A transition into an assisted living or senior community is like any other move to a new home. It is a major life event, which requires advance research and consideration. There are ways to make this move, if needed, a right and healthy choice that is rational, affordable, and considers everyone’s emotional needs.
Here are five initial suggestions to start your research, which will take you through receiving a contract from a community you and your parent are considering.
- Understand the main types of senior communities
- Continuing care retirement communities (CCRCs) are ‘small towns’ which provide a continuum of housing, transitioning the resident as needed from catered/ independent living to assisted living to a nursing home for medical sub-acute or rehabilitative care. It usually is a long-term relationship of care. Most have a one-time entrance fee in addition to monthly fees, but some are on a rental basis.
- In assisted living communities, residents live in small apartments and are mobile, but need assistance with personal care, meals, and often medication. Assisted living does not provide the skilled daily medical care of a nursing home. The community can coordinate medical assistance with outside providers, but overall medical care is the family’s responsibility.
- There are also unique community models such as the Green House homes that combine residential care and a social community in a setting that is more homelike and personalized.
All types of communities are organized either as a nonprofit (faith-based or association owned) or for-profit (over 80 percent of assisted living communities).
- Match the community to the person.
Will your parent be comfortable there long term? The apartment size, floor plan, location, dining/dietary options, décor, and amenities are all factors, but there are others. According to the National Center for Assisted Living (NCAL), assisted living residents are older than ever—over half of the residents are 85+ and 70 percent are women. This may or may not be a good fit for a younger person or a man. Ask for the activity list—see if there are stimulating activities that encourage purpose, meaning, and connections to new friends, as well as programs that provide social, spiritual and cultural support. A community in a familiar area with good transportation can help in staying connected to their present social network. Two key quality of life indicators in a community are physical fitness programs and resident’s councils, according to ChangingAging.org. Some communities are pet-friendly, though there may be restrictions on type and size. (Guide dogs for the visually impaired must be permitted by law.)
- Anticipate and budget for future needs.
Most assisted living communities can ‘mainstream’ residents with mild cognitive impairment or early-stage Alzheimer’s with some additional care support. When the condition progresses, that person can be transitioned through an internal move to a specialized memory care area, which minimizes disruption at a difficult time but is a higher and more costly care level. If your parent has Parkinson’s or another chronic, degenerative disease, investigate how much care can be provided in the setting, what that additional care will cost, and if there are other residents with similar conditions. Check to see if the apartments and common areas are disability and wheelchair-accessible, as some pre-1991 buildings are not. Two final checks: the quality of the nearest hospital and the community’s disaster preparedness, from blackouts to evacuations.
- Make visits to several communities—and use your senses.
Pick several ‘candidates’, whether from your own search or from referrals by friends, the local Area Agency on Aging (AAA), or a local geriatric care manager. Then go on at least one screening visit, preferably two—day and night. Meet with a staff person (the higher level the better) and take at least one tour that includes a meal or two. Ask questions, write down the answers, and take pictures if helpful. A ‘snap’ night visit can give you an idea of night staffing (ask about it) and their attentiveness to the residents.
Andrea Swayne, COO of Guardian Angels Senior Services in Elk River, MN, advises that on your visit and tour, “Use all your senses. See, touch, and smell. See the condition of the physical plant, maintenance, common areas, and apartments, that they are well maintained. Check the appearance of the residents and interactions with the staff. Smell for bad odors, which indicate the quality of housekeeping and resident care. Touch surfaces for cleanliness. And use your intuition. If it snowed two days ago and the lot, walkways, and driveways are not cleared, that is not a good sign.” Another recommendation from her: during the visit, use a public bathroom and run the same check.
Speak with residents, especially the head of the residents’ council, and privately ask a few questions on issues such as care, staffing, activities, and incidents such as onsite theft.
- Compare and review agreements, and have your family or elder law attorney read them before signing. The agreements should detail what is included, what is not, and the staff-to-resident ratio. Find out how they care for residents as they age or become sicker. Determine if there are penalties or costs for leaving the community early, what those conditions are, refunds, and time frames. Find out when rate increases occur; two to five percent in January or July is standard. In a competitive market, you may be able to negotiate favorable timing or lower rate increases, which is important if your parent is on a fixed income. Some communities also have an ‘exclusionary clause’ where the community states they can no longer stay for reasons such as behavior or running out of money. Not all communities accept Medicaid or have fewer beds allocated to Medicaid with a waiting list. You should be aware of this situation upfront.