Assisted Living and Nursing Home Options: Questions to Ask
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:
- 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?
- 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?
- 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?
- 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.
- 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!