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Questions to Ask Before Choosing an Assisted Living Facility

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Are you considering assisted living for yourself or a loved one? If so, then it’s essential that you and your family do some careful homework, because making the right assisted living choice is a crucial decision.

In recent months we’ve seen several articles voicing concern about the state of the assisted living industry. Some months back, we featured a report here on the Blog describing how assisted living facilities are feeling the strain, as residents with increasingly serious health problems, including dementia, place a burden on staff and facilities. The combination of rising costs and limited availability of staff is making the task of selecting the right assisted living facility an ever-increasing challenge.

With that as a backdrop, we’re bringing to your attention this late-2023 article from the Washington Post in which two reporters, Yeganeh Torbati and Julie Zauzmer Weil, provide some suggestions on how families can best choose the right facility for a loved one. Torbati and Weil have been part of a reporting team that has recently produced some chilling articles exposing deep flaws in the senior care system, including this December expose about resident deaths caused by improper care. The point is not to be alarmist – rather, these articles are intended to make certain that families take this important decision seriously.

Assisted Living: The Choice Can Be Overwhelming

Torbati and Weil begin by recognizing the high stakes of choosing a facility for a loved one, especially when it can be difficult to find reliable practice and safety information, and even more especially when your loved one has memory problems or dementia.

“Residents with memory problems wander away from assisted-living facilities unnoticedjust about every day in America, according to an investigation by The Washington Post. Since 2018, nearly100 have died,” they write. “These incidents occurred even at some facilities that charged families more for extra vigilance.”

To help avoid such a tragic outcome, the Washington Post has compiled the following short guide to help you find the best home for yourself or a loved one, based on recommendations and interviews with experts and former facility staff.

Choosing Assisted Living: Start with Trusted Recommendations

According to Torbati and Weil, one of the unique difficulties of choosing an assisted-living facility is that there is no government website that reviews their quality, the way there is with nursing homes. “Experts say to ask for recommendations from people you trust, such as doctors, friends, relatives and members of support groups for the elderly or people with memory loss,” they write.

One way that you can look into a particular facility is through inspection reports online, if your state makes them available. “The sites are not always easy to navigate,” Torbati and Weil warn, “but the reports often provide details about consumer complaints and other problems at a facility, including whether residents have wandered away, experienced repeated falls or found unsanitary conditions.”

What if your state doesn’t post this information? Another option is to ask facility managers directly to provide their latest inspection reports. This request can do double-duty for you, since the manager’s response can be very revealing in itself, especially if they refuse.

The article adds, “You can also contact your state’s long-term care ombudsman, who can sometimes share complaints about facilities.”

Online Assisted Living Referral Sites May Not Be Objective

While online referral websites might seem like an obvious resource, Torbati and Weil urge caution with them. “These websites often earn fees for referring you to the facility,” they write. “Online reviews can also be skewed negative or positive, and they may not offer accurate information about the quality of a facility.”

Instead, you really can’t beat a firsthand look at a facility, especially unannounced and at a busy time of day, which the article notes is usually in the morning or at mealtimes: “Feel free to visit repeatedly, including on weekends, and ask for a tour.”

Choosing Assisted Living: What to Look For

When you’re visiting a facility, observe the following:

Staff: Look closely – how are they interacting with the residents? Torbati and Weil pose these helpful things to watch for: “Do they seem frustrated or shorthanded? Do they speak to residents by name and interact with them as individuals? Ask if they feel burned out or understaffed, and whether they feel able to raise concerns about safety.”

If you can, it can be very beneficial to speak directly with the facility administrator. According to one former administrator, “it’s a good sign if the administrator knows most of the residents by name. Ultimately, this person isresponsible for what happens at the facility.”

Along with this, ask the facility administration if they can arrange for you to meet family members of current residents. “If the facility refuses, that may be a sign that you should keep looking,” the article states.

Residents: Torbati and Weil write, “Observe their activity level. Are they busy or left on their own? Do they seem happy? Ask if they feel safe and cared for. If relatives are visiting, ask about their experiences with the facility.”

Facility: “Are public areas and residents’ rooms clean?” Torbati and Weil ask. “Is there a secure outdoor area where residents can get fresh air without leaving the facility? Can staff easily keep an eye on residents while they’re outside?”

You should spend as much time as you need to, gathering information about a particular facility, and one way that the article suggests that you do this is by arranging a short-term stay, for a few days or weeks. “This can be costly, but it may be worth a try to see how you or your loved one enjoy living there day-to-day.”

Choosing Assisted Living: What About Memory Care?

Torbati and Weil provide the following list of very insightful questions that you should pose to a potential facility, regarding the safety and monitoring of a relative with dementia or memory issues. We think this is a great list, so we’ve included it verbatim from their article:

*What kind of cognitive assessment does the facility do on admission? Can family members be involved in making a care plan? They should be, according to experts.

*Are there door alarms? If so, how are staff required to respond? Are they required to look outside if an alarm is triggered on an exit door? Try to get a sense of whether the facility takes door alarms seriously or views them as an annoyance.

*What is the typical ratio of staff to residents? How many aides are awake at night, and how often do they check on residents? The Post’s investigation found that many residents who walked away unnoticed from a facility do so at night.

*Do all staffers get at least six hours of training to care for people with dementia? Is there any kind of test? How often are staff expected to train?

*Give examples of difficult behavior you may have observed in your family member and ask how the staff would handle them.

*What changes in health status would require you or your relative to move out of the facility or trigger an increase in your monthly fees?

What If Your Loved One is Already an Assisted Living Resident?

Keeping an eye on a facility’s suitability doesn’t end when you sign the papers and move in. Torbati and Weil suggest that even after a loved one becomes a resident, you should keep your eyes peeled to make sure that they are receiving the highest level of care.

“Visit often, at different times of the day and week,” they write. “Keep aware of your relative’s physical condition. If you see drastic changes in weight or overall health, ask the staff what’s going on. Get to know the staff. Bring them treats, and learn about their lives.”

And if a problem does arise, or you suspect neglect or abuse, you can file a complaint with your state ombudsman or other regulatory authorities. Torbati and Weil explain—and conclude— with the important reminder that speaking up can do more than just help your loved one: “a complaint can trigger an investigation by state authorities, which could reveal violations and result in a fine or corrective action. At the very least, it helps to establish a record, which can help inform other families looking for a facility.”

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