[Editor’s note: Original published by The Voice of Aging Boomers. The author has spent the last ten years as an assisted living facility resident]
1. Before you sign the contract, check the Exclusionary Clause. This is the “We can throw you out if ” . . .list. It can include incontinence, dementia, and dying.
2. If you use a wheelchair, know that the overwhelming majority of assisted living facilities are not wheelchair accessible.
3. The primary objective is to make a profit. Everything else is secondary. **I’m going to revise this one after reading a letter from my friend, Sue Anagnostou of ACHCA, who correctly pointed out that profitability is not a liability, but rather an asset. What I should have said is that the problem of profiteering becomes a problem when it’s done at the expense of personal care attendants making a living wage.
4. Ask for a copy of the Activities Schedule. The greater the number of interactive activities, the better.
5. As a general rule of thumb, not-for-profit and religious facilities often provide the best care. Here’s another way to think of it: the number of phone calls necessary to reach a decision-maker, is an accurate barometer of how responsive staff and administrators are likely to be.
6. Find out how many employees are on the 11 pm – 7 am shift. These are the hours most falls occur.
7. Does the facility have a Resident’s Council?
8. Do residents have access to mental health professionals? Ambient Despair — the hopelessness many residents feel due to higher-than-normal rates of disability, depression, dementia and death — can spread like a virus in communities without mental health support.
9. How much emphasis is put on physical fitness? Believe it or not, this is usually a good indicator of how much the facility is truly invested in a resident’s quality of life.
10.How “self-energized” are the residents? Residents who are active and community oriented, always do better than those who stay in their rooms all day. What programs does your prospective facility has to encourage “purposeful living?”
Alzheimer's Caregiver says
Thank you very much for the advice. Assisted living could be a great option for many people, however, in home senior care might be a better option. It allows a caregiver to come into the home and cared for loved ones.
Ridley Fitzgerald says
My dad is getting too old to take care of himself. We’re trying to find an assisted living facility for him, so these tips are perfect for us right now. I like how you said that we need to look at what sort of activities they offer. He likes to do things, so that will be great for him.
Reyan Loeffler says
Hey Martin it was really a nice blog post about Assisted living care. Last year i hired a old care house for my mother, (She could not walk and most of the times stay on wheel chair). My mother have a pet and she wants to bring her pet in old care center with herself. They allowed my mother to bring her per with herself. I think asking about pets is also important to know before signing any contract with these old care centers.
Mike Shirk says
I am 72 years old, nonambulatory due to a rare disease (inclusion body myositis), and am living in an assisted living facility. It took me a lot of searching before I could even find one that would accept me. Most said that they would not take care of someone who wasn’t able to stand or walk. My “neighbors” are almost exclusively people 20 years older than me and most are incapable of carrying on a conversation. The caregivers here are very conscientious, but like most, they are overworked. I am fortunate that I can be my own advocate and thus I get very good treatment.
Every so often, I will check the surrounding area of Southern California to see if something new has arrived that might provide a more stimulating environment. At the end of each search I always return to my room and feel grateful for what I have, because it is fully wheelchair accessible including an enormous roll in shower. Most of the facilities have tiny tub-showers with fiberglass enclosures and little built-in seats that could not possibly accommodate me. As for their “activities” the larger facilities seem to focus on the needs of the least common denominator and provide “sing-alongs” featuring music from the ’40s, bingo, and various childish games. For this, they charge anywhere from $5000 – $7000 per month. By comparison, I like to spend my time studying computer programming via the free Stanford University lectures on iTunes and maintaining several blog sites. I know that I am not the only person who is older or disabled but also has a continued desire to learn and produce.
It is obvious that we need a new paradigm for the care of an aging population. As we live longer, more and more of us will develop chronic illnesses that reduce our mobility or our cognitive facilities. In my own case, the ideal solution would be to live in my own home with visiting care givers to get me out of bed and shower and into my wheelchair in the morning and then get me back into bed at night. For most of the day I can be independent except for meals, which I could obtain at a local restaurant or my local microwave. The problem comes from not knowing exactly when I might need help. If I were in bed at night and an emergency arose, what would I do? If, during the day, I dropped something important and couldn’t pick it up, how would I get help? Right now, I can press the pendant that is always around my neck and someone will be around to help me. At home alone there is no such system. The cost of round the clock in-home care is prohibitive and would be a terrible waste of human resources anyway.
My guess is that the movement of for-profit corporations into this field means that any rational and humane solutions will be forever blocked.
Ms. Dale Goodloe says
My Mother lived in an assisted living facility for 2 yrs. before moving into a nursing home where she lived for 5 years. I visited 9 nursing homes (some not for profit; most were not) before choosing the one she moved to. B/c I was very involved in her care, I can speak first-hand. I chose the one I did b/c it was the least disturbing. NONE of the nursing homes were a place i would want to live. All of the places were grossly understaffed.
Altzeimer patients were mixed in w/the others. My Mother had one roommate who screamed whenever anyone came in the room. The staff were indifferent to my complaints about it and said my Mother would have to move to another room, although she had been in her room for a year and didn’t want to move. The upper level staff there were always distant and lacked compassion. Their attitude was that if I didn’t like it there, I could move her. I always felt like I had to pamper the ones who took care of my Mother by bringing cookies, pizza, etc.
It is a disgrace the way our elders who aren’t financially well off have to live out the rest of their lives. I watched my Mother’s emotional health and dignity decline each day she was there. Although she died almost a year ago, I can still cry just thinking about what she had to go through.
Dennis Brown R.N.BC. (@CareProvider) says
I certainly agree with most of the list. However, I have been a Director of Nursing for a large skilled Nursing home specializing in Alzheimer’s as well as an owner/Administrator of a small 6 bed RCFE (Residential Care Facility Elderly). All Assisted living facilities are actually licensed as RCFEs in California. I sold my care homes in 1998 and started the first online elderly care referral service to show digital images of care homes in 1998. I am an RNBC, Certified in Psychiatry. I can tell you while looking for a care home for your loved one, you will make a “purchase decision” based on the 4 P’s variables of the Marketing mix, Price, Product, Place, Promotion, (I also have a degree in Marketing). I can tell you about research done on the lives of CNA’s in Nursing homes. They are low paid, hard working and sometimes caring individuals who get to go home at the end of a strenuous thankless shift to be rewarded and beat up by an abusive unemployed drunken husband. On a good day, Nursing home CNA’s have a care ratio of about 1 aid to 12 patients. When someone calls in sick that ratio can increase to 1/18. The big fancy Assisted living facilities have that same type of care ratio with less compromised patients. As a expert in elderly care homes I recommend. 1. Stay away from large Fancy Assisted Living Facilities and their slick brochures with low care ratios and they provide little actual care. 2. Choose a small 6 bed private facility owned by a Registered Nurse who trains and supervises the staff. 3. Visit at least 3 care homes recommended by a reputable referral service before making an informed decision. 4. Make an unannounced visit during meal times, if fish sticks and hot dogs are frequently served, avoid that home, ask to see the weekly menu. If a care home is not wheel chair approved, avoid it because your loved one can go into a wheel chair at any time. Approx 60% of Care Home residents are non ambulatory and a high percentage have dementia, find a care home with similar residents as your loved one. Even dementia residents need stimulation and appropriate activities to avoid the negative slope of Alzheimer’s. 5. Choose a home with an awake night person. The best Care Homes are 6 bed owned by Registered Nurses. Don’t bother looking in the Yellow pages, you won’t find the best care homes there. Contact a local referral service, they have a list of valid private care providers and have already visited the home in most instances.
Kort Nygard, Ph.D. says
Excellent article! As to the comment about whether assisted livings “care” about the residents, I have worked in 17 nursing homes and 5 assisted living facilities as a psychologist. I have never seen a facility that didn’t have brochures that talked about caring and quality. I have found no correlation between what is talked about and what is done. Watch some activities: are residents doing them or is the staff going through the motions? Are there things to do that engage residents in helping others in some way? The loss of meaning and purpose in life is one of the most devastating losses with aging, much less institutional care. Look at the staff break room: is it reflecting management’s “care” for the staff? Is it dingy and minimal? Look for residents, especially in locked units, who are slumped, staring, unresponsive…sedated. They superficially look content, but they are often sedated with antipsychotics, hypnotics, anxiolytics or other drugs. An oddity in the industry is that most are oriented toward pampering and then discharging to nursing homes. Few a seriously rehabilitation oriented, urging residents to do for themselves and keeping them independent. The turnover is around 100% per year in standard assisted living and around 20% per year in rehabilitation-minded, “tough love” facilities. Also, studies find that the quality of care is better in not-for-profits.
Ann Hutchens says
Whereas most people who work at Assisted Living Communities want the best for the residents there are many responsibilities. It is essential to assess these areas before deciding where to reside. Also if possible just drop in without an appointment the first time you visit just to see how things are without “putting on the best face.”
YES! Who would have thought that ALL assisted living centers ARE built (or remodeled) to accomodate wheelchairs! Thanks for the helpful advice.
Robert Albert says
Top Ten lists… Always a good thing to see new versions out every now and again, to review and refresh. Thank you.
DITTO to the ‘community,’ vs ‘facility,’ comment.
stuart greenbaum says
Very practical and thoughtful advice; always especially helpful to get perspectives from actual residents. One minor suggestion, to me “community” is a much more respectful name than “facility” for the place residents live and call home.