Alternative living situations for seniors

Last month’s Part 1 on this topic provided an overview of alternative living options when our limitations or those of our loved one negatively impact on our ability to care for ourselves or them.

Once you have identified the type of facility (assisted living, memory care or nursing home) that best meets your needs, narrow the list of acceptable facilities within type to two or three.

The next step is to vet each of these acceptable alternatives.

Importance of visiting care facilities

The importance of visiting each facility you are considering cannot be overstated.

Preparation for the onsite visit involves online and phone research to identify key features of each facility.

What you learn can help differentiate facilities and set the stage for your visit.

Involving Seniors in the Decision Process

Several reputable sources and organizations (e.g., Centers for Medicare and Medicaid Services and American Geriatrics Society) recommend that the potential patient, to the extent possible, be involved in this assessment process.

The need for involving older adults in their care decisions helps to ensure that choices are aligned with their values and preferences and helps to build trust.

Key Questions for Vetting Facilities

I have enhanced a list of questions/concerns prepared by the care.com clearinghouse that you should ask yourself and your family, as well as the professionals and residents in each facility. It isn’t an exhaustive list.

Logging truthful answers to these questions in a systematic fashion by date and source based on your experiences should identify your best options. I hope you find it useful.

Neighborhood and Facility Research

Before you visit, get a feel for the neighborhood you are considering.

Determine if the neighborhood is generally safe or if the facility is in a high crime area.

Trulia.com and NeighborhoodScout.com have tools to help you evaluate neighborhood environments and safety rates.

Local police precincts canalso be helpful.

Checking Reviews and Feedback

What are others saying about this provider in reviews?

Can you find any information about the provider through the Better Business Bureau or your local Area Agency on Aging?

Read both positive and negative reviews by these bureaus as well as reviews from the community.

Online Research for Additional Information

Check the websites and Facebook pages of each facility for reviews.

Often there is a compilation of comments from those with experience with the facility, its services (including the availability of religious services), and personnel.

Note responses or explanations that address specific issues raised: and also note if nothing is explained.

Gathering Materials for Your Visit

Gather online materials from the facilities you are interested in visiting, such as:

• A sample admission contract.
• Copies of the Resident Bill of Rights.
• The most recent survey results from state regulatory inspectors.
• A recent list of weekly activities and events.
• Menu of meals and snacks.
• Visiting hours.
• Rules allowing overnight guests (e.g., a family member from out of town).

These documents will be helpful in generating specific questions for your tour.

Compare what is described with what people are saying in their reviews.

First Impressions Matter

On the way in, take notes on your initial impressions of the neighborhood, parking options, whether the grounds are clean and well kept, etc.

Do you feel safe getting out of your car?

Facility Design and Layout

Upon arrival, be aware that assisted living and nursing home care designs will vary.

Assisted living environments typically offer a more homey feeling with a variety of amenities throughout the facility, as many residents are ambulatory.

Nursing homes may be more hospital-like, with the need to have amenities surrounding the patient.

You may have to adjust your expectations based on the level of care needed.

That said, hallways should be easy to navigate, with hand rails and plenty of room for wheelchairs, and patient comfort and security needs should be a priority in both.

Observing the Facility’s Sound Atmosphere

Use your senses. What sounds do you hear throughout the facility? Pay attention to:

• Resident activity. Do you hear residents chatting and laughing, or are there sounds of yelling and distress?
• Staff communication. Is staff interaction respectful and welcoming?
• Noise levels. Excessive noise can be a red flag. A balance of quiet and activity is ideal.
• Announcements and alarms. Frequent alarms can be stressful.
• Music and entertainment. Pleasant sounds enhance the environment.

Assessing the Facility’s Cleanliness Through Smell

What smells do you notice throughout the facility?

• Common areas. Should smell clean and fresh.
• Dining areas. Should smell appetizing, not like garbage or chemicals.
• Laundry areas. Is laundry done consistently?
• Pet areas. If allowed, are they well-maintained and odor-free?

Evaluating Staff and Tour Guide Interaction

Do you like your tour guide? Are they listening? Do you feel pressured? Do they include your loved one in the conversation? Can you speak with other staff?

• Personality. Are staff friendly and professional?
• Expertise. What training do they have? What’s the turnover rate?
• Staff ratio. Are there enough staff for the number of residents?
• Background checks. Are they performed before hiring?
• Physician rounds. How often do doctors visit?
• Emergency preparedness. What’s the facility’s plan?

Note: Tour Guide’s Limitations. They may not know all the answers, but they can refer you to someone who does.

Note: Regulatory Compliance. Nursing homes are governed federally and by the state; assisted living is state-regulated. Ask for staff-to-resident ratios and regulatory details.

Observing Subtle Signs and Unspoken Issues

Be aware of what isn’t said:

• Resident activities. Are staff engaging residents meaningfully?
• Activities director. Can you speak with them or see the schedule?
• Personal items. Are they visible in rooms?
• Signs of abuse or mistreatment. Look for warning signs.
• Staff behavior. How do they treat residents?
• Response to requests. Is staff responsive?
• Understaffing concerns. Do staff seem overworked?
• Social isolation. Are some residents isolated?
• Food quality and cleanliness. Are meals clean and nutritious?
• Bedsores. Ask how they prevent and manage them.

Final Thoughts

Finding a facility doesn’t guarantee a permanent placement. Evictions can happen — more on that in a separate article.