Financial Caregiving 101

How to Choose an Assisted Living Facility

By Cameron Huddleston • January 9, 2023

If your parents or aging loved ones can no longer care for themselves and live safely at home, it might be time to consider an assisted living facility. These facilities provide round-the-clock assistance for adults who need help with everyday activities and some health care needs but don’t require the type of skilled medical care that nursing homes provide.

Assisted living facilities also provide prepared meals, social activities, exercise programs, and housekeeping services in a home-like setting. Accommodations can range from shared rooms or private rooms to apartment units. Most have common spaces for residents to gather, and some have amenities such as pools, salons, movie theaters, and on-site cafes or ice cream parlors.

However, there can be a lot of variation in the services, amenities, and quality of care provided at these facilities. So it’s important to vet facilities carefully to make sure you find the right fit for your loved ones.

How to find a facility

There are nearly 29,000 assisted living facilities in the U.S., according to the National Center for Assisted Living. The highest concentration is in the West, where about 40% of the nation’s assisted living facilities are located. The Northeast has the smallest concentration, with just 8.6%.

To find a facility near your loved one, you can use a variety of sources:

• Eldercare Locator, a public service of the U.S. Administration on Aging, has links to state and local Area Agencies on Aging, which can provide a list of facilities and information about options in your area.
• Senior care referral services such as A Place for Mom, Caring.com and SeniorLiving.org
• Recommendations from family, friends, or physicians

Create a list of properties that best fit your loved one’s needs and wants. To do that, Carlene Motto, chief marketing officer of Belmont Village Senior Living, recommends considering three key things: whether the facility can support your loved one’s current and potential care needs; whether the facility’s amenities and offerings fit the personality and interests of your loved one; and whether the management team has a wealth of experience in senior care and the staff are trained to provide senior-specific care.

Also, make sure all of the facilities you’re considering have the proper state registration, licensing, or certification. Then check with your state or local long-term care ombudsman office to see if there have been any complaints or citations at those properties.

Of course, cost is a factor. However, you shouldn’t rule out a facility just because it might be outside your loved one’s budget. Management might be willing to work with you to find a solution.

What to look for

Ideally, you should identify at least three properties that fit your loved one’s needs and preferences. Make an appointment to tour each and to speak with administrators. Motto also recommends making unannounced visits to “get a better feel of the culture and atmosphere in the community.”

During your visits, pay attention to the following:

• Appearance: Is the facility in good condition? Does it look comfortable and homey or sterile like a hospital? Does it have good natural and artificial lighting?
• Physical features: Is the floor plan easy to follow or confusing? Are there common areas where residents can socialize and enclosed outdoor areas?
• Safety features: Are there handrails, widened doorways for wheelchairs, zero-threshold showers, and other accessibility and safety features? Are there well-marked exits? If it’s a memory care facility, is it secure so residents can’t wander off?
• Cleanliness: Does it meet your expectations of what clean should be? Are there strong, offensive odors?
• Residents: Do they look clean and well-groomed? Are they happy and engaged in activities?
• Staff: Are they friendly and interacting with residents? Do they treat residents with patience and respect? Do they seem to enjoy their jobs?

What to ask

When you visit facilities or speak with their administrators, you should ask a variety of questions. For starters, ask for a copy of their resident agreement to see a list of prices, services, admission and discharge criteria, and facility rules. Then, use the list below to find out what key things you should learn about each assisted living facility you visit.

Care services

You’re considering an assisted living facility first and foremost because your loved one can no longer care for himself or herself. So you need to ensure the facility can provide the level of care your loved one needs.

• Does the facility do a needs assessment for all new residents and assessments annually?
• Does the facility create personalized, written care plans for all residents?
• Who oversees care?
• Is there a memory care unit and skilled nursing unit in the facility?
• What conditions would cause my loved one to need to move to another level of care?
• Are there different costs for varying levels of care?
• Are services such as physical, speech, and occupational therapy available in the facility?
• Is there a nurse onsite 24/7, and, if not, is there a nurse or doctor the facility contracts with to provide care to residents?
• What is the medication management policy? How is medication stored? How is it administered?
• Is there a proactive plan for fall prevention?
• What is the procedure for responding to residents’ medical emergencies?

Amenities and community culture

For a facility to be the right fit, “the amenities and hospitality offerings should align with your loved one’s hobbies and personality,” Motto says. The more there is to keep your loved one entertained, engaged, and comfortable, the happier your loved one will be. It's also important, if possible, for them to be in facilities with people like them.

• What types of activities are available to residents, and how often do they occur?
• Is there live entertainment or outings to community events?
• Is there a TV room or theater, a game room, library?
• Is there a fitness center with senior-friendly equipment or a pool?
• Are there outdoor spaces residents can enjoy?
• What are residents like? What sort of backgrounds do they come from?

Dining

If possible, have a meal at the facilities you visit to test the food quality. This will also give you an opportunity to talk with residents and staff to see how they feel about the facility.

• How many meals are provided per day?
• Do residents have a choice in what they eat, or must they eat what they are served?
• What does the menu offer and how often is it updated?
• Can meals be tailored to residents’ special dietary needs?
• Does the facility have a dedicated chef and culinary team?
• What options are available between meal times?
• Can residents keep food in their rooms or apartments?

Living spaces

The type of living spaces a facility offers can affect not only your loved one’s comfort but also the cost. To find the best fit, you’ll want to learn as much as you can about facilities’ accommodations.

• Does the facility offer units in different sizes and types: shared rooms, private rooms, apartments?
• Do the facility allow pets?
• Are units furnished or can residents bring their own furnishings?
• Can residents decorate their units?
• Do units have kitchens with sinks, refrigerators, and cooking elements?
• Are there 24-hour emergency response systems in units?
• Are bathrooms handicap-accessible?
• Can residents lock their own doors?

Staff

Having compassionate, dedicated, and knowledgeable staff is key to providing great care, Motto says. So it’s important to gather details to determine whether a facility’s staff can meet your loved one’s needs.

• What is the ratio of staff to residents? How many staff are on duty throughout the day?
• What sort of experience must staff have to be hired? Does the facility perform background checks?
• Do staff receive in-depth training about caring for older adults and those with dementia?
• Is there ongoing training for staff?
• What is the staff turnover rate?

Services

Find out what services the facility offers and whether they are included in the cost of the facility.

• Does the facility provide laundry and housekeeping services for residents?
• Are transportation services available?
• Is there a salon onsite or salon services?
• Are religious services offered?

Costs, finances, and contracts

Costs can vary greatly from facility to facility and within facilities depending on the type of unit you choose. So can the terms of facilities’ contracts. Make sure you ask the questions before signing a contract.

• What is the basic monthly cost?
• Is there an entry fee? Is it refundable?
• Is a security deposit required?
• What services are not included in the monthly fee?
• Are there annual rate increases?
• Does the facility accept long-term care insurance?
• Does the facility participate in Medicaid or VA benefit programs or offer any financial assistance programs?
• What is the facility’s policy when residents deplete their funds and can no longer pay?
• What is the discharge or termination policy?
• Does the contract limit the right to bring legal action against the facility? (Many require disputes to be settled outside of court.)

Red flags

If something doesn’t feel right about a facility, trust your instincts. In particular, Motto says to be wary of the following issues:

• A lack of cleanliness, sanitation, and organization throughout a facility
• Empty community spaces—a lack of residents socializing or engaging in activities
• Restrictions on unannounced visits or limited visiting hours
• Reluctance to disclose costs

Bottom line

Take the time to thoroughly research and vet all of the assisted living facilities you’re considering for your loved one. This isn’t a decision that should be rushed, which is why you should explore your options before there is any sort of emergency that would force you to move your loved one into a facility.

Cameron Huddleston

Cameron Huddleston is an editor-at-large at Carefull and the author of Mom and Dad, We Need to Talk: How to Have Essential Conversations With Your Parents About Their Finances . You can learn more about her at CameronHuddleston.com or follow her on Instagram at @cameronkhuddleston _.