It can be extremely difficult to find reliable data on assisted living. Federal and state statistics are not easy to discover and it’s often easier to search for hotel reviews in Mexico than it is to locate rating and reviews for a local assisted living facility.
So where should you begin to look if you are considering sending a loved one to assisted living? After questioning a number of experts, this is what they had to say.
1. What Are Your Needs?
First off, it is imperative to understand what level of care you require and how that may change with age. This is especially true in the case of seniors with dementia. A 2009 study by Johns Hopkins University found that 46 percent of assisted living residents suffered from at least three chronic conditions, yet only 54.5 percent of facilities surveyed in the study had a registered nurse or a licensed practical nurse on staff. As the survey authors note, “Some residents with multiple, complex medical conditions present a challenge that some [assisted living facilities] may not be prepared to manage.”
In some cases nursing homes may be the better solution for seniors.
“So many people have heard their mother say, ‘Promise me you’ll never send me to a nursing home.’ And a lot of people make a mistake in choosing assisted living because it looks nice rather than what the person really needs,” says Catherine Hawes, director of the Program on Aging and Long-Term Care Policy at Texas A&M University.
2. Have You Made A Visit?
If you have decided on assisted living, visit prospective facilities a number of times. Experts recommend visiting at different times of the day — mealtimes are a great place to begin.
Don’t be content with a tour of the building from the director, they say. Take the time to speak with residents and staff for a sense of the facility’s culture and environment. Question the available services and what staffing is like throughout the day and at night. To gain insight into the reliability of their services, ask about turnover as well.
And for residents with dementia, it’s important to understand how the facility manages their care and safety: what type of programming is available? Are the doors locked at night for residents who wander?
Checklists for visiting an assisted living facility are available from several organizations, including the AARP, the Alzheimer’s Association, California Advocates for Nursing Home Reform, the Assisted Living Consumer Alliance and the Long Term Care Community Coalition, among others.
3. For-Profit or Non-Profit?
This designation may influence how resources are allocated for care. Close to 82 percent of residential care facilities are privates, for-profit facilities, with close to four in 10 belonging to a national chain. Such for-profit chains often have “requirements for a return on revenue that mean that they’re always pressing for higher occupancy and for constraining variable costs, and the variable costs are staffing and food, and to some degree, activities.”
From 2006 to 2011, for example, profit margins at privately owned assisted living facilities went from 3.5 percent to 6.4 percent, according to research from Sageworks, a financial information company. Those gains corresponded with drop in payrolls from 45 percent of sales in 2004 to 38 percent in 2012.
That’s not to say you ought to dismiss for-profits and focus exclusively on non-profits because there are good and bad facilities in each category.
Since assisted living is not covered by Medicare, it can be expensive. in 2012 the average monthly base rate in an assisted living facility rose to $3,550, according to a survey by MetLife. Rates can reach up $9,000 a month in some states.
Also, be weary of charges for additional services. Some facilities will charge a resident extra for meal delivery, while others tack on fees for services such as transportation to and from the facility, or laundry and housekeeping.
(Related: Obamacare and Long-Term Care Insurance)
5. What’s in the Admissions Agreement?
Experts advise you to take your time and the admission agreement carefully. On occasion the fine print will reveal language requiring 30 days notice to stop billing for service, even if the resident has died, says Patricia McGinnis, executive director of California Advocates for Nursing Home Reform.
Negotiated risk agreements are another red flag. These clauses are often offered as a way for residents to make preferred choices about their care, even if they prevent risks. McGinnis warns, if something goes wrong, “You have signed away your right to sue.”
The same problem can be realized through liability waivers, which are common in admission agreements.
“To me, that is a sign that the facility may not have either the ability or the commitment to meeting your needs,” says Nina Kohn, a professor of law specializing in elder law at Syracuse University. ”If you’re confronted with a contract with that kind of liability waiver, I think it’s reasonable to say, ‘I’m going to cross out that provision.’ See how the facility responds.”
Consult with an elder law attorney if any portion of the admission agreement is unclear. The American Bar Association also provides a checklist for choosing an assisted living facility.
6. Where is the Facility?
While it’s convenient to find a residence that’s close to friends and family, experts caution against allowing that to be your deciding factor.
“It is really important to have a place that’s easy to visit, but it’s more important to find a facility that’s really good,” says Hawes of Texas A&M. “Don’t choose a facility that’s five minutes closer to you, or 10 minutes closer to you just because of that. Make sure that you’re getting the best facility for what your loved one needs, and be realistic about what they need.”
7. What Does the Ombudsman Say?
Experts recommend contacting the long-term care ombudsmen for your local area for additional checklists or information on any citations against a facility. Additionally, they will answer any other questions you may have
Karen Love, president of the Center for Excellence in Assisted Living, says to look out for any medication administration violations. She also suggests asking “Have they been cited for not having staff trained, if it’s a state requirement, and have they gotten dinged for not having enough staff, again if that is a state requirement?”
The National Long-Term Care Ombudsman Resource Center provides a map on its website with contact information for ombudsmen in all 50 states.
Christopher J. Berry is a Michigan elder law attorney Dedicated to helping seniors, veterans and their families navigate the long-term care maze. To learn more visit http://www.theeldercarefirm.com/ or call 248.481.4000