Society of Certified Senior Advisors: How To Choose an Assisted Living Facility or Nursing Home

Finding the right place for Mom or Dad is both an art and a science. You have to do your research and trust your gut.

Assisted living facilities are widely available to help take care of older adults who need help with bathing, dressing, or other daily activities. When that is no longer enough, a nursing home can give 24/7 health care. Either way, it is important to research facilities to determine which one seems to give the best care.

Cost

Before deciding on a live-in facility, make sure that is the option you want to pursue. Include the older adult when considering other care options. A major factor can be cost. In 2020, the Genworth Cost of Care Survey documented median annual costs for five options. Remember that the Genworth numbers are not reflective of higher costs in more expensive areas, and that costs in your neck of the woods may be much more than those listed:

• Nursing home (private room) $105,852

• Nursing home (semi-private room) $93,072

• Assisted living $51,600

• Home health aide (full time) $54,912

• Adult day care $19,236

Check if your parent has long-term care insurance. Generally, it will cover assisted living, but most health insurance plans, including Medicare, do not. It may not cover the full cost of care, either. Read the policy carefully. Medicaid may be an option for those with limited assets, or your state may offer some other assistance. Contact your state’s Medicaid Agency to find out more.

Veterans may be able to get help through the Aid and Attendance benefit, but there are specific criteria that must be met. While it won’t cover room and board at an assisted living facility, the VA health care plan may pay for additional services. Check with your VA pension management center.

Size

Facilities may have just a few patients, or house more than a hundred residents. Each has benefits and drawbacks. A small group home can have a great staff-to-patient ratio where caregivers know every person’s preferences well. They are often located in neighborhoods.

Where to Get a List of Facilities

Trying to determine what your options are can be daunting. Here are options you can check out to locate facilities in your area:

Remember to ask neighbors, friends, doctors, and other professionals for recommendations.

Larger facilities can offer more amenities such as libraries, music rooms, gyms, and swimming pools. They are sometimes set up to care for residents who start off in independent living and then transition to assisted living and/or memory care units that specialize in people with advanced dementia. They may also have a van or bus to provide transport to shop or obtain health care. Some may have doctors who make house calls and an in-house hair and nail salon.

Services

Basic services usually include housekeeping, laundry, medication management support, wellness programs, and meals. Some facilities may even offer specialized care for those with health conditions.

Consider your mother or father and what activities she or he may be interested in doing. Does the facility have an area for gardening? A year-round art program? Musical outlets? Church services? Reading material? Activities for those with impaired sight or hearing? Will hospice come take care of your parent there if needed?

Also, check to make sure that the facility will give additional help to your parent as their needs increase over time. “This is a really important question and it has to be clearly delineated in writing,” says Nancy Avitabile, owner of Urban Eldercare, a geriatric care management practice in New York City. “So, they may bring someone a tray but they might not be sitting there helping somebody to eat.”

The Facility

AARP has developed a comprehensive, printable checklist of what to look for in a care facility. Here is a modified list of the basics to ask about and verify when you visit:

• Cleanliness

• An emergency generator or alternative power source in case of an outage

• Enough common areas, such as dens and living rooms

• A floor plan that is logical and easy to follow

• Large enough rooms for your family member’s needs

• Rooms and bathrooms with handrails and call buttons

• Safety locks on doors and windows

• Security and fire safety systems

• Services such as banking, a beauty salon or a café

• Well-lit stairs and hallways with well-marked exits

You will want to visit prospective facilities several times before making a final decision. Be sure to visit on the weekend when it is likely to be busier. Eat a meal - or two or three - to see if Mom or Dad likes the food and to observe if residents in the dining room appear happy. Do staff members address them by their names? Are they chatting over lunch and dinner? Are meals served without excessive waiting?

Tips From a Caregiver

One former caregiver wrote her thoughts about how to get past the fancy salesperson giving you the tour and ask the people who really know how well the facility is run: the certified nursing assistants (CNAs) who take care of residents.

She recommends finding out the average salary of the CNAs and comparing it to other places you are considering. The higher the salary, the happier the help, and the better care the residents receive. Also ask about staffing ratios. Do all staff usually show up for every shift? How many residents are they usually caring for on a shift? Do they like working for the facility?

You will have to talk to CNAs without any supervisors around to get honest answers. You might try scheduling a meal at the facility and finding someone assisting a resident who can talk. Or check the area where they take breaks outside.

The Contract

Don’t sign anything without taking it home and giving the contract a close review. Highlight any parts you don’t understand or have questions about. You can hire an Elder Law Attorney to review it. It may be helpful to have other family members go over the document as well. Be sure to check for an arbitration clause, which Consumer Reports found in many assisted living contracts. It requires you to give up your right to sue, mandating disputes to be settled outside the legal system.

No facility is perfect, but there are better and worse homes for assisted living, and better and worse situations for each prospective resident. Do your research, visit, ask plenty of questions and then make your decision based on a combination of all those factors combined with your gut feeling about a place. Do residents and staff seem happy? Stressed? Do people say hello when you walk by? Does the place smell good? What does your parent think? Can you afford it? The answers to these questions will ultimately help you find the best facility for your needs.