How to Find the Right Assisted-Living Facility
There can be many benefits to moving into assisted-living communities, particularly if you need only a minimum amount of care. But because such places are not as well regulated as nursing homes, you need to be careful when choosing one. Click here to view article.
Marcia recently moved from her townhouse to an assisted-living facility. “I got tired of being alone. It was hard to stay social,” she says. At her new residence, she can eat meals with others, join the book club, attend movie night or socialize with others in the communal space.
More than 900,000 Americans live in about 39,500 assisted-living facilities, according to estimates (“How to choose an assisted-living facility,” July 2013, Consumer Reports).
What They Encompass
Assisted-living facilities are defined as residential units that often include a kitchen or kitchenette, housekeeping, meals, transportation to doctors and activities, and various levels of personal assistance.
They are a bridge between living independently at home and needing comprehensive care in a nursing home. Assisted-living facilities are a popular choice because they are less expensive than a nursing home but offer access to care and services if needed. For a list of services generally offered by assisted-living facilities, see the sidebar.
The national average monthly base rate for an assisted living unit (which includes room, board and some personal care) was $3,550 last year, according to a survey by the MetLife Mature Market Institute (Consumer Reports). In comparison, the median monthly cost of private nursing home care was $7,000 in 2013, according to Genworth’s 2013 Cost of Care Survey (Money, cnn.com).
Besides being more affordable, assisted-living facilities can end the isolation of living alone and provide a community of older, often active individuals. Said one resident about her new residence: “I got tired of going to fitness clubs where everyone was younger and more athletic than me. Here, we’re all at the same level, and it feels more comfortable.” Many facilities offer a range of social and recreational activities.
Assisted-living facilities also are good for those who are tired of the responsibilities of maintaining a house and yard. Many facilities even provide transportation, which can make it easier for those who have mobility issues or don’t wish to drive.
Regulations Vary from State to State
However, assisted-living facilities are not regulated as strictly as nursing homes, which the federal government oversees. Instead, control is left to states, and regulations vary widely from state to state, including requirements for licensing procedures, inspections and ratio of staffing to residents. In addition, each state sets its own definition of assisted living, including “residential care,” “board and care,” “adult home” and “retirement residence.”
(To find regulations for your state, go to the National Center for Assisted Living State Regulatory Review.Published in March 2013, this report offers a state-by-state summary of assisted living regulations covering 21 categories, provides contact information for state agencies that oversee assisted living activities and includes each agency’s website address.)
A recent investigation into assisted-living facilities found a pattern of problems across the country. ProPublica, an independent, nonprofit newsroom that produces investigative journalism, reported in a Frontline documentary, “Life and Death in Assisted Living,” allegations and citations for a lack of staffing and training, and medication errors. A Government Accountability Office (GAO) survey revealed a pattern of deficiencies in most of the homes sampled in four states. According to the report, frequently identified problems included failure to provide sufficient care to residents after an accident, unqualified or insufficient staff, failure to provide medications or store medications adequately and failure to follow admission and discharge policies required by state regulations (“Abuse in Assisted Living Facilities,” Nursing Home Abuse Center ). The GAO blamed inadequate staff training and high staff turnover for the problems.
Issues arise when people who need greater care, more consistent with that of a nursing home, remain in assisted-living facilities. In fact, in some states, caregivers in assisted-living facilities are not required to have any training, which has resulted in poor care of people with dementia or other serious health problems. More than 40 percent of assisted-living residents have the diagnosis of dementia (“10 things assisted-living homes won’t tell you,” March 4, 2013, Market Watch).
Unless contractually required to move, many people stay in assisted-living facilities rather than move to nursing homes, even when their health worsens, not only because the facilities are cheaper, but also because keeping residents adds to the bottom line. While 82 percent of assisted-living facilities are run by for-profit corporations, only 68 percent of nursing homes are owned by corporations. Libby Bierman, an analyst with Sageworks, says that much of that profitability is due to decreases in staff. Payroll fell from more than 45 percent of sales in 2004 to 38 percent of sales in 2012 (Market Watch).
However, the regulatory environment is improving. Since January 2012, 18 states reported making regulatory, statutory or policy changes affecting assisted living/residential care communities. At least nine of these states made major changes, including Colorado, Georgia, Michigan, Missouri, New Jersey, New York, Ohio, Oregon and Washington (National Center For Assisted Living).
Finding the Right Facility
When starting to look for an assisted-living facility, make sure you’re getting what you want and an institution that will be safe and secure. Consumer Reports suggests how to go about your evaluation.
To start the search, you can contact a geriatric-care manager, who is knowledgeable about the assisted-living option, including facilities’ financial strength (and who charges a fee for the service). To find a manager in your area, go to the National Association of Professional Geriatric Care Managers website or get recommendations from family doctors or local senior centers. You can also find information about local facilities on websites such as SnapforSeniors senior housing locator, a nonprofit advocacy group, and NewLifeStyles.com. Your local Area Agency on Aging is a good resource also. To find the agency that serves your region go to the website for theNational Association of Area Agencies on Aging. Your local senior housing guide will likely have information, also.
Once you have a list of places, make calls to inquire about availability, cost and so forth. Once you have a short list of three or four places, visit the facilities. When touring a community, notice the physical appearance (but don’t be deceived by the fancy lobby, which may have been decorated to impress prospective clients). Is the facility clean and well lit? Does it have safety features like grab bars on all the walls and nonslip flooring materials, especially in the bathrooms? If possible, have a meal there and pay attention to the quality of the food.
Check out the activities to see if they interest you; for example, inspect the fitness equipment, entertainment options and social groups.
Find out how many employees are assigned to each resident and if the facility has a licensed nurse on duty or on call at all times. Ask about the staff’s training in such areas as safety, emergency care, first aid, mental health, residents’ rights and medication administration. Observe the interaction between staff members and residents. Is it cheerful and respectful? Do staff members seem genuinely interested in the residents? Talk to staff members and ask residents what they like best/least.
Make sure you get a copy of the admissions contract and the residence rules. The facility’s contract outlines fees, services provided and residents’ rights, and the appeal process if a resident is asked to leave. Unlike nursing homes, assisted-living facilities don’t have an industry-wide process for appealing evictions, and assisted-living facilities can evict a resident for any reason, including if the resident goes on Medicare (Market Watch).
The contract should also specify whether a resident is allowed to return to the same unit after a hospital stay. Nursing homes are required to hold a room for Medicaid patients, but many assisted-living facilities are not.
After the initial visit, Consumer Reports suggests returning unannounced several times to your top two or three choices, this time avoiding the “official” tour.
When you’ve narrowed the field to one, review the fees and costs for any extra services, policies regarding the return of a deposit or down payment, costs involved during hospitalizations and the possibility of unexpected rate increases. If you need more assistance than the level covered in the base rate, the costs could add up. For example, if more help is needed with what are known as instrumental activities of daily living, such as medication management, the average additional fee is $347 a month, according to the MetLife survey.
Unbiased information can be hard to come by. Only a handful of states post records online for inspections, fines and violations, and state inspections can be rare. In comparison, nursing home ratings and deficiencies are available for every facility in the country, at Medicare.gov. You should ask an assisted-living facility for its record of fines and violations, which should be on file and available to view in person.
The best source for finding out if the assisted-living facility has had complaints or infractions is your local long-term-care ombudsman, who acts as an independent resident advocate. You can find your state’s contact information through the National Long-Term Care Ombudsman Resource Center at www.ltcombudsman.org or by calling 202-332-2275.
Finally, have the contract reviewed by an attorney before you sign it. You can find one in your area who specializes in elder-care issues on the website of the National Academy of Elder Law Attorneys .
Services at a Typical Assisted Living Facility
- Three meals a day served in a common dining area
- Assistance with eating, bathing, dressing, going to the bathroom and walking
- Housekeeping services
- Transportation
- Access to health and medical services
- Round-the-clock security
- Emergency call systems in each resident’s living space
- Exercise and wellness programs
- Medication management
- Laundry services
- Social and recreational activities
- Staff available to help with scheduled needs, as well as unexpected issues
Source: HelpGuide.org
http://www.optimumseniorcare.com/services/alzheimerscare.php