Embarking on the journey of finding the right assisted living facility for yourself or a loved one is a significant step. It’s a decision that involves careful consideration of various factors to ensure comfort, safety, and quality of life. One crucial aspect of this process is the assisted living tour – an opportunity to get a firsthand look at what may be your next chapter. A frequently asked questions I receive from families starting this journey is – what questions to ask during an assisted living tour? If you google this, you’ll find some exhaustive lists. While thorough, they’re unrealistic and sometimes a bit obvious. I also find the conversation largely sticks to the pricing for various room types and services, food menu, and calendar of events. Knowing that’s all well covered, here are additional questions to ask during your assisted living tour.
What Levels of Care Do You Provide?
Understanding the range of care services available is potentially the most important aspect of the community to understand. And if the community doesn’t pass your standard for this question, there is really no sense moving onto the rest – so it’s important to start here before getting too invested in closet space and dinner menus. You may see right on the sign they offer independent, assisted, and memory care. But you’ll want to dive deeper into what’s included in those levels of care. For example, any assisted living will say they help with the 6 activities of daily living (ADLs). But what is the line where they say… “This is too much for us to manage. Your loved one needs to hire a private aid to help us or should consider a skilled care community (nursing home).” This deficiency in understanding is what I find eventually causes the most angst. Not to mention can be a significant unanticipated cost of care.
And keep pushing for answers if they say they “accommodate all levels of care.” Accommodate simply means when the worst happens, they’ll allow for you to retain an aid to assist the resident. They typically reference hospice coming in at the end to administer any skilled nursing or palliative measures. And that’s certainly true, plus hospice is covered by Medicare/Medicaid. But if your loved one doesn’t qualify for hospice (which is so often the case) yet needs more extensive measures, the assisted living will “accommodate” you hiring a private aid. Now you’re interviewing agencies and paying the cost of the community + the hourly cost of a private aid. It’s not what most people bargained for when moving to an assisted living.
You may be wondering what non-hospice circumstances I’m talking about. What I’ve experienced and witnessed may be issues related to the handling of aggressive behavior. I’d recommend asking how the community handles aggressive behavior that’s uncharacteristic, toward staff and toward residents. Sometimes they have a 3 strikes you’re out rule. Others require a 24/7 private aid at the first offense. Potentially a geriatric psych evaluation or medication will be recommended with more time given for observation. And certain communities specialize in this sort of issue, managing it with a number of calming measures to prevent aggression from happening at all. Much could be said on this topic, and I find this particular issue to be fast growing in the world of elder care.
More common/traditional issues are related to mobility. Once the resident can no longer meaningfully participate in their movement (the biggest signal is not being able to pivot), they’re considered a 2-person lift. And diagnosis such as Parkinson, dementia or stroke can certainly evolve to this level of care. Similarly, issues with incontinence and swallowing may arise. To be fair, any of these issues can be considered skilled care depending on the severity, but there is a lot of gray area here as well. So it’s very variable on whether an assisted living community is able to create an enhanced care package to address these issues to some extent. Unfortunately, a deficiency in any of these offerings usually causes the resident to move to a skilled care unit (many times prematurely in my opinion). Or require the need for a private aid to help. However, there are some communities that have a great deal in place to meet these scenarios, it just means being on their highest level care package.
Lastly, understand that many states don’t allow assisted livings to directly offer skilled care. Massachusetts is one of these states. Think of a skilled care need as something a nurse would be required to perform (IV, wound care, injections, handling vegetative states – just to name the most common.) Or potentially having the worst version of incontinence, swallowing, and mobility issues. Any one might be handled by an assisted living, but once you combine severe issues it becomes clear that they’re better suited for a skilled community. That said, our neighboring state, New Hampshire, is allowed to perform these services within assisted living. I mention this because potentially in a state like MA, your loved one may eventually have good reason to move to a skilled care community to receive advanced care. This isn’t a shortcoming on the part of the assisted living, it’s simply how the care is structured in many states. Knowing that ahead of time, you may opt to review NH options or preemptively research skilled care communities so that if that time comes, you’re not making a hasty decision on where to move next. I often bring this up with diabetics or those with an ostomy bag. I found this chart very helpful to understand the distinction, and potentially you could bring it with you on the tour to best define what can be managed by their direct staff or partnerships.
If the community passes the first gauntlet of having reasonable care packages in place that will help avoid your loved switching communities, it’s then time to ask the following:
What is the Staff-to-Resident Ratio?
The ratio of staff to residents directly impacts the level of attention and care each individual receives. Ask about the staffing levels during different shifts and how they ensure adequate coverage. I’ve received the tip that many places don’t have a nurse on staff at night, just a nurse on call. It allows them to say 24/7 nursing coverage but that’s not exactly true. Some residents are very active at night, so having true coverage may bring more peace of mind.
What Safety and Security Measures Are in Place?
Onsite safety should be a top priority. Inquire about security features, community and room design, and any specialized amenities for residents with specific safety and medical needs. I particularly think about this for dementia patients who may wander, attempt to cook, or may act out aggressively toward other residents. Or those who are frail and may have a hard time navigating their room, let alone a large building or campus. In the same vein, ask about their procedures to safeguard dentures and hearing aids. How do they ensure they aren’t tossed in the dining room trash, creating medical hardship as an aftermath?
Can Residents Personalize Their Living Spaces?
Ask about options for decorating, furnishing, and personalizing rooms or apartments. What’s helpful to have (like a lifting recliner chair) vs what’s actually a hazard (throw rugs come to mind). Ask about how to best tag a resident’s belongings and their ability to correctly handle laundry. I would not recommend bringing anything too valuable or sentimental, especially in memory care. It’s annoying enough to have misplaced clothing, but a special ring or photo album can be heartbreaking to lose.
How Do You Handle Medical Emergencies?
Emergencies can happen, and it’s important to know how they are managed. Inquire about onsite medical staff, emergency response procedures, and coordination with external healthcare providers. For example, what hospital is my loved one sent to? Do you work with our pharmacy, or will we have to switch?
Is Transportation Provided for Medical Appointments and Outings?
Access to transportation is essential for maintaining independence and participating in community activities. Inquire about transportation services for medical appointments, shopping, and other outings. If it’s limited, you’ll have the expectation to factor in a private service such as family, ride share or wider community options.
How Do You Handle Care Plan Updates and Communication with Families?
Open communication and collaboration between staff, residents, and families are vital. Ask about how care plans are developed, updated, and shared with families, as well as the channels for ongoing communication.
Can You Do a Respite Stay?
This is the absolute best way to get a sense of the community, and so many families don’t know it’s an option. Simply ask if you can stay at the community for 1 week to a month. Yes, you’ll pay a rent, but you’re not committed to an ongoing stay and you don’t have to plunk down any entrance fee. Eat the food. See if you feel comfortable in the room. Understand what you’d need to bring. See the capability of the staff and friendliness of the residents. Try out their hair salon and do a group exercise class. A perfect time to do this is when family caregivers are going away on vacation. It gives the family peace of mind to enjoy their vacation and gives the senior some space to test out the idea of an assisted living community, without feeling like their house is being sold out from under them.
Take your time, trust your instincts, and don’t hesitate to ask for clarification or additional information on any aspect of the community. By asking the right questions, you can make a well-informed decision and find a place that serves you better than home can. And remember, I’m here to help with your elder care planning needs!
