How to choose an assisted living facility

A guide to finding the right assisted living facility for you

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Finding the perfect assisted living facility for you or your loved one takes time. Not only do you need to think carefully about what type of community environment is best; you’ll also want to consider long-term finances and exactly what type of help you need now and for the future. Once you determine a budget, your preferred amenities and services and the level of care you need, it’s time to begin your search.

If you’re unsure about how to start your search for an assisted living facility, the following information should give you a better understanding of your service, care, amenity and assistance options.

What to look for in an assisted living facility

No two assisted living facilities are the same. Even facilities run by the same corporation can offer varying services and amenities. Knowing your options for care, amenities and services will help you find the best facility for you.

Knowing your options for care, amenities and services will help you find the best facility for you.

To help you narrow down your choices, think about what amenities and features are most important to you. After considering your personal preferences, think about tasks or activities you either currently have difficulty performing or may have difficulty performing in the future. Remove from consideration any facilities that don’t offer the services you’ve prioritized.

Looking for an assisted living facility can be an overwhelming and daunting task. The following are examples of the different services, community features and amenities you might find at various assisted living facilities.

Social environment: Visiting the facilities can give you a firsthand look at what type of community you’ll be entering. With an in-person visit, you can see what activities are available, how residents interact with each other and how the staff treats residents, getting an overall feel for the entire community. Speaking with current staff and residents about what it’s like living and working in the community can help you get a better understanding of the atmosphere.

Activities and meals: Most assisted living facilities provide three meals a day; snacks may or may not be included. Most facilities provide all kinds of dining options — some serve meals similar to gourmet dining, while others are more casual and laid-back.

For activities, think about your current hobbies and interests. Also consider if there’s anything new you’d like to try and how active you’ll want to be in the community. If you think you’ll want something to do all the time, look for a facility that offers activities all throughout the day. If you like a slower pace, a facility that offers fewer activities might be fine for you.

Day/night visits: If you’re really considering a specific assisted living facility community, make sure you visit at least once during the day and once at night. This gives you a better idea of what you can really expect from living in the community 24/7. Ideally, you can visit unannounced, but for security and safety purposes some facilities may require advanced notice, especially for night visits.

Location: Local and state laws determine what types of services and care assisted living facilities can provide. If you require specific medical care, make sure the laws allow the type of service you need. Even if you currently don’t require medical care, you’ll want to take this into consideration; if the facility cannot legally provide medical care you might need in the future, you might end up having to transfer to a new facility.

Other things to consider regarding location:

  • Proximity to family and friends
  • Distance from local shopping centers
  • Nearby medical facilities
  • Community ties

Contract that details all fees and rules: Assisted living facility contracts provide detailed accounting for all fees. They outline everything included in the monthly base rate and explain what type of services may be available for an additional fee.

Your contract should also outline the rules residents must follow in order to live in the community as well as the consequences should you fail to follow these rules.

Training and background checks: Ask about what type of training, accreditations and experience staff needs to work at the facility. This will give you a general idea of whether or not the staff has the knowledge and experience it takes to care for residents.

All assisted living facilities have a duty to protect their residents. Background checks help communities to avoid hiring individuals who have a history of serious offenses such as violent crimes, theft or fraud. Ask about what type of employee background check the community runs — some facilities only look for extremely serious crimes, which means employees could have committed other offenses, like domestic violence or drug crimes, which can put you at risk.

Medical professional availability: Understand what happens in a medical emergency. Does the facility keep a nurse on-site at all hours? If a nurse isn’t there 24/7, is a doctor or other medical professional available for emergencies?

Financial assistance programs offered: Insurance usually doesn’t provide coverage for assisted living residency. However, you might be able to find local community funds and assistance programs to help with these expenses. If you’re a veteran or the spouse of a veteran, financial assistance for personal care services or community expenses might be available to you through the VA’s Aid and Attendance or Household program.

Number of rooms or spaces available: Do you want a community that’s smaller and more intimate, or do you prefer a larger community with more opportunities to meet and socialize with new people?

If you need to move immediately, you’ll need to know if space is currently available at the facility you’re considering. If there are no openings and you really want to live in a particular community, ask about a potential waiting list.

Facility security: What measures does the community take to make sure you’re safe and secure? Examples include in-room monitoring, motion sensors on doors, video surveillance, perimeter access control and on-call electronic bands or pendants.

Accreditation or licensing certificates: Most states require assisted living facilities to be licensed; this means a facility has met state-mandated requirements.

Receiving certification and accreditation is not mandatory; however, if a facility wishes to accept Medicare or Medicaid benefits, it will need a certificate or accreditation. Ideally, a facility has both.

Most state laws require that assisted living facilities keep their license, certification and accreditation visible at all times. This gives residents, regulators and other individuals easy access to this information.

Questions to ask assisted living facilities

Asking questions helps you to better understand the specifics of how a facility will provide the services and care you need to thrive. The following questions are a good start:

What is the staff-to-resident ratio? Employee productivity increases when the staff-to-resident ratio is lower. Residents tend to feel they get better, more personalized care with lower ratios.

Are staff members available 24/7? Support staff is available at most assisted living facilities 24/7 to help with personal care services. Inquire about how many staff are on duty at night and during the day. Facilities often have fewer staff at night, which means residents may have to wait to receive help and assistance.

Is medical personnel available 24/7? Are nurses or doctors available on-site at all hours? If medical personnel isn’t on-site 24/7, who’s there to help in the event of a medical emergency?

What types of living spaces or apartments are available? Living spaces can vary in size and setup. Some assisted living facilities have a college dorm setup with private bedrooms for residents and shared community areas. Other assisted living facilities are more spacious and resemble private homes or apartments.

Is house cleaning included in the overall price? Housekeeping may or may not be included in the base cost for a facility. If it isn’t included, ask how much it costs to add the service.

How many meals are provided each day? Ask how many times a day a facility provides meals. Can you order from a menu, or are residents all served the same meal? It’s also helpful to know what times meals are served and what happens if you miss a meal.

Can food be tailored to meet specific diets and requests? How does the facility handle dietary restrictions and food allergies? Does it require advanced notice for any special requests? Can residents customize their meals based on personal preferences?

Is smoking or drinking allowed? Assisted living facilities can place restrictions on smoking or drinking — contracts should outline any restrictions or rules regarding these activities.

What types of activities are available on-site? Find out what types of activities are offered on-site and how often they’re held. Are activities available all week or only on the weekdays?

Are personal pets allowed? Facilities determine their own pet policies. Some allow personal pets, while others have no-pet policies. These policies typically do not apply to service animals.

Some facilities have a shared community pet. Community pets do not belong to a specific individual — instead, they’re considered pets for all residents.

Do you perform a health assessment upon admission? Health assessments help facilities better understand what care and assistance you need. Are health assessments performed upon admission? What do they check for, and who conducts them?

Is there a contract or agreement in place for these services? Receive a detailed outline that explains what services the facility is agreeing to provide.

What is the billing policy and fee structure? How are you billed? Does the facility bill at the first of the month or on a specific date? Do you pay a set rate each month, or does the cost change depending on the services and care you receive?

Is security on-site 24/7? Is the facility monitored by an on-site security guard, or is security provided remotely through video surveillance? Who do you call if you have a concern about your safety? What measures are being taken to protect residents and their personal property?

Assisted living facility requirements

Every state is responsible for creating rules and regulations for assisted living communities. Even though there are no federal rules and regulations, there are some basic services almost any assisted living facility should provide and rules they should follow:

  • Any and all personal information, including financial information, health information and other identifying information, should be kept safe and secure. A facility can do this by creating a separate locked storage area or with electronic encryption.
  • Residents should be able to provide a list of individuals who are authorized to receive personal information.
  • Most assisted living facilities are required to keep all prescription medication safe and secure in a lockbox.
  • All residents must sign a contract before moving onto the premises.
  • Facilities are subject to random inspections from the state agency responsible for setting rules and regulations.
  • Residents have the right to refuse medication or medical treatment unless it’s court-ordered.

Are assisted living facilities regulated?

Assisted living facilities are regulated at the state level. This means each state determines what rules and regulations an assisted living facility needs to follow in order to operate — it also determines the agency responsible for making sure all rules, laws and regulations are met. For example, assisted living facilities in Ohio are regulated by the Ohio Department of Health, while in Washington these facilities are regulated by a division of the Department of Social and Health Services.

The federal government has specific requirements for facilities that wish to accept Medicaid funding. An assisted living facility that accepts Medicaid must meet these federal requirements as well as any state Medicaid requirements. The government does allow flexibility in how facilities set up Medicaid funding.

Bottom line

There are several factors to consider before choosing an assisted living facility. Not only do you need to think about finances, but you’ll have to consider what personal amenities you want and need in a home, what activities you wish to take part in and what level of care and assistance you require.

By considering exactly what services, amenities and community features you need, you can more easily determine if a specific assisted living facility will be a good fit. If specific services, amenities and features are absolutely essential to your day-to-day care and a place you’re considering doesn’t offer them, you can remove the facility from your list and focus on finding one that offers exactly what you want and need to thrive.

Article sources
ConsumerAffairs writers primarily rely on government data, industry experts and original research from other reputable publications to inform their work. Specific sources for this article include:
  1. Centers for Medicare and Medicaid Services, “Official Home Page.” Accessed April 28, 2021.
  2. Washington State Department of Health and Human Services, “Aging and Long-Term Support Administration.” Accessed April 28, 2021.
  3. Ohio Department of Health, “Residential Care Facilities - Assisted Living.” Accessed April 28, 2021.
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