How to Choose an
Assisted Living Community

Much of the information I have included here comes from an article written by Bill Young, an executive in the senior living community in Maryland for over 20 years, published in the November pamphlet of Reflections

Choosing an Assisted Living community for your loved one is an important and complex decision.  Sometimes, some communities try to hide certain things from you or be less than transparent

Budget for the Highest Level of Care

We all have a budget.  We may be shopping for a car, a house, or groceries, or almost anything else; we have a budget.  When looking for an Assisted Living community, the same reality applies.

The number one mistake consumers make is to ask, “How much are your rooms?”   The industry makes money from their “level of care”, rather than their room rent.  An additional question you need to ask is, “How much are all your levels of care?”  How much are levels one, two, three, and four?  Always budget for the highest level of care. 

Recently, a woman toured our facility looking for a community for her mother.  She had found a community with lower rates than ours.  Her mother was accepted there at a meager rate but then suffered a devastating fall a few months later, and her monthly rate was increased by over $2,000 a month above the rate she paid when first admitted into the community.

The daughter had not budgeted for the higher rate and was forced to move her mother from the community she called home to another community where she had no friends or acquaintances.  We are all one stroke, heart attack, or fall from needing the highest level of care.

Be aware that in most senior care communities, each resident is “re-assessed” every 45 days per state regulations (states may vary).  A nurse must review each resident's chart for any cognitive or physical change that may change their care level

Many states require only a 45-day notice for a basic increase in the room rent.  Some communities do offer an “all-inclusive”  price, where there are no care levels but just one price that includes care.

In Maryland, assisted living communities must use an “assessment” to determine a potential resident’s care level.  This often starts with a “health care practitioners form” filled out by the primary care physician that includes a current detailed medicine list.

This form provides an overall cognitive and physical picture of the incoming resident.  If your chosen community is not asking for any type of health information, they are most likely not licensed.

Location, Location, Location

Now you have a list of communities you can afford,  What’s next?  Be sure you are being realistic about the location of the community, not just the price.  Many budgets are so tight that some families place loved ones far away in a more affordable community. 

With no family or friends nearby, the individual never has any visitors.  Sadly, sometimes, this is the only viable option.  Proximity to where you live and work is important.  Pick a community on your way to or from work or along any route that is frequent to you or other family members.  This makes life more enjoyable for your loved one, with you being able to stop by on a whim with lunch or to visit.

Ask the Right Questions

How do you know if the community is safe, compliant, and provides good care?  One of the best ways is through a personal referral.  Ask for a copy of the most recent state survey.  This will give you a good idea of how well the community is being managed.

Don’t panic if you see any “deficiencies” in the survey. Occasionally, communities receive surveys with no deficiencies, but that is not the norm. Look for repeat offenses in the survey.

If the survey mentions that “resident A” was found half-dressed and soaking wet with urine, and it was a repeat offense, this may indicate a problem.  If you see a notation that a staff member missed a training session, there may be no need to be concerned.

Ask about staff retention.  While touring the community, stop the staff and ask how long they have worked there.  Poor management and poor staff will result in high turnover.  It’s not always the management’s fault, and it’s not always the employee’s fault.

A community that is well-established and well-run will have minimal staff turnover.

Talk with residents and family members who are visiting the community.  Ask them about the food, the property's condition, the available activities, and the cleanliness of the facility.  A licensed dietitian must approve the menus.   Often, the food is tasty and nutritious.  Ask to view the menu.

Is the property clean and well-maintained?  Realize that accidents do happen even in assisted living communities.  You may note unpleasant smells or stains, but these should be the exceptions rather than the norm.  If you are unsure, make a surprise visit or two to see if it is an exception or a standard operating function.

Are light bulbs burnt out for months at a time?  Do walls need fresh paint?  Is the carpet torn or excessively worn for extended periods?  Though this may have little to do with the quality of care, the building must be safe and presentable for the well-being and dignity of your loved one and others living there.

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