10 Questions to Ask When Looking for Assisted Living
You’re asking yourself, what does this gal think she knows about assisted living and why is she trying to give me advice? Well, even though I had a brief career in the senior living industry I learned a lot about family dynamics, senior living, leasing and healthcare. I also learned that there is a huge shortage of information out there for families searching for senior living.
1) I worked in a small, but very competitive senior market. 3 counties and 4 smaller towns. 2) My role was in community relations so I oversaw nursing, activities and maintenance and had a close relationship with the branch director 3) I worked for a privately-owned company at a memory-care assisted living so my view is geared towards families struggling with memory issues 4) My smaller branch had 37 apartments
Now, lets get started by setting the scene. You’ve just been to grandma’s house for Thanksgiving dinner and you notice a few things that seem off. Maybe you found some cereal in the refrigerator or she doesn’t want to make her cookies that she makes every year. You decide to take a look at assisted living facilities near where you live just to get an idea of what’s ahead.
Here are 10 Things to Ask the Community Relations Director/Liason/Sales Manager:
1. Have you had any citations from the state? If so when and for what issue?
- You can look this information up on your state’s department of health website or state government services. For example, the link for Wisconsin is here. It is very important you look at these citations and learn more about them. Especially if the staff isn’t honest with you, this is your first very large red flag. If the person you are working with (consultant) says, “I don’t know, let me look that up and follow up with you”, that’s okay. That means they are being honest.
2. What is your staff turnover?
- Staff turnover is a very good indicator of a senior care facility. Don’t be surprised if it is higher than other industries. There are many nursing students who are working as a CNA and leave if they get a nursing job. However, if it is an extremely high number- run, don’t walk, away from that facility.
3. How many CNA’s and CMA’s do you have on staff every night? What is your procedure if you are short-staffed?
- By Iowa law (as of 2012), there has to be at least 1 CMA (Certified Medical Assistant) and 2 CNA’s (Certified Nursing Assistant) on staff at all times. Staffing decisions during the day are made by how many residents are there/level of care of residents. Higher resident # + higher level of care= more CNA’s and CMA’s on staff. More than 1 CMA on staff at night is a very good sign for a senior care facility- especially if it is larger. Most night shifts start at 11pm-7am so if you are able to stop in/call either late at night or early in the morning spontaneously to see how many are on staff and if they are being attentive at night.
- The procedure for short staffing is important. Most places will call a staffing agency if none of their staff can fill in. Then, ask what the staffing agency is and interview them as well. It’s very important do this- there are some staffing agencies that don’t drug test (It’s not mandatory in some states, like Iowa) and hire people you don’t want taking care of grandma.
- Along the nursing thought- make sure to ask if their medical charts are electronic and if you are able to view their charts at any time. (you should be able to)
4. How often do you drug test your employees and how many of them do you drug test at a time?
- You’d be very surprised to hear how many CNA’s and CMA’s aren’t on the straight-and-narrow. It’s important to choose a facility that has a drug testing policy that goes above and beyond state law requirements.
5. What is your community or buy-in fee? How long do I have to move-out with a full refund?
- This is very important because many assisted living facilities like to bury this way down in the small print. Also get a copy of the leasing contract, read it cover to cover before you move-in. The facility I worked at had a $5,000 community fee and would not refund that within the first year of living, so if you moved out you basically lost $5,000.
- Also, ask what the notification time period is for moving out. Most places have a 30-day policy which is common. If you don’t give a 30 day notice you can be stuck paying the next months rent.
6. What is included with my monthly rent?
- Ask about meals, medication distribution, bathing assistance, social activities, nurse visits, extra helpings of food at dinner, social events, family meals, trash services, electricity…etc.
- Think about everything you would want at home, then ask if they include that there.
- Do you take medicare/medicaid or insurance?
- Do you have veterans benefits? So many people didn’t take advantage of this. Get connected with your veteran representative and ask- there could even be spouse benefits upwards of $2,000/month.
- Ask about their security system- where are the sensors? When is the building locked?
7. Can I see a copy of your activities calendar? Do you take residents on outings?
- It is very important for grandma to have a good social life. Get the calendar, bring her to one of the activities. Also, it’s extremely important for seniors to get out and enjoy the community without having to worry about transportation. If the facility doesn’t offer regular (monthly) outings, move it to the bottom of the list.
- Also ask, what options are there for transportation? The facility I worked at didn’t have any type of transportation for residents and no regular outings which made it very difficult for residents to enjoy their community. Even if they tell you that there are transportation options- get specific and ask exactly what they are.
8. Do you have in-facility Physical Therapy or Hospice?
- Many assisted living facilities have this, and I think it’s a great option for seniors. If they don’t have transportation and need PT, you’ll have to find someone to take them every week.
- If they do have in-house PT, make sure to ask if they staff outside and what company it’s with. Interview them, too.
- Hospice is a hard thing to think about, but not having to move grandma when the time comes to another facility to be kept comfortable is important.
9. Can I have lunch with you? Can I have your cell-phone number?
- Don’t be afraid to ask this! I had many lunch meetings with potential residents. It’s a great way for grandma to taste the food, with is extremely important to seniors and socialize a little with residents. This is essential when looking for assisted living.
- Make observations during lunch, do residents look happy (are any of them sleeping?), do staff mind their P’s and Q’s, how is the menu displayed, do staff look frazzled?
- Get the liaison’s cell phone number and don’t be afraid to call it. 7pm, 6am, 11pm anytime they should be at your beck and call- I was available 24/7 for families to offer guidance, advice, answers and help for anything they needed. (what air conditioner brand do you use? How far does the air conditioner stick out from the wall? What size windows do you have?) I called myself “your concierge!” I got phone calls from families just needing someone to talk to and I listened- anytime.
- Meet the nurse, activities director and building director. Most importantly, ask the nurse to meet with you and discuss her work-style, hours and any other questions you have about grandma’s health. The nurse will be making big decisions about medication and health so it’s helpful to have a good relationship with the nurse.
10. How do you like it here?
- This question is for other residents. Don’t be afraid to walk around, talk to other residents. I set up an ambassador program my facility so prospective families could talk with my “ambassador” family and ask how move-in process went.
- Ask how long they have lived here- take a consensus. The smaller the number the higher the resident turnover and the less happy residents are.
General Tips & Guidance:
- Ask for lower community/buy-in fee & move in towards the end of the month. Also, say you are looking other places but need a good deal to move in sooner. The sales person will be looking to meet quotas for the end of the month and could even waive the community fee if she/he is low on sales.
- Be upfront with grandma, don’t EVER bring her to an assisted living facility without telling her or being upfront. Get a counselor, psychologist, doctor… anyone to facilitate the conversation. Most of the time it’s the doctor telling grandma that she can’t live at home any longer. It’s a tough conversation to have, but it will be even tougher if you take her on a “surprise” trip to an assisted living facility. Trust me. Don’t do this. I’ve seen it happen and it’s not only tough on you but really awkward for the Community Relations Director.
- Use the amenities before moving in to see if grandma likes them. Ask if she can stay overnight or for a weekend- they should be able to have her do that.
- Get a Power of Attorney and Medical Power of Attorney decided before researching places to live. These will be required to move-in and will be overwhelming to deal with during a assisted living facility search.
- Start saving money, now. This advice is for you.
- Pick a place that is close to her doctor or find a doctor she likes before moving in.
- Decide on plans if grandma weren’t able to make a decision for herself about her health. Hospice? Home-care? These are really important for you all to be on the same page.
Lastly, don’t be afraid to ask questions and really get to know the facility. You should feel welcome and at home at the facility. People should be willing to go out of their way to please you. Remember, the person you are working with (Community Relations Director) is being evaluated on her/his sales and should want to do anything to get you moved in- whether it’s a good deal on a nice apartment, free perks or anything else you want.
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