I've visited assisted living facilities in the past to check them out for future personal needs but feel I'm not asking enough questions.

What questions do you think I may be missing from what you've seen happen and need to ask?

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Can family visit at any time or can at least one primary person visit at any time?
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This is an important question when looking at facilities. These are some I suggest:

Is the person assessed to determine the necessary level of care?
Is there a care plan for each resident?
Does the facility doctor become the LOs PCP? If so, is he/she covered in your LOs health plan?
What activities are offered?
What is not included in the monthly rate?
What is the staff ratio? 1 to 5 is good (in MC) but you won't find that. Instead of the ratio, keep your eyes open and noticed how the residents are treated and cared for.
VERY IMPORTANT- What is the facility's discharge policy, i.e., What would cause the resident to be discharged from the facility.
These might trigger some additional q's by you. Ask them.
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Aging in place. Some facilities make you leave if LTC is required.

I always think of AL as a room and a meal. All other services are ala carte which adds up fast.
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Ask family members of people that you meet in the hallways. And try to do it privately. That's how you're going to find out what really goes on. Also google the facility and read the reviews. There's always going to be a big complainer, but evaluate OVERALL what people say. Had I done that prior to a rehab thing for my mom, I would never have sent her there. Everything they said on reviews was going on.
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Find out everything you can about how they are handling government mandated lockdowns. My mother moved into IL just after the quarantines got started in April 2020. She was quarantined in her 2 room apartment for FOUR WEEKS. Had a serious panic attack after 5 days and was put on medication to manage the stress of it all. Fortunately she lived on the first floor, so we were able to window visit, but it was really hard on everyone.
Things opened up recently, but just yesterday they’ve started full lockdown again with no visitors. I had been coming into her apartment as her daytime caregiver for the last 10 days (she was recently put into hospice care) but am now banned unless I stay in her apartment 24/7. Not an option and there’s no way we will be able to hire someone willing to do that - if she would even agree to it. This condition is totally absurd when staff and hospice workers come and go all the time.

We finally decided enough was enough and gave 30-days notice today. We’re moving her in with me.

This is a “high-end” $$ 4-year old facility that served “hot, gourmet” meals, brought to the apartment in styrofoam containers and plastic cutlery and was always cold. Dispensing of meds was sporadic because the staff was allowed a 2-hour window to get meds to the residents - not a good practice for someone in pain! A snafu between hospice and nursing caused an overdose of painkillers that I found out by chance. Family was never contacted to question a change in meds, even though they supposedly questioned it internally.

My intention is not to frighten you, but to make you aware that moving into a facility right now may not be the best option. You have little if any access to family and that can be really hard on a new resident.
Best wishes to you and your family.
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jimlindac Oct 2020
It is sad but I wanted to ask if you were talking about Bickford Assisted Living. My mom is there and I have the exact same 2 hour med window issue as well as disgusting food in styrofoam containers all for $6400 a month. Insanity.
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It will be more challenging at this time to visit facilities and get a better feel for what it is like. Until they can reopen for all, you'll have to rely on questions and answers, perhaps SOME reviews and word of mouth from friends or relatives.

There are various types of places, so you'll have to educate yourself on the different types. There are at least:
Continuum of Care
IL (independent living)
AL (assisted living)
MC (Memory care)
Board and Care homes

There are some who accept Medicaid, but not a lot. Most of the time it appears that Medicaid generally applies to NHs, sometimes ALs. There are exceptions, but this is something you have to ensure, if you think you might ever need it.

Continuum of Care:
"The phrase refers to the increasing level of care services you may need as you continue to age. A CCRC, also known as a Life Plan community, by definition must offer these varying levels of care to residents, from independent living options to assisted living, rehabilitation, skilled nursing and memory care services."
Often these require a substantial deposit that doesn't apply to the monthly fee charged. One site indicates this is a "refundable" fee, but can sometimes be drawn upon if the monthly fee can't be paid. Some you "buy into" and have to "sell" to an accepted buyer. My mother often went to the free lunch/tour for places local to where she lived. Once I heard of the large fee needed just to get in, I avoided looking at those!

Board and Care:
"Board and care homes, also called residential care facilities or group homes, are small private facilities, usually with 20 or fewer residents. Rooms may be private or shared. Residents receive personal care and meals and have staff available around the clock. Nursing and medical care usually are not provided on site."

While there are places that might be just IL, AL or MC, it is probably best to search for those that cover at least AL and MC, so that transition is easier if/when needed. These vary widely on whether they are for-profit or non-profit, how they determine costs, etc, so it's best to get ALL the details! One place my OB checked near where he lived, after we had decided on a place, he questioned the fee saying this place was MUCH less. I checked and the amt he quoted was just for the room. Services (meals, laundry, cleaning, etc was all ALA CARTE!) It was also a for-profit. Cost cutting can happen in these places, paying staff less, cutting corners, etc so investors can make more.
IL is generally for those who can still provide for themselves, but want freedom from caring for a place and have some transition available.
AL is for those who need some assistance with their care. It can be a lot of care needed or a little, or anticipating needing additional care.
MC units are for the cognitively impaired, generally locked down and can usually care for other needs as well. Mom's place has mobile residents, non-mobile and others needing more care.

Some questions:
Type of facility
Profit or Non-profit
Base cost
What the base cost covers
What add-ons might be expected
Cost of add-ons
Staff ratios
On-site medical care or local medical available

If you can find GOOD reviews, check employee reviews and resident/family reviews
(The star ratings found online or even on Medicare site are often misleading)

If you have a computer, make a chart with all known questions and facilities checked and to be checked, list responses. Some responses may lead to additional questions, so add those, call back to ask, etc. This way you can compare between facilities, what they offer, what they charge, what they cover. The hardest part right now is being unable to assess the place in person. Most sites have pix, but seeing, hearing, tasting, talking to residents and smelling are the best ways to actually rank places after comparing the care and costs.

Example of how we (mostly me) found a place for our mother will be posted as a reply to this post.
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disgustedtoo Oct 2020
My mother is in a non-profit IL/AL/MC. By the time she needed to move, it was right to MC. We couldn't tour the place initially, as it was torn down and rebuilt (heavily subsidized too.) The deposit was FULLY refundable.

We checked 3 places. There was a CCRC locally, but as noted, I avoided those.

One was a lousy "tour", no meal, set up was not ideal (2nd floor with cognitive and mobility challenges, what do they do in emergency?) They didn't even provide a list of costs, etc. If they can't even provide basics to those looking for a place, how good is their care of residents? First impression was really poor. Nope.

Another was new and fairly nice, but more expensive, further away for me and the cost quoted was a shared space - 2 BR with shared bath - NOPE! Mom would NOT like that. I'm sure they had private rooms, but the cost would be even higher. The view was also not great - overlooks a parking lot and a 4 lane road!

Once her current facility was rebuilt, we could tour the place and later when it was opening (stages, IL first, then AL, finally MC) we brought mom for the tour and meal. It is nice, clean, lovely grounds and MC circles an interior garden area. They also have on-site hairdressing area, bring in nail-trim help, yoga/exercise room, movie "theatre", and often have very nice BBQs for residents and family and other fun functions, entertainment brought in (B4 virus), etc.

She's been there almost 4 years now, and I recently found out she can stay to the end, no need to move to NH!

Her fee covers room, board, medication management, laundry, cleaning and up to 1 hour of personal care. They did allow me to continue providing her prescriptions (MUCH cheaper through her insurance!) There are limits to laundry, etc, so we have periodically have had extra charges for carpet cleaning (accidents) and extra laundry (more accidents), but not too bad yet. Interestingly, the cost was less than the place above, and only recently (3 years later) reached that level! The other place would have yearly increases as well, so I can only imagine how much that would be!

She was mobile and could do most self care when she moved in. Only recently has she needed more care. She was already in a wheelchair (1 yr or less now, mostly self-induced) and recently had a stroke, so it will require additional care now. The only downside is if personal care increases, the add-on is about $1K/hour - I do wish they would make it incremental, say 1/4 hour, but it is what it is. I am VERY happy with the place. Staff is nice. They LOVE my mother. The meals are good (I have eaten there multiple times with her.) Passing through the IL/AL area to get to MC I have interfaced with some staff and residents. So far I've only met one man who didn't like it in the AL, but it was more because he didn't want to be in a facility at all! AL likely has a base fee for room and board, laundry and cleaning, but add on costs for medication management, assistance needed for bathing, etc. IL is also one fee, and I think you can add on services, if you need/want them, for laundry, cleaning, meals, etc. They do have covered parking and a lot, so people can have their own cars when possible.

Given that we couldn't really check the place or interface with staff or residents before the move, I am happy with the place. I've said if I ever need to move, this would be my first choice! It is closer for me (bros don't visit or do anything, it's all on me!) than her place was (about 10-15m vs 1.5 hrs!) We are also well outside the real danger zones (virus) and so far have had NO cases in residents or staff! They are allowing some limited and scheduled visits, outside during the nice weather, inside in the cafe just inside the building.

The last thing I found out is because they have a trust fund, which can assist those who have outlived their funding! Not a concern with our mother, but nice to know!
From personal experience with my brother I think I might ask what their numbers of patients with severe dementia versus mild they have. I do know in my brother's cottage he was one of three without severe dementia. As he had almost no dementia, just a little short term memory loss and poor balance issues, with a diagnosis of probable early Lewy's dementia (so he would have, had he lived, suffered more severe challenges). It was the feeling of some residents at his place that some were suffering enough that they needed a higher level of care (calling out constantly, going awol, coming into the rooms of others). When this was brought up at community meetings they were told that most families simply could not afford memory care in this facility, and they were trying to help people stay in their facility. So there is no real good answer to this. I think that they do as well as they can, but there is no ideal answer in some of this.
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The assisted living should any and all questions that you have.
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Imho, no question is too much. Prayers sent.
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Consider how "a day" would go in the facility. Ask how they manage each aspect of the day.
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I agree with other post about food/dining: sis first community after moving to my area. Tour we had lunch in the bistro-nice tuna salad and good service. Reality: assisted dining was processed canned or frozen items. Maybe apples, banana-too ripe on the salad bar. Long waits even if you got there early-they would process take out orders first then in person orders....Independent dining nice looking menu nothing like the assisted i never saw a meal served in other area so i don't know if it was good or not.

Staff ratio: sounds good on paper but no way to guarantee they are doing their job. Sis had falls injuries, stranded in the hallway in a wheel chair sis could not move on her own, mean residents scared me. Call button sis could not use. they did not check on anyone if they could get a way with it. Several times they put sis to bed in the afternoon. I arrive she is in the dark and bawling her eyes out......I get her up we tallk, we walk, have a snack she is fine. No explanation as to why they are doing this to my sister.

Recommendations from others: Unless they have had a family member in the community do not use the recommendation it is a good place.....Same community was recommended by 2 physicians. If their family needed the care they would go here.....reality is place was horrible-i have filed state complaint. They did not recognize or treat for scabies until i ask what is this all over her body???? I want to send physicians pictures of my sister with her injuries, dirty hair, dirty dining area, aides messing on their phones, residents asking me where is the snack tray, water, etc. if this is their idea of good care????

I have checked things like job websites: if it looks like the place is always looking for a lot of help-aides, housekeeping etc. maybe not a good sign of worker happiness. Lets face it not all people are a good fit for caring for the elderly or people with a lot of issues-very demanding, smelly, difficult work, as many will tell you on this site.

The problem is you can not go unannounced-only with appointments set they will make sure you see what they want you to see. Tour person will give you all the scripted details they are supposed to say.

Activity calendar looks full and interesting: reality I only saw something good interesting happen a few times. Music time was having the radio on. I would go for several hours at a time-nothing to engage enrich residents. Puddles of urine under the resident chair, people needing help, was a depressing neglectful atmosphere.

As a result of our experience at the two facilities-my search was frustrating (understatement) to find something a lot better=long wait list, high cost, no guarantee it will be any better. Covid putting a strain on fewer staff and more restrictions-family can not come and give staff even a small a break by visiting.

Medicare/Medicaid supposedly implemented some kind of nursing home system overhaul-years ago-stating they will make changes to make good care available to all who need it. I have not seen this. Homes cited for abuse are still open and people living there is shameful. Social worker at last community recommended a place cited for abuse-what the heck.

the bottom line: yes some places will charge one price-but then when you get to sign the contract-they are suddenly charging for all kinds of extra fees-sis had a walker-they were going to charge a fee for that-hey people we bought the walker-we will fix or replace if needed-why are you charging me for this it is for her safety and necessary. We did not go there for that reason plus the nursing area had horrible reviews-which seems to be a pattern-Assisted can be well rated but as needs increase more demands and time needed from staff care and attention seems to be a sliding downward scale. cost up=less care quality of life. Charging fees based on the type of meds-not including actual RX cost. Nickel and dime you $$$ every month-only place i have seen this done.
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You should ask if you can have a Camera Installed in the Room so you'll be able to check on your loved one 24 7
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Ask to eat in the central dining room with residents. Some facilities will serve a “special” meal to visitors and then serve totally different food to residents.

Ask the Activities Director if they can implement activities of interest to you or your loved ones.

Find out about staffing. What type of staff.

Ask about special services for hearing impaired.

Ask if fees are all inclusive or if there are additional charges for specific add-one. Get a copy of the service fees.

Ask what happens if You run out of money. Medicaid generally does not pay for assisted living. Some AL’s have special rates or policies when one runs out of money.

Find out if you can have pet, any weight restrictions, etc.

Can you have cameras in your rooM.

Is WiFi available in all areas.

How long is your monthly fee guaranteed and how often are rate increases implemented and how are increases calculated?

Read your contract thoroughly and if possible have an attorney review. Don’t assume anything.

There are many good facilities available, but there are some sleazy/greedy operators.

Ask for resident references.

Find out their dispute resolution process. Do they have a resident coordinator?
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Is this for yourself or for a family member?
There is not much in your profile so I am going to assume that this information is for you.
I would look for a place that starts with Independent Living, you can transition to Assisted Living then if necessary to Memory Care. And many will have the ability to also care for you if you need Skilled Nursing but not Memory Care.
Many will allow you to "try on" the community for a week to see how you like it. When you call around ask if that is an option. Obviously it will not be a free week but it might cost less than a vacation. Also ask if they have other communities across the country and if you travel would you be able to stay in a "sister" community for a nominal cost.
Talk to residents.
Tour or try walking in at odd hours.
When asking about fees how are they structured? Do they charge for every bit of help that you need or is it a flat fee. While the flat fee might be higher to begin with you know the charges will not increase with each ADL that they may have to help you with.
Do you have to "Buy in"
Do they have Medicaid beds available? If so how long would you have to be "private pay" to qualify for a "Medicaid bed"? (if it would ever be necessary for you to qualify for this)
Some other questions:
What is the staff ratio?
What type of training does the staff get?
Is there a Nurse 24/7
Is there an in hose Doctor?
Do you have experience with-------------condition?
Activities? Ask to see a calendar or activities
Do you provide transportation to shopping, doctors appointments, other venues?
Cost and how is it structured?
These are just a few I pulled from one site but there are plenty that give you way so "shop" for Assisted Living locations. (wild guess that a click on Assisted Living on this site will also give you some answers)
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I would also strongly suggest you only consider facilities that offer a continuum of living arrangements, i.e. IL to AL to MC to LTC so that one never has to be upended and moved at the worst possible time. Also, the admin and staff will already know you and your needs and you'll already know you're in a good place. Pick one that is close to your PoA as possible.

If there are any in your area please consider faith-based facilities since they are less profit driven but usually have the support of a larger organization. My MIL is currently in Presbyterian Homes and it's very well run and the people are fantastic. You do not have to be a member of that religion. They see what they do as a mission, not a job and tend to cost less money than for-profit, privately owned facilities. I hope you find one a great place!
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There are a number of threads on this site that discuss this. Try searching "questions to ask when selecting facilities". Also try to google it.
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