By 2030, the United States will be home to nearly 60 million baby boomers. A significant percentage of them will need living accommodations that can help with medical oversight, food preparation and social integration. This particular type of care setting is known as Assisted Living.
As an Internal Medicine physician, I have practiced in the assisted living setting for more than 25 years. I have worked with patients and their families during the challenging and often overwhelming transition from their lifelong homes and comfortable lives into a new and unfamiliar place of residence. Although they come from a wide variety of situations and needs, there are a few common threads that flow through all their stories. It’s the unfolding of those stories and eventual decisions that have informed me over the years.
The process of selecting an assisted living facility typically begins within the normal channels: an internet search, a friend’s recommendation, perhaps by simply noticing a facility that is along routine traffic routes. The next step is usually a call, followed by a tour and a sharing of brochures and information, typically related to amenities, associated services and costs. That’s a great place to start. My experiences take up where this initial introduction leaves off. I have learned that there are many questions and considerations that potential residents and their families may want to consider that go a bit deeper and can turn a good fit into a great one.
The Care Team
Two people who are absolutely vital to the residents of an assisted living facility are the executive director and nursing director. It is critical to meet them both. The vast majority of communication and day-to-day operations depend on them. You must get a feel for their ability to communicate and handle problems. Are they present? Are they approachable? Are they responsive? Take the time to find out.
The executive director takes care of the business side of things. A good sign is an open door and easy approachability. Be sure to ask questions about different levels of care and potential changes in cost so there won’t be any surprises down the road. This relationship is important in making sure you are getting what you pay for.
The nursing director is in charge of anything medical that happens in the facility, including interactions with medical care providers. They will serve as a liaison for any home health services, hospice services, changes in condition and anything that can and does happen with the resident’s health. They have to be a good communicator and somewhat of a bulldog to ensure that the residents’ medical needs are being met.
Some additional questions regarding these two important people:
How long have they been in the position? Longevity typically runs with stability.
What is their experience in the assisted living setting? The more the better.
What hours do they keep?
What is their availability for calls and communication?
When they are out of the building, who is next in line for issues that come up?
Also, be sure to ask if there is a physician who does rounds in the building. If so, do most of the residents use their services? What is the relationship to the nursing director like? Are they easy to reach for problems? Do they provide an after-hours call service? How frequently are they in the building?
Food, Fun, Freedom
Food is a major part of the assisted-living experience. You will certainly be given many details about meal times, menus and the dining experience itself, but be sure to dig a bit deeper into flexibility for special diets such as gluten sensitivity, diabetic preferences, religious diets and after-hours food availability. Inquire about meal options. Is there fresh fruit? On-site food prep or outsourced? And most of all, make sure to try the food. Dietary intake plays a deceptively important role in the success of a resident’s stay. Make sure you know what is offered.
Activities are often the lifeblood of a facility. Vibrant, active communities are a source of routine and motivation for aging residents, so meet the activity director. Pay close attention to the calendar of activities. Are there religious services? Do they go off-site for shopping and outings? How often? What is the attendance on activities in the building? Are beauty services available? A resident’s day should be filled with meaningful, well-planned activities to enrich and enliven their time.
Lastly, check out the grounds and surrounding area. What is the physical space like? Is there room to roam? Areas for privacy other than their primary room? Are there designated spaces to walk and exercise? Are there places outside for residents to enjoy a nice day or time with visitors? Make sure there are many options for getting out of their room on a daily basis.
Support Staff
These are the people who make the building run. The category includes the medical aides and assistants, kitchen crew, janitorial team and maintenance staff. Take time to ask about hours of medication administration, room cleaning services and frequency, assistance with in-room help with cable or TV problems, availability for issues with plumbing or AC, etc. Be sure to inquire about how much of the staff is full-time and how often they rely on outside agency staff.
Watch and Learn
Everybody puts their best foot forward for prospective patient visits. Tours and information gathering are certainly important; however, you want to make sure real life matches up with your expectations. Take the time to find a spot to watch, listen and observe. What is the interaction like with the residents? Do the staff members know them by name? Is the interaction hurried or is there evidence of a deeper relationship? Pay attention to the sights and sounds and smells of this potential new home. Usually, half an hour will give you more than enough information to inform your decision.
Every assisted living residence is unique. Each comes with its own strengths and weaknesses. This is a huge decision and will directly affect the quality of life and happiness of you or your loved one for what most likely will be the final phase of their life. Feelings of confusion and intimidation are completely normal. Just remember, the facility is there to care for and enhance the lives of its residents. Your job is to be bold and direct in your information gathering and questions. Getting to know the whole story will make the difference between a good fit and a great one.
This article appears in Thunder Season Preview.