a broad range of assistance. Standards vary widely among states. Small board-and-care homes with one or two residents living in a spare bedroom, professionally-run small group homes, and large corporate facilities with hundreds of residents all fall under the label of assisted living.
What services can I expect to get? They may range from little more than group meals in a dining hall, housekeeping, and a pull cord in the bathroom to full-blown dementia care. Is there a nurse on duty 24/7? Is a doctor available? Know what the facility is really capable of providing. For instance, just because it says it provides dementia care doesn’t mean it knows how to do this well.
What will my quality of life be like? Will I be able to eat when I want, and with the people I choose? Are there activities (beyond the usual three Bs–Bible, Bingo, and birthdays) I’m interested in? Do other residents seem active and engaged?
How much will it cost? On average, assisted living will cost $3,000-$4,000 per month. But many ALFs change by levels of service, or tiers. The more care you need, the more you will pay. Often, high levels of care are as costly as a nursing home. Be sure you understand the details up front.
What is the most important thing to know? It is all about the aides. Forget about the wood paneling and fresh flowers in the lobby. When you visit facilities, watch the interaction between staff and residents. Do the aides know the residents by name? Do they seem rushed or do they spend time to chat with residents? What are staffing levels like, especially at night?
Where can I get more information about residential care facilities?
You can try your local Area Agency on Aging (AAA) or Aging and Disability Resource Center (ADRC). These are government-funded but vary dramatically in quality.
Another government resource may be your state or local health or aging office. It may keep information on complaints and reports of safety violations, falls and the like. This is important, but a facility’s safety record is just the beginning of the story. You also want a place that offers the quality of life that is important to you. And no government data will tell you that.
You can also seek out local, non-profit information services (full disclosure, I serve as an unpaid board member of one of these, the Jewish Council for the Aging of Greater Washington).
Another alternative is to hire a geriatric care manager. They are usually nurses or social workers and the best have excellent knowledge of local facilities. Prices vary but expect to pay around $500 for an initial consultation and assessment.
There are many websites, of varying quality. Some are non-profits. Others are for-profits. Access to these sites is usually free, though some may make you register. But it is important to know where their information comes from. Often, descriptions are written up by the facilities themselves and no effort is made to verify what they say. Some sites require facilities to pay for a listing, or for their facility to be highlighted. Keep in mind, if you are not paying, somebody is. And it is usually the facilities themselves.
Choosing to move a loved one into a care facility is a big and often emotional step. But take the time to learn about what is going on beyond the wood paneling and flowers in the lobby.
One other point that perhaps should be included here Howard is that some assisted living programs, at least in New York, are included in the Medicaid program. Other than that, I do agree with your assessment that general staff attitude is important as is the care that is delivered. However, I do think that there should be a little more importance placed on the socialization and activities that these communities offer than what you suggest. As you are aware, as people age, it is important for them to have good care, eat well, and have meaningful relationships and socialization.
Thanks for the article.
my mother-in-law was at a non-profit assisted living residence for three years. The nursing staff was good but there were plenty of staff with sticky fingers. Lots of nice jewelry went missing from my mother-in-law’s apartment. We complained to the director but it kept happening. I told my husband to make a police report but he did not want to “cause trouble”. I would suggest that family lock up the family jewels before the resident moves in. A lock box might work but the elderly often have a hard time with such things. Best to keep valuables elsewhere, sad to say.