Evaluating assisted living options: beyond the site tour

BY JA Strom —
Today’s seniors have more choices than ever in options for retirement living. But often, as we age, the need for help with daily living activities influences that choice in the direction of an assisted living community. Doing your homework before you or your family member have to move and sitting down to discuss what is really valued or needed in housing can make the transition a lot easier.

I don’t know anyone who is eager to move into an assisted living community. My mother, even into her late 80s, resisted it, saying she did not want to be around “those old people.” I think what she really meant is that she did not want to be around people who reminded her of her aging and what possibly lay in front of her.

Click here to download a checklist for evaluating assisted living communities.

But today's assisted living communities aren’t your Grandmother’s “old folks home.” Many have spacious apartments, large common areas and lots of activities. With the growing senior population on the minds of developers, assisted living buildings are sprouting all over Minnesota, so you probably have lots of choices, unless you are in a very small town. Some independent living communities are also offering in-home care packages.

For many seniors with health problems which make living on their own impossible, assisted living can literally be a life saver. Some thrive in a community setting with others around to visit. Many gain weight by having regular meals served and like the security of knowing there is someone around to check on them. Most of the time, the initial reluctance to move is replaced by a high level of comfort.

Finding out what’s really important

However, people have different priorities. Before you even start touring these facilities for loved ones, it’s a good idea to have a sense of what is really important to them. My mother would have been very unhappy to have to eat all of her meals in a communal dining room. She didn’t want to eat as early as many facilities serve dinner (Why do they do that anyway?) because she liked to watch the evening news. Her generation dressed up for dinner and sometimes she just didn’t want to do that. I often wonder what the bluejean-clad Boomers are going to do.

If it is a male relative that you are looking for, be sure to see if some activities are male-oriented. There are usually more women than men living in these communities, so activities might have a more female bent. Some places have a hobby room where the “guys” can do woodworking or other activities.

Knowing what things are really important to your loved ones can save unhappiness down the road — whether it be having lots of windows for natural light, an outdoor area to sit or walk in, the ability to entertain or eat in one’s own apartment, keeping a pet, a certain religious affiliation, or something unique to them.

How long can you stay?

One thing that may be important is how well the facility deals with the aging process. You or a family member might be in fairly good health when you move to an assisted living community, but can you stay there if your health deteriorates? The industry refers to this as "Aging in Place."

There might be limits to the kind or level of medical care that can be provided. One important thing to check is are there any health or cognitive conditions that would necessitate a move to another facility? Better to know ahead of time under what circumstances you would need to move your parent than during a medical emergency.

Location, location, location

Many times location is an initial key factor in choosing an assisted living facility. You want it to be near family and friends for easy visiting.

But be sure to check out the surrounding neighborhood to make sure there are not bright lights that might shine in windows at night or noisy traffic too nearby. That outside patio may be lovely, but does the noise from the nearby freeway make visiting impossible or at least unpleasant.

Going beyond the tour

Everyone will be on their best behavior during your tour of the community. Most likely your tour guide will be the marketing director, whose job it is to keep the facility full, so he or she is going to — understandably — present the best portrait of the community. Residents you encounter during your tour might be hesitant to give a negative review in front of a staff member. If you know someone who lives there with whom you can talk to in private, that might be the best way to get an accurate assessment.

Assisted living communities offer very similar services and amenities. A key factor in the quality of care you or your family member will receive is the staff. It pays to take time to carefully check this important area.

A reality in today’s labor market is that many care workers are immigrants from South America or Africa. The good news is that those cultures value the elderly — often more than our American one does — but their accented English can be difficult for older ears to understand. It might be hard to ascertain this, but check whether any staff members who have accents seem patient with having to repeat what they just said (perhaps more than once)?

What’s for dinner?

Go beyond some of the typical questions to get a real idea of the quality of meals. Ask for several months of menus to see whether the same food is served each month (which could get boring). Also, look for the appropriateness of the food. Not only should it be tasty and nutritious, but easy to cut for frail hands. My mother-in-law’s memory care facility insisted on serving meat in forms that were very hard for memory-impaired residents to cut. Several couldn’t handle a knife. I kept thinking a tasty tuna fish casserole would have been a better choice.

Sometimes a facility with several branches may have a central food preparation or ordering area, so all of the facilities get the same meals, whether or not they are appropriate. Check this out.

Planning ahead

If you know that assisted living might be in the near future, it’s a good idea to start thinking about what factors are most important. Too often, the move is necessary because of declining health and there is no time to choose the best option. Would you really want to move twice?

And remember, there could be a waiting list at the community you really want. If you know that location is very important should you need to move a parent to an assisted living community, you might want to check out some places near your home ahead of time.

Where to get more information

Assisted living facilities are licensed and regulated by the Minnesota Department of Health. Minnesota’s laws related to assisted living are based on the concept of “housing with services.” You are renting “housing” and buying assisted living “services.” A single company may provide both the housing and the services, or the building may have an arrangement with home care agencies and other companies to provide services. (Search the GrayTimes directory for assisted living facilities in Minnesota.)

It is worth visiting the Department’s Website for information on Assisted Living, including the Minnesota Home Care bill of Rights for Assisted Living Clients, a Consumer information Guide and results of compliance reviews.

The Medicare Website can tell you if the home care agency the assisted living facility uses is Medicare approved and, if so, Medicare has a rating on how well it performs (http://www.medicare.gov/HHCompare/Home.asp)

Figuring out what it costs

It may be difficult to do a price comparison among facilities because it is not going to be "apples to apples." Unlike some other states, Minnesota does not mandate that its assisted living facilities charge their services in a standard way.

Many assisted living facilities have a monthly fee which pays for the apartment and for such things as utilities and meals. But what is included in that fee varies. Some include all meals, some personal care services and things like utilities and housekeeping. Others charge only rent for the apartment and break out the additional charges.

Be sure to learn exactly what is included in the standard fee and what is not. And ask about extras like transportation to medical appointments or assistance with medication. Unfortunately this will call for a personal visit or a phone call, as most facilities do not list this information on their Websites.

In addition to the standard monthly fee, there are often Care or Service Plans which charge additional fees, depending on how much assistance is needed with daily living. These fees can quickly add up, so be sure you know ahead of time what personal care might be covered in the monthly fee and what will be an extra charge.

These personal care costs often called activities of daily living ("ADLs"). ADLs include dressing eating, mobility, hygiene, grooming (bathing, toileting, incontinence), etc. You should be given a list of ADLs and what the facility charges for each. Ask if there is a different cost for day, evening or overnight time periods and how they define the times for each.

Facilities vary on how they describe and charge for these personal services. Some have levels of care, progressively getting more expensive as the level of care increases. Others use a point system, where care services are assigned points which translate into dollars. Some use increments of time, such as 15 minutes, which cost a certain amount. A current trend seems to be an “à la carte” system, where you can purchase care options such as a single bath or one wake up.

Usually the amount of personal care a resident will receive is based on a care plan that is done prior to move in and reevaluated a few months later. Care plans begin with a comprehensive assessment, including level of function and social, emotional, mental and medical condition. The assisted living facility should revise the plan every three months or whenever the resident’s condition changes. Note that this revision can results in increased charges.

Family still matters

Finally, no matter how nice an assisted living community is, the staff is still not your family. You and your loved ones need to be realistic in your expectations of what you can expect from staff. Just because a loved one moves into an assisted living facility, doesn’t mean family has no role or no responsibilities. Even if you are across the country, you should keep the lines of communication open to see where and when your parent might need supplemental help and monitor the care he or she is receiving. And you should know where to go at the facility if you sense any problems with this care.

My husband spent every meal with his mother the last month of her life (we didn’t know it was the last month of her life at the time) trying to get her to gain weight — bringing special nutritious drinks and her favorite snacks. The staff just couldn’t provide that level of personal attention with 30 other residents to help during meal time. We are not sure it prolonged her life, but it sure made him feel that he did all he could, which was — as the ad says — priceless.

(Posted June 6, 2008)