We are in the process of choosing an assisted care living center for my father. It is a challenge to say the least, especially since we do not know what to look for with certainty.

We thought a smaller place would be better because they have better ratios of care givers to patients. However, the smaller place during the day, everyone seems sad and depressed. No one talks to each other, they just sit around staring at nothing. Bigger places people seem to be doing things, interacting, etc. One place has a physical therapy clinic in the building.

Others he would have to have physical therapy come in and work with him in his room.

There is a place in a house that is very close to our house, but it is small, dark, and everyone just sits staring. The rooms are tiny and the patients just sit in wheelchairs side by side staring at the TV. There are only five residents (all women). Dad is mentally good - although some places said he needs memory care (he doesn't but he cannot answer who the president is because he just does not care so they think he has dimentia. Some places listen to us and ask him questions about things he cares about, other places have their set questions with check boxes and will not vary from their protocol.) He cannot hear very well at all. Right now he cannot get up on his own, but once up, he can walk with a walker. He needs two people to help him get up. He has been pretty much laying in bed all day since the beginning of November. He needs a place that will get him up every day. Most place say they will do that, but some clearly will not.

Does anyone have experience with multiple assisted care places or nursing homes? Any ideas how to identify ones that will provide better care vs. ones that will simply leave patients in bad so they can tap on their phones? Other suggestions?

isaacs: Perhaps you can look at reviews on
Helpful Answer (0)
Reply to Llamalover47

As a former Admissions director for a government facility and a current holder of an Assisted Living Certification in NJ, I can tell you that over 16 years I have reviewed lots of ALs, SNFs and MC. Overall, even though I did not place my Mom in one (needed something closed and the administration knew me) I have found, at least in the current economic environment, that faith based facilities do a slightly better job at caring for residents than profit entities. I think there was a study done on that in 2022 and they came to the same conclusion; if I find the link I will post it here.

Not sure where you are located but in NJ the ALs that will accept Medicaid (and many do not) will do so only after you have been private pay for about 2 years. You definitely want to get a facility that has a specialized and secured Memory Care (MC) unit; that will ensure a smooth transmission within the same campus should the need arise in the future. In NJ we have the Health Care Association of NJ that has a listing of all ALs in the state although they don't post any reviews but some site like that would give you a place to start.
Since Als are independent individually run businesses, they do have different rules and regulations (when you visi,t ask for a copy of their contract.. if they are one of the ones you like... make sure to read it and ask questions on your second visit). Many will may not be able to handle someone who is 2 person assist to standing. They offer an "assist" to living so they don't staff at the same level as SNFs and everyone is having a hard time getting and keeping staff these days.
First thing to do is make a list of your priorities- which means what kind of care does your LO have to have vs what it would be nice to have. Make up your list of facilities and try to visit each one on your first visit around lunch time. You can check out the menu (ask them to give you the menu for the month) and see how people are enjoying their food. Ask what type of menu they can handle - e.g can they prepare a chopped diet or a pureed diet. If they say yes, ask if there is a fee for that as some ALs are "a la carte". This means their base rate is lower but the moment you need services ( could be incontinence, special diet (chopped/pureed), medication management) there will be a fee(sometimes a hefty one) . On your first visit to a facility, smile and engage in the masterful marketing presentation you are being given. At the same time, use your ears, nose and eyes to take in the situation; do the resident rooms, hallways smell nice, are residents participating in activities or just sitting in the activity room, do residents and staff greet each other in a friendly way?

In NJ many ALs start at $3500/ per month but that is really for people who need no assistance and simply partake of meals in the dining room
In an ideal situation (which means you have plenty of money) I would recommend a faith based CCRC (Continuing Care Retirement Community) because it has all stages of living from independent through end of life; however, most require a significant entry fee upon admission. One of the larger Presbyterian (they have changed their name to make it clear that they welcome all people regardless of belief) ones in NJ has just started a new program, that will allow one to stay in their home while receiving needed medical services from the organization. They started their work in 1916 and know what they are doing. I will have to research their new program further.

Hope you can find something but it is a an intensive project. Have an spreadsheet ready so you can compare statistics. Wishing you good luck in yur quest.
Helpful Answer (2)
Reply to geddyupgo

Yes, this is a huge undertaking. This is why it is important to visit places BEFORE you have to make the decision.

Here is what I looked for:
1. No strange smells (e.g. urine, feces, sanitation smells, fragrance sprays)
2. People that were in the halls, whether it was nurses or care givers or residents
3. Activities: what are they, how well are they attended. Go visit a place during their activity time and see what they are doing. Is there a calendar? What is on the calendar? Is it something your Dad will do? Do they truly try to get the resident out of their room?
4. If something should go wrong, where do they take their residents? How far away is a hospital or rehab center? What is their policy about where they will take residents? Will they allow you to use your own doctors or do you have to sign up with their doctors?
5. Does the facility care for them until end-of-life? Or at what point will the resident have to move out?
6. Cost structure: monthly, laundry, medication management, bathing
7. Can you visit at any time or are there regulated visitor hours?
8. Look at the care givers. Is there anything about them that your Dad would find offensive? Do they appear happy to work there or does it look like just a job? Are they polite or always in a hurry? Harsh voice or calm voice? How do they explain things.
9. Menu and food - do they ensure that their residents are eating (like helping them get to the dining room and actually see that they eat), or do they just drop the food off in the room and collect it later? (My BIL parents used to have the food delivered to their room, then toss most of it in the trash....he died from malnutrition) What happens if they don't like what is being offered? What other food options are there?
10. How do you exit from the contract? How do you bring forth grievances?
11. Would they recommend your Dad be in assisted living or memory care or ??? What is their criteria?

I would go multiple times at different times of the day. Go when they are serving lunch or breakfast.

Your father is not ready for a nursing home. In fact, due to his mental capabilities, to put him in a nursing home would be a huge dis-service. Each facility has their own guidelines for Memory Care versus Assisted Living. If you don't need it, I suggest no Memory Care as many of those patients have no ability to sustain or create a friendship and they are not able to leave the floor since many of the people are wanderers.

It is common for people to be sitting in a room at various levels of disinterest if they are watching TV. Most of the shows are of interest to only some people. Nearly all are hard of hearing. Most are just there to be with others or so that the caregivers on duty can have an easier time watching them.

If you have reservations about the place, just scratch it off the list. A place can always be re-evaluated. Just a change in administrators will make a huge difference to the quality of care and atmosphere of the facility.

As you are evaluating these places, see how they react to your questions. Do they just dismiss them or are they overly eager to get past the subject? This is the same way they are going to treat any concerns you have about your father's care.

It is common to have some reservations about every place you look. However, after you visit more than a few, you will start to get a better instinct.

Best wishes on your journey.
Helpful Answer (8)
Reply to ChoppedLiver
geddyupgo Feb 8, 2024
great response!
Google the names of the facilities and read the reviews. My inlaws were in a smaller one because that was all they could afford and it was homey, they would not have accepted your father since he needs 2 people to get him up, they were sticklers for that. My father is in a bigger one , it has skilled and assisted. It is much nicer, better food and more staff. Since they also have skilled there you do see a lot of residents in wheelchairs just sitting and watching tv, but that is their choice, they do try to get them involved in the activites. We used A Place For Mom as a starting point, then just searched "assisted living 63026" and found more, and checked the reviews.
Helpful Answer (2)
Reply to SherryH1968

For us, it had to be a Medicaid waiver facility. Things I looked for:

-How are the activities?
-Are the residents engaging with each other? I went to several places that was so quiet during mealtime that you wouldn't know people were in there if you hadn't seen them. My mom's facility was a robust crowd that hangs out in the common areas often.
-How is the food? I took my mom to lunch at the facility, long before she had to go to it.
-Talk to other people who have had to put their parents in a facility and see if they have recommendations.

All in all, my mom's facility is older and needs updates, but the residents are happy, and the employees are caring. Finally, her place had the best apartments.
Helpful Answer (3)
Reply to darts1975

Because my daddy was coming out of the hospital I had a social worker and she helped me. I did have my daddy in a facility but because he needed a wound care nurse the facility would not let him back in because of the pandemic blah blah. Anyway, It came down to a group home. The first one was awful! I made it a point to introduce my self to all staff - even when he was in the facility. I wanted to know them and them to know me. When he went into the group home I stayed with him all day and waited for the night staff to come on. I waited until about seven and then asked the day caregiver when was the night shift due and I was told there would be no change of shift. I was floored - because my contract said there would be two during the day and two at night. I call the Social Worker and informed them what I was told. I had to keep him there overnight because it was too late to move him that same night the next day I went to several different group homes - finally found one that would satisfy my needs and then transported him by five that evening. There was a lot if prayer involved inbetween homes I called the prayer chain of our church and had everyone praying that the correct decision be made. When the facility was chosen I introduced myself and let them know that I wanted to come daily - remember this was during the pandemic and once the person was in visitors were limited. What was great was each room had access to the deck and we were able to sit on the deck and see him daily. So to summarize - make sure you see the places and introduce yourself to the staff.
Helpful Answer (2)
Reply to Ohwow323

Go to read reviews of these places and Propublica has a report of what nursing homes had reports of neglect reported to Medicare . Go to the Senior center and ask them for a list and what places they recommend ? I visited a series of rehabs , skilled nursing facilities between my Mother and Brother over 4 years . You really have to
read reviews . Can you just hire caregivers to come in and help him
since he is mentally sharp ? Have the Doctor write a note for a CNA to bathe him , PT for in home physical therapy and a VNA to check his medications if he is on any . people advertise on there as Caregivers and Next Door. com also . It’s great you are observing the clients in these places . Check out the Food too . I got my mom into one decent place she was near the end . And my brother a Carribean place with a great social worker he was near the end . Maybe get some Live in help ? Try .
Helpful Answer (5)
Reply to KNance72

My brother & toured 15 facilities before deciding on the one for my stepfather & stepmother. My stepfather was deaf.

We chose a home 11 miles from us, newish building, very nice, activities, good service.

He passed we kept her in AL for around a year, her dementia got worse, we moved her to MC in the same facility, it got too expensive so we moved her where our mother is in AL, stepmother in MC.

A smaller older facility, maybe 100 rooms, also nice.

What you describe sounds more like a NH, rather than an AL or MC unit.

There were some that we walked in the front door, smelled urine and saw people like you are describing, we turned around and walked out. Kept moving on.

All I can suggest is to keep looking, view at lunch time and you will get a better feel for the residents there. Also, we did attend a couple of lunches ourselves to test out the food. These facilities will accommodate you doing this as well.

Take your time, ask questions, search reviews on line.

Good Luck!
Helpful Answer (1)
Reply to MeDolly

I think you are covering all of your bases by asking the important questions. Ask others who they recommend.

You’re also observant and concerned about your family member’s well being. You will be a wonderful advocate.

I wouldn’t consider size to be a major factor. If a larger place appears to be a well oiled machine and you are satisfied with it, then go with it!

The same applies when we are selecting universities for our children.

Our daughters would not have been at all happy in a small university. They chose larger universities for specific reasons. The university they chose is a flagship institution and has an excellent reputation. They would not have had the same opportunities if they had attended a smaller school.

So, look at the entire picture to see what is offered to the residents. There may be additional fees for specific services but it may be worth the extra money to get what you want.

On the other hand, if the smaller places have everything that you want and you feel like it will be more personal, choose it. Maybe you don’t need all of the additional amenities.

Is your family member more comfortable in smaller or larger settings?

Do you want a place that offers physical and occupational therapy to help with mobility issues?

There are always going to be pros and cons to all situations.

Wishing you and your family all the best!
Helpful Answer (3)
Reply to NeedHelpWithMom

My mom was in assisted living, then memory care, then nursing home, then end of life home. My understanding of assisted living is that they won't do a 2 person assist, but your dad might be an exception since he walks. I liked that my mom was in a small assisted living and memory care. They were more personal and seemed more like home. Sometimes the choice is concerned more with practicalities, like larger facilities where your dad could move from assisted living to skilled nursing without changing facilities. I didn't like the enormous nursing home my mom was in toward the end and found her a small end of life home that had only two residents with three caregivers and hospice. In all places there are usually more women, but they really like when men arrive. If in the smaller place you looked at the people were sitting around in wheelchairs looking depressed, I would suggest you not choose that one. My choices were by how the places seemed when I visited and imagined my mom there. The nursing home that I didn't like was the only one she could get into because of covid and I wasn't able to visit before she was moved there from hospital.
Helpful Answer (1)
Reply to ArtistDaughter
isaacs Feb 2, 2024
Maybe we are going about finding the homes in wrong places. So far we have relied on Google Maps to find homes in our vicinity. I wonder if they cover everything?

How did you find your homes?
In my family's experience, we had my MIL in a small, faith-based AL run by a small church. They were very nice staff but there was the minimum of activities. Then we transferred my MIL to a larger faith-based facility that had a continuum of care from IL to AL to MC to hospice. They also have plenty of Medicaid beds (this is critical!) This facility is one of many in our state run by the Presbyterian Church. It's been around for 30+ years and has had a stellar reputation. You don't have to be Presbyterian or even of the same faith. The see the care as a mission, and the national Church organization has a very generous budget for their facilities, which help offset the cost to the client. If at all possible, research this type of facility in your area. It is non-profit.

I would join and ask for recommendations. is an intranet of your actual local neighbors and is non-anonymous. I use it all the time. You will get really helpful opinions from people who have relatives in facilities in your area.

Also, if the facility tells you your Father needs MC or LTC, please believe them. If he can't get out of a chair without the help of 2 people, this puts him in another care category. And, I hope you are aware that PT needs to be ordered by a physician... you cannot just request it (at least in my state). Physical Therapists won't continue with the PT order if the patient can't do or won't cooperate with the exercises.

I wish you all the best in your search!
Helpful Answer (3)
Reply to Geaton777
isaacs Feb 2, 2024
Thank you. I hadn't considered faith-based facilities. I will be sure to consider this as an option. How did you find out about it?

Nextdoor is a very good suggestion. I'm not sure if I can trust the reviews on A Home for Mom. Are there any other places that I can find reviews and recommendations?
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