What can older adults expect from assisted living communities?

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Do

Do replace your image of nursing homes

Until you have visited assisted living communities, it is common to visualize the traditional atmosphere of nursing homes, with the elderly lined up in wheelchairs and unpleasant odors everywhere.

While nursing homes continue to serve a distinct purpose, most seniors can live in assisted living communities and enjoy a much richer quality of life. These communities typically consist of 50 to 200 apartments, with multiple public areas that include a restaurant-style dining room, activity room, theater, library, beauty salon, exercise room, pool (in some cases) and lovely grounds in which to safely walk outside.

In most cases, residents live in their own studio, one-bedroom or two-bedroom apartment with a spacious bathroom and either a kitchen or kitchenette. In order to accommodate residents with limited budgets, some communities offer shared apartments, with separate bedrooms and shared living/dining spaces. Residents bring their own furnishings to make the apartment feel like their own home. Furnished apartments are sometimes available for short-term (respite) stays or for residents’ guests.

Do understand how assistance is provided

The majority of assisted living communities have ‘floating licenses,’ which allow any apartment in the community to be licensed for the provision of care services. In some cases, residents may move in without requiring assistance, but when/if that changes, they don’t need to relocate within the community. Prior to move-in, residents are assessed by a nurse to establish a baseline for their physical health and cognitive status. The outcome of the assessment determines what type of care (if any) is needed and the frequency of these services.

Trained caregivers are employed by the community to provide assistance with the following: Medication management, bathing, dressing, toileting, transfers (from bed to chair), grooming and hygiene. Each state and, in many cases, each community may have unique requirements as to the extent of assistance they can provide in toileting and transferring residents.

Do look beyond the bells and whistles

Assisted living communities are increasingly being built and renovated to appear like upscale hotels. While modern decor, fancy theaters and swimming pools certainly add to the appeal of a community, the number one priority should always be the quality of care provided. It is vital to inquire about each community’s most recent state survey results, as they are indicative of the way in which a community is operated. It is also important to recognize that the current generation of seniors may or may not feel comfortable in a ‘fancy’ community. If a senior moving into an assisted living community is capable of making competent decisions, he or she should be involved in selecting the one that feels most comfortable.

Do use a checklist as you tour communities

The following questions will help guide your tour experience:

As you approach the assisted living community:

• Is the primary entrance on a low-traffic street? This is an important factor if walking outdoors is a hobby.
• Is the community in good shape physically? Does it have fresh paint, nice landscaping, and clean sidewalks and patios?
• Are the doors easy to open and close for those with mobility issues?

As you enter the lobby:

• Are residents engaged in activity or sitting/sleeping in the lobby?
• Is the lobby inviting in terms of décor, smell and overall appearance?
• Are you welcomed by a receptionist and asked to sign in? This is often a good security measure.
• If you are asked to wait, are you offered seating and coffee/water? How long must you wait for a tour?

During your tour of the public areas:

• How long are the hallways? If mobility is an issue, ensure there are benches along the way or apartments available near the elevator or public areas.
• Are there activities that you can observe during your tour? Is the activity well-attended and are residents engaged?
• Is there an activity calendar posted and accessible to residents? Consider the activities you or your loved one specifically enjoy. Are these available or can they be accommodated with transportation provided?
• Are a variety of options available at each meal? Diabetic and healthy options?
• Is there flexibility in meal times? How many meals are offered per day? Are you invited for a meal?
• Is seating assigned or open? Do new residents have an ‘ambassador’ or another resident to introduce them to others in the dining room and at activities?

During your tour of the apartments:

1. Are there emergency cords or systems in place?
2. Is the kitchenette well-suited to preparing meals if less than three meals are offered daily?
3. Can the stove/burners be disabled if necessary?
4. Is there plenty of closet space and storage available?
5. Is there a walk-in shower or cut-out bathtub available?
6. If medication management is needed, will the medications be administered in the apartment or the assisted living office? (Privacy vs. encouraged interaction outside of the apartment.)
7. If a pet will be moving in, are there patios or exterior doors nearby? Is pet care provided as a service?

Do consider a short-term stay or visiting as a guest

Many assisted living communities will invite prospective residents to stay in a furnished apartment, either on a complimentary basis or for a daily rate. Particularly when seniors have cold feet about making such a big change, this approach can be instrumental in easing into the idea during a trial period. If possible, schedule the visit to coincide with activities on the calendar that are of particular interest. The staff also can arrange introductions to residents with similar interests for more engagement during meals and activities.

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Don't

Do not assume that rates are all-inclusive

Assisted living communities typically charge for rent and care separately. The apartment rates will vary depending on size, location within the community, view and amenities. If a couple will be occupying an apartment, there will be a second-person fee that applies to the rent. It is common to pay for a phone line, if preferable to using a cell phone and, in some cases, residents are expected to pay for internet access.

Based on the outcome of the initial assessment for care, assisted living rates are usually determined by the extent of and frequency of care required. Charges will either be based upon each service (a la carte) or upon a level of care at pre-determined rates. As care needs change and typically increase over time, the rates also increase. Dependent upon the market, there are usually rent increases of three to five percent per year as well. Finally, a community fee upon move-in is standard to cover administrative expenses and the apartment turnover upon move-out. However, this fee can sometimes be waived as an incentive, so you may use it as bargaining power.

Do not believe that Medicare will pay for assisted living care

Medicare does not pay for any portion of assisted living care. This is one of the most common misconceptions and contributes to sticker-shock for many people exploring care options. While Medicare covers a portion of the expense for hospitalizations and skilled nursing services, assisted living communities usually accept only private pay or long-term care insurance. In some cases, communities will license a limited number of apartments for Medicaid recipients, and others may offer programs to assist residents whose income falls below a particular median range.

Do not make proximity to family the most important factor

For families who have been providing for an aging loved one’s care needs on a daily basis, it is natural to think about whether the location is convenient. However, when seniors move into an assisted living community, their care needs will be managed by the staff and they will have the companionship of other residents. This transition provides an opportunity to resume parent-child relationships, so visits will be about catching up and enjoying one another’s company rather than providing hands-on care. With that said, if concerns arise at any time, checking in and acting as a ‘squeaky wheel’ is always beneficial.

Do not wait for a crisis to occur

It is common for families to put off conversations and decisions about moving into an assisted living community until a crisis occurs. Most seniors want to stay at home for as long as possible and the outcome is often social isolation and unsafe living environments.

Assisted living communities are intended to support the independence of seniors, while providing for care needs as they arise. In almost all cases, after the initial transition period, seniors enjoy the companionship of other seniors, meals prepared in a restaurant-style dining room, and the safety and security of knowing that someone is there to help 24 hours a day.

Do not go it alone as you explore communities

Eldercare advisors and consultants are available in every major city and most small cities to assist families in making confident decisions. Their expertise will save you valuable time and energy in narrowing down the options based on care needs, finances and geographic factors, as well as lifestyle preferences. These services are often complementary to families, as eldercare advisors are reimbursed by the communities to which they refer their clients.

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