Checklist for Choosing an Assisted Living Facility
- Independence and Risk
- Meals and Nutrition
- Service and Responsibilities
- Staff and Training
- Wellness and Healthcare
Choosing an assisted living facility for yourself or for a loved one can be challenging and confusing. Assisted living has evolved over the past decade to include a wide variety of home-like settings and services. In some facilities, services are limited to meal preparation, housekeeping, medication reminders, and minimal assistance. In others, more intensive services, including medication administration, on-site nurses, and regular assistance with daily activities such as bathing and dressing, are available for frail or confused older adults. The services of most facilities are somewhere in-between. The resident's ability to make choices, take risks, and be independent must be considered. The philosophy of independent living is based on "dignity of risk," or the right of the resident to make choices about his or her health and safety even when those choices may be deemed risky by others. The interpretation of this philosophy and the choices available vary among facilities.
Individual Needs, Individual Choices
The first step in making a good choice of a facility is conducting an accurate and honest assessment of the person's physical, financial and lifestyle needs.
The next step is narrowing down the choices. Start by making unannounced visits to facilities. Talk with residents. What do they like or dislike about the facility? Talk with staff. Are they friendly and knowledgeable? Find out what the basic costs are. Then rank your choices.
The Consumer Consortium on Assisted Living (CCAL) developed the following questions to help to evaluate facilities and make the best choice for you or your loved one. You may have other questions, too, but these are questions you should certainly ask and have answered before you make a decision.
What is the monthly fee? What is not included?
Can the fee change? When, how often, why? How are you involved and what notice is given?
Does the contract clearly describe the responsibilities of the home and the resident?
Can you make changes in the contract?
Are extra charges clear and reasonable?
What is the grievance procedure? How is a complaint filed and to whom does it go? What if you are not satisfied with the decision? What outside agency will help?
What kind of assessment is done to determine your needs? What are the qualifications of the person conducting the assessment?
What happens if your needs change? What if you need more help, become incontinent, become cognitively impaired, go to the hospital?
Are there limits to the amount of care you can receive?
What are reasons for discharge? Who makes the decision? What notice is given?
How does the facility assist you if you need to be discharged?
What happens if your funds run out? Is there any financial assistance? What agencies can help?
- What if you want an exception to a policy, e.g., skipping breakfast, signing in and out?
- What if you refuse meals or don't want to adhere to a special diet?
- What if you are confused and refuse meals or medication, or want to wander the neighborhood?
- What if you don't like the staff person assigned to you, or the people at your table?
- What input do you have in activity and meal planning?
Is there a set schedule for help with such needs as bathing and dressing? Can this be changed?
How are staff scheduled to meet emergency or unplanned needs like incontinence, unexpected outings, or unanticipated problems?
Who notifies the responsible party in emergencies, when toiletries need replacement, when a status change is noted?
What is your responsibility in an emergency, or when your condition changes?
What is the housekeeping schedule and who has the responsibility for your room?
What happens if there is a spill or accident that destroys property, yours or the home's? Who is responsible for cleaning/repairing, payment or replacement?
How many staff are there for each shift or time of day? What are their responsibilities?
Who gives the direct care? What training/certification do they have? What are the trainer's qualifications?
How many residents are assigned to each direct care staff person? What other duties do they have during these hours?
Is there any special training for staff to learn about dementia and Alzheimer's disease?
Are staff trained to deal with aggressive individuals, or in behavior modification?
What kind of emergencies are staff expected to handle and how they are trained for them
Wellness and Health Care
- Is there a nurse? What are the nurse's responsibilities and hours? Who is responsible when the nurse is not on duty?
- Are there regularly scheduled visits by a nurse or other health care provider? Where are the records kept? Are they confidential?
- Is there a plan of care? How and with whom is it developed and revised? How are you involved? What involvement does a confused resident have?
- What if you don't agree with your plan of care?
- What health services are available in the home: lab work, physical therapy, wound care, hospice, social work, podiatrist, etc.? What does the home provide, and what can outside agencies provide?
Who gives medications? If not a nurse, how are staff trained and supervised? Who reviews medication procedures and how frequently? What are their qualifications?
- How and by whom is the medication system managed?
- What kinds of activities are provided?
- Who develops and supervises the activities? What is the person's background?
- Are there activities outside the home? How often? How are residents transported? What staff are included?
- Can you walk on the grounds? Are their accessible pathways? Are there protected/enclosed walking areas for demented residents?
- Can religious/spiritual needs be met? Are there services in the home, or transportation to them?
Meals and Nutrition
- What times are meals served?
- What happens if you are late, miss a meal, or refuse a meal?
- Can special diets, such as those with specific salt, calorie or protein levels, be accommodated? If yes, who develops these? Does he/she have specific training for this?
- Does a nutritionist or dietitian review meals and special diets? If yes, how often?
- What kind of security system is in place for the building and personal property?
- Which doors are locked and when? When doors are locked, how does one access the home? Are exit doors alarmed?
- Are there safety locks on the windows? If yes, what type?
- Is there an emergency generator, or alternative power source?
- Is there a fire emergency plan? Are there fire drills? Are emergency plans publicly displayed?
- Are there call bells in each room? How often are they checked to be sure they are working correctly?
- Is the home layout conducive to wandering? What safety measures are in place?
What transportation is provided by the home? How can special appointments be scheduled and what is the cost?
Is the transportation wheelchair accessible?
What qualifications does the driver have? How are these verified?