Assisted Living and Nursing Home Options: Questions to Ask – Days 27/28 of Family Caregiver Series

 Assisted Living and Nursing Home Options: Questions to Ask

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I was initially going to separate out details for assisted living and nursing home options. For the most part, the questions to ask when considering an assisted living or nursing home facility are the same. There certainly are some differences but overall, the list is consistent. Here is a list of the top questions to ask when evaluating an assisted living facility or nursing home:

 

Administration

  •   Is the facility in good standing with state inspectors?
  •  Does the facility meet local and state licensing requirements?
  • Is there a written care plan for each resident? When is it written? Is the resident and family involved in writing the plan?
  • What’s involved the needs assessment and contract? How about the detailed list of costs?
  •  Are fees competitive?
  • What services are included under all quoted fees?
  • What services are extra and how are they billed?
  •  Is Medicaid and Medicare accepted? What are the medical and payment limits? Are doctors and specialists covered in network if they are seeing patients in an in network facility or are doctor bills considered out of network if they are part of a hospitalist group coordinating care? Do you have multiple insurance policies? Who is primary vs secondary?

Insurance_TandyElisala

  • Are billing procedures acceptable. NOTE: I discourage having facilities manage your loved ones funds directly. There are no regulations governing this oversight. Facilities must be bonded up to a certain amount when managing residents’ trust accounts but most facilities have a small staff dedicated to all financial related activities. Be sure to get a monthly statement clearly showing all activity.
  • What are visiting hours? May relatives stay overnight?
  • Is there free, accessible and reliable internet? Are meals available for family members and what  is the cost? Is there a family meal order deadline each day?
  • Is administration accessible 24/7 if needed? What is security protocol?
  • What are top level administrator requirements and experience? Background checks required? If so, what kind and how often?
  • Are community organizations  involved? If so, how are they vetted to ensure resident safety?
  • Is transportation of residents provided to and from doctors, shopping, etc… ? If so, what is the process and cost involved?
  •  Are social work or mental health services available? If so, is this included in fees or extra?
  • What is the grievance process should a resident or family of a resident disagree with how something was handled with their loved one?
  • Are physical, speech and occupational therapy available? On site  or off site?
  • What is the policy on insurance and personal property?
  • Is there housekeeping provided? If so, how often?
  • If more intense care is needed for assisted living facility residents/patients, how is nursing care coordinated and billed/paid for during this time?

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  • Are there organized activities and is this schedule posted where residents and families can see what’s going on?
  • Are activities varied and appropriate? Are they interesting? How’s attendance and participation?
  • Are religious services held weekly? What kind of services?

 

Medication and Overall Health Care

  • May residents administer their own medications? What is the facility policy regarding the storage of medications, training of staff and record keeping of all medications given and when? Is this log available to families upon request?
  • Who coordinates home care visits from nurses, therapists, etc… as needed?
  • Who coordinates visits from doctors, as needed?
  • Are staff available to help residents experiencing memory or orientation losses? At what point does administration and family meet to discuss care need changes if such issues worsen beyond the facility’s capabilities (for assisted living)?
  • Does a nurse or doctor (typically a nurse) visit the resident regularly to provide medical checkups?
  • What procedures are in place for responding to medical emergencies? Is there a medical alert button in each room?
  • Are staff available to assist with activities of daily living (ADL) including:  dressing, hygiene/grooming, bathing, incontinence, laundry, mobility, eating, walking, using the phone,  etc…
  • Can a resident be evicted? If so, under what circumstances? How much notice is given? What will administration do to prevent this from happening, to the extent appropriate?
  • Is the care team available to meet  with the resident/patient and their family to discuss their care?

 

Staff

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  • What are staff to resident ratios? Does this ever change and when?
  • What experience and skills are required of all staff? Background  checks required? How often?
  • What is the average tenure of the staff; especially the nursing staff? What’s the turnover rate?
  • What times of day do shift changes occur?
  • Who is part of the resident/patient care team?
  • Can you talk to staff about their experience working there? Get a feel for how they like it, why they chose this field and what keeps them working at this facility?

Extra tip: If possible, talk to the other residents and family members about their experience.

 

Food

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  • Does the facility provide three balanced meals daily?
  • Are snacks available? May residents bring their own snacks/food?
  • Are special dietary requests accommodated?
  • Are there set times for meals or may residents dine on their time?
  • May residents eat in the common dining area or in their rooms as they see fit?
  • Is the food hot and tasty?  Is water and/or other beverages available for residents at all times?

Extra tip: Hang out in the cafeteria for two reasons. First, you’ll get a feel for the taste of the food and you’ll see first hand how residents like the food and how comfortable they feel at the facility. You’ll also get a sense of  how engaged the staff are. Are they happy? What are they talking about? Do they interact with residents/patients?

Having answers to these questions means you are well on your way to managing your loved one’s care with world-class support. Ensure these questions are addressed before making a decision about where to place a loved one. A high quality facility will welcome your visit and questions.

Next up: Rehabilitation considerations: Acute vs. Sub Acute

It’s your turn: Which of these tips (or sections) will you find most helpful when you are placing a loved one in an assisted living or nursing home facility? Is there anything you would add? Please comment below!

 

 

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Tandy Elisala

Family Caregiver Coach, Cancer Empowerment Advocate and Chief Inspiration Officer at Center for Inspiring Greatness | Empowered Family Caregiver
Tandy Elisala is passionate about helping family caregivers go from being overwhelmed and stressed to empowered and calm. Tandy went through cancer four times and learned how to heal using conventional, complementary, and alternative therapy. Tandy left her corporate career to take care of both parents simultaneously while raising three kids as a single mom. She took care of both parents for 2 1/2 years until their respective deaths. Tandy now teaches what she learned on her journey. Tandy is a family caregiver coach, a multiple best-selling author, inspirational speaker and mom to three adult kids, one angel dog and one diva cat.

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22 replies
  1. Jennifer Thompson
    Jennifer Thompson says:

    Hi
    Great post you have shared, and seriously, it is too informative and it helps me a lot, because now days I am searching for a care home for my parents because, I am not living with my parents and I want some one who take care them like home care. And these factors about care homes will surly helping me for find perfect home care.

    Thanks for the sharing this useful post. I am sure that it will be helping others like me.

    Warm Regards
    Jennifer Thompson.

    Reply
  2. Coreyschlifer
    Coreyschlifer says:

    Hey Tandy Elisala,

    Great Share !!

    Its been great to read such blog.I really appreciate it.One of the most common questions families ask A Place for Mom is “how do we know when it’s time to move from assisted living to a nursing home?” We received the following question from Margaret:My 88-year-old mother has been in an assisted living community near me for the past two years. She has been declining slightly, almost imperceptibly, over the years. Recently she had a fall in her room and couldn’t get up or reach the call cord. When a staff person noticed she had missed dinner, mom was found after three hours on the floor, but with no problems other than general weakness.

    Keep posting !!
    have a great day

    Reply
  3. Thewillows
    Thewillows says:

    Hey!!
    Yes, it is very important for us to choose an assisted living community or nursing home for our old age years.We should investigate properly before going to choose any assisted community.The medical facility,yoga and exercise etc are available there or not these are the questions we should ask them.Thank you for sharing great information.

    Reply
  4. Donny E. Barker
    Donny E. Barker says:

    Hey Tandy,
    Great Post !
    The post is really very informative and the questions that you have mentioned in the article are must to ask when someone wishes to choose a life with assisted living care options.Every one who wishes to opt for these facilities should ponder on the points mentioned in the articles.
    It was worth reading.
    Thanks for sharing such a valuable post and Keep posting 🙂

    Reply
  5. Elden Gatley
    Elden Gatley says:

    I agree that you should find out the ratio between staff and residents. I feel like there needs to be a lot of staff at a place like nursing homes. I say so because many of the residents need very individualized care.

    Reply
  6. Johnny Shi
    Johnny Shi says:

    I really appreciate what you had to say about them providing a well balanced diet. Our diet has such a huge impact on our health and if they didn’t have balanced meals then I would be worried about my loved ones health. I love the idea of hanging out in the cafeteria, it would be a great way to see the food first hand. Thanks for sharing.

    Reply
  7. mikeanderson
    mikeanderson says:

    Look sounds like a wonderful and informative article for who are choosing a best assisted living center to their senior. It should be necessary to ask these all question when we go for assisted living centers..

    Thanks to share and it really a too much informative post.

    Reply

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  1. […] Towards the end, we covered transition of care, the who, what, when, and hows of assisted living, nursing home and rehabilitation. This was quite a bit of ground we […]

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