The assisted living option

Steps to Finding the Best Assisted-Living Facility by Karen Love

Consumer Consortium on Assisted Living ssisted-living facilities are a bridge between independent home living and residence in a nursing home. Instead of the hospital-like environment of many nursing homes, seniors live in private apartments and share communal dining and recreational facilities. In some cases, it's a bit like living in a hotel, but with the addition of around-the-clock help from staff members. Residents get help, if they need it, with medications, personal care (bathing, eating, dressing, etc.), laundry and other services.

Traps: Assisted-living facilities get varying degrees of oversight from state agencies... the quality of care varies widely... and the fee-for-service plans are often confusing, loaded with fine print and full of hidden costs.

About one million Americans live in assisted-living facilities, a number that's expected to grow as the population ages. Seniors and their families considering an assisted-living facility need to consider such factors as cost, location, services provided, current and future health concerns and the quality of supervision and care. To make the right choice...

List the Main Possibilities
Because seniors who require an assisted-living facility may be physically or cognitively impaired, the decision about which to choose is often made by family members. Start by making a list of facilities that might be appropriate. If you aren't sure where to begin, talk with your doctor or a geriatric care manager. Then visit each of the facilities to see which ones come closest to meeting your (or your loved one's) needs. Looking at many allows you to compare the features of a wide range of facilities. Key factors to consider...

Location. Some people prefer cities, others want a rural environment. Proximity to family members should be a priority.

Range of services. Seniors in reasonably good health might require little more than meals, laundry services, transportation and a range of social activities. Those with serious cognitive or physical impairments might require help with taking medications, bathing, using the toilet, etc. You may have to pay for extra services. Don't get more than you need -- or want to pay for.

Cost. Monthly fees at assisted-living facilities range from about $1,800 to $6,000, with the average charge about $2,500. About 85% of assisted-living residents pay out of pocket. The rest are covered by Medicaid waivers and long-term-care insurance.

Flexibility of care. Consider whether the facility can provide the range of care your loved one might need in the future. Some facilities require residents to move out when health needs change -- for example, if a resident becomes incontinent. Check the contract. This type of contingency should be explained in detail, along with any added costs.

Consult a Care Manager
Experts certified by the National Association of Professional Geriatric Care Managers, Inc. (520-881-8008, www.caremanager.org) can provide information about the facilities you've selected -- and how well they meet personal/medical needs. It's difficult for families to sort through the enormous range of services and prices offered at most facilities. It's also hard for nonmedical professionals to determine what level of care is required. Working with a professional makes it easier.
A care manager can help you decide which facilities provide the best value. He/she can also help you navigate the often-complex contract arrangements.
Example: If a loved one is in good physical health but has been showing signs of dementia, a geriatric care manager will help you choose a facility that provides high-quality dementia support.
Cost: About $300 for an initial consultation, then $100 to $150 per hour for additional visits. One or two hours is usually sufficient.

the Top Picks
Narrow your selection to your top two or three choices. After reviewing brochures and other written materials, visit each facility at least one more time.
Trap: The "chandelier effect." Expensive furnishings and perfectly appointed rooms don't always mean quality care. Residents can be better off in a bare-bones facility with a lively social scene and attentive staff than in a country club-like atmosphere where their needs aren't met. Important...

Visit the facility at a "low-staff" time -- say, between 5:30 pm and 7 pm. Are residents getting attention and help from staff... or do they seem to be on their own?
Does the environment seem chaotic, with phones ringing constantly and staff members running around? This might mean the facility is understaffed.

Get a sense of whether the residents seem relaxed, engaged and happy -- or if they're sitting around with nothing to do. An assisted-living facility doesn't have to be a beehive of activity, but with a few visits, you'll be able to tell whether people seem content or bored.

Arrive unannounced. You can see how the facility normally runs. Talk to residents or visiting family members and get their impressions. You might not be allowed the run of the place if you show up without an appointment, but it's worth trying because you may see what the place is really like.

Check for cleanliness and senior-friendly furnishings -- armchairs that look sturdy, grab rails in bathrooms, no-slip flooring in baths, etc.

Get Staffing Details
Ask the administrator how many staff members are in the building day and night... the level of staff training... and the average length of employment. A revolving door of staff often indicates problems with administration and working conditions.

Try to get a sense of how much time staff members spend with residents. Do they engage the residents... laugh with them... give them personal attention? Or do the interactions seem perfunctory?

Ask About Medications
Errors in medication are among the main causes of poor outcomes at assisted-living facilities. Ask the administrator to explain the medication policy -- who can give medications... what kind of training is required... if a nurse oversees the staff (which my organization recommends).
Ask to see the procedure guide for medication administration. If they won't show it or there isn't such a guide, that's a problem.

Check Complaint History
Every state has a long-term-care ombudsman who tracks complaints and is required to disclose problems with facilities. The Eldercare Locator (800-677-1116, www.eldercare.gov) will direct you to the ombudsman in your area.
Also helpful: Call state licensing agencies for inspection reports, a history of problems, etc. The Web site of my organization, Consumer Consortium on Assisted Living (www.ccal.org), provides contact information for the licensing agencies in each state and helpful consumer resources.

Closely Review the Contract
A 2003 study by the federal Government Accountability Office uncovered frequent incidents of deceptive marketing at assisted-living facilities. Marketing teams often promise more than the facility actually delivers at a certain price.
Example: Families might be told later that a resident's health-care needs are greater than anticipated, requiring extra charges.

A contract should itemize every service (or package of services) and the corresponding fees -- and what conditions (such as changes in health status) could result in higher-than-stated fees. Don't take anything for granted. Some facilities, for example, require residents to use one particular pharmacy -- which might not accept your existing drug insurance. This could add up to hundreds or even thousands of dollars a month.
Important: Ask an elder law attorney to review the contract. It's well worth the cost, generally from $150 to $200. You can find a directory of attorneys at the Web site of the National Academy of Elder Law Attorneys, www.naela.org.