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Ask the Experts: Questions and Answers on Assisted LivingBy: John Briley For many seniors, life holds few decisions as
weighty as whether or when to trade some independence and familiar habits
for the greater security of supervised group living. The decision can
affect everything from how much control you retain over the last years of
your life to how much, if any, savings you can conserve to pass on the
next generation. Assisted living facilities
(sometimes called sheltered or residential care communities) head the list
of senior housing options for those who no longer want or are able to live
independently but who don't need full-time medical care. In return for a
monthly fee – and, sometimes, a hefty down payment – these loosely
regulated facilities offer housing (with options ranging from shared rooms
to full-sized private apartments), communal meals, transportation,
apartment maintenance, basic care, housekeeping and linen service, and
social and recreational programs. The typical resident stays about two
years before transferring to a nursing home, moving in with family members
or dying, according to the "Consumer Reports Complete Guide to Health
Services for Seniors." Choosing an assisted
living residence, however, is about as simple as reading international tax
law. But even more is at stake, from physical comfort to financial
security, from the freedom to maintain personal habits to access to
friends and family. Government and nonprofit sources are full of advice
for how to approach the decision, complete with checklists. But we wanted
to dig a bit deeper. So we turned to the experts – the authors of six
popular books on the subject. We dug through them to find answers to some
of the stickier questions, and arranged the excerpts below. Our questions are designed
to complement the more comprehensive guides you'll find elsewhere The
books we've chosen to consult, recommended to us by elder care
professionals, represent a slice of the available literature. In some
volumes, assisted living is lumped under the broader topic of long-term
care, and matters related to assisted living appear in a single chapter.
Other books are devoted entirely to assisted living. We tried to surface
answers that represent a range of opinions – but, truth be told, we did
not encounter much radical thought in the field. Wherever possible, we let the authors speak for themselves – quotation marks surround short excerpts from the books cited at the end of each paragraph. Material not enclosed in quotes is paraphrased. Full titles and publication information appear in the box above. Pretty brochures, polished
salespeople, well-choreographed facility tours – this is all pretty
slick. Can I trust these sales pitches? Assisted living marketing
is often designed to create an image rather than convey facts about the
services provided. And it's often directed more at the adult children of
prospective residents than at the clients themselves. Much of assisted
living "is sold as real estate rather than as appropriate care.
Hardly any of the facility tour guides I encountered were interested in
why my mother needed care." Beware of salespeople or tour guides who
focus on price or emphasize how quickly you can move in.
"High-pressure tactics are always a sign to continue shopping."
Chatting with people who live in a facility, not listening to sales
pitches, is the best way to gather intelligence. – Consumer Reports
Complete Guide to Health Service for Seniors Dig for detailed answers
to a list of questions you decide you want answered. Before you visit,
establish standard questions about all issues you consider crucial, from
policies on pets and furniture to personalized health care, emergency call
system, eviction policies, and precisely what services are provided –
and at what cost – by the facility. – The Unofficial Guide to
Eldercare So what should I look for during a tour? "Expect staff members
to know the residents by their names." – When Aging Parents
Can't Live Alone Warnings include an
arts-and-crafts room that seems unused and few people in the common areas
and activities. (This may signal a half-full and financially unstable
facility.) Look for genuinely warm relationships between staff and
residents. Request a copy of the contract and house rules; consider
reluctance to part with such crucial information "a red flag." –
Consumer Reports Complete Guide to Health Service for Seniors Ask to see rooms that are
not part of the regular tour. "For example, most facilities will
happily show off their dining area but not volunteer to let you go
backstage to the kitchen. Many have model rooms or apartments . . . ask if
you can see one that's currently occupied." – The Unofficial
Guide to Eldercare Consider your needs six months from now. "For example, [you] now walk with a cane but may need a wheelchair next year (even if only for part of the day). Are there access ramps? Ask about kitchen modifications, an emergency pull cord, accessible shelving units. Who pays if these modifications are needed?" – How to Care for Your Parents Consider the mix of
residents. Are they at a comparable level of functioning? Are they active
and interesting? Do they share your interests? If a facility has shared
rooms, how are roommates matched, and what happens if you don't like your
roommate? – How to Care for Aging Parents For residents with
Alzheimer's disease or other forms of dementia, the nature of the
relationship between staff and patients is particularly critical. Most
personnel will tell you they are experienced, but "[y]ou want staff
trained to provide special attention to residents . . . not merely to
shuttle them from one place or activity to another." – Beat the
Nursing Home Trap I am only 64 years old but some parts of assisted living appeal to me. Am I too young for this sort of life? The average assisted
living resident is early to mid-eighties, female, divorced or widowed and
suffering from a mildly disabling disorder but still capable of performing
many tasks of daily living. Assisted living may be the answer for elders
who are relatively self-sufficient but are having trouble keeping up their
own homes and want the reassurance of some on-call services. – The
Unofficial Guide to Eldercare Age matters less than your
capacity to manage alone without placing yourself at risk of harm. Causes
for concern might include a loss of balance that makes you prone to
falling, memory loss that raises the chances of disorientation, and
wandering. – When Aging Parents Can't Live Alone Elder care should be
weighed seriously when the problems are recognizable as a condition that
will cause continued limitations, not a medical emergency. "The
crisis will pass – emergencies always do – but the problem will not go
away." – How to Care for Your Parents Entrance standards may
include a minimum age (55 to 60 is typical), and some facilities with few
vacancies may suggest that a relatively healthy person remain at home
instead, paying for help as needed. – Beat the Nursing Home Trap What reliable government resources provide objective information about assisted living facilities? Every state has an
ombudsman who monitors long-term care facilities (though in some states,
this means just nursing homes, not assisted living facilities) and
generally can offer solid insight. – When Aging Parents Can't Live
Alone Many ombudsmen are under
pressure from the elder care industry, so the quality of their assistance
varies. Ask the ombudsman if any facilities have ever denied them access;
avoid places that have. Also, call the agency that licenses assisted
living facilities in your state (see resource list below) and get a copy
of the regulations. Only half of states require employees be trained to
prevent infections; 15 states require a staff knowledgeable about
cardiopulmonary resuscitation; and only 10 require staff to complete an
approved course in providing care for residents. [Maryland and Virginia
require at least one person on duty to be trained in CPR. Virginia also
requires someone trained in first aid. D.C. is considering but hasn't
enacted a similar first aid/CPR regulation.] The bottom line: It's largely
up to you to judge a facility, so question persistently and demand full
answers. – Consumer Reports Complete Guide to Health Service for
Seniors Government attention to this area is widely scattered and disconnected. Check for complaints against a facility with the Department of Consumer Affairs or the Better Business Bureau. (See resource list below.) – How to Care for Aging Parents States that do require certification or licensing lack sufficient investigative personnel on staff to ensure that state regulations are followed. – The Unofficial Guide to Eldercare I am very particular about what I eat. How can I be sure that a facility will provide consistently good food? Try it out. Some
facilities don't offer special diets. Learn if credit is given for meals
not eaten or if tray service [meal delivery to your room] is provided.
Some facilities charge extra for that. – Consumer Reports Complete
Guide to Health Service for Seniors Eat several meals there and observe whether the residents seem interested in their food. Also learn the total meal policy and what happens if you regularly skip meals. Will you be asked to prove that you're getting enough nutrition? – Beat the Nursing Home Trap Under what circumstances
can they run me out? When a resident is in the hospital, many facilities send a representative to talk with hospital staff about her post-release care needs. The facility "may refuse to take her back until she has reached a lower level of care." – When Aging Parents Can't Live Alone Many facilities "do not admit or keep residents who need ventilators, catheters, or have continence problems they can't manage. About 40 percent of all residents eventually go to a nursing home because the assisted living facility cannot accommodate their increasing frailty." Contracts should allow for at least 30 days' notice if the facility wants to end the agreement. – Consumer Reports Complete Guide to Health Service for Seniors All facilities have eviction policies, but many are more flexible with established residents than with prospective ones – for example, by allowing them to contract privately for additional health care so they can remain. – Beat the Nursing Home Trap I don't like being told how to live, but I need some help. To what extent can I retain my autonomy in an assisted living environment? Many facilities embrace a
concept they call "dignity at risk," in which "residents
can make their own decisions about their care and safety, and even choose
certain courses of action that others consider risky" – diabetics'
eating ice cream, for example. Residents may have to sign a contract
detailing how much risk they are willing to assume and how much risk the
facility will take. "Closely question facility personnel about
independence versus oversight. For example, what is the policy on nightly
bed checks? . . . People who have been loners all their lives are unlikely
to enjoy the communal nature of assisted living. Assuming they can get
along by themselves at night, those people might be better off in adult
day care or home care." – Consumer Reports Complete Guide to
Health Service for Seniors Residents in assisted living facilities "usually maintain a relatively high degree of independence and privacy. They generally have their own phones, many have at least minimal private cooking facilities, and are usually free to entertain guests and visitors just as they would in a private apartment situation." – The Unofficial Guide to Eldercare Free Publications Several free publications offer basic guidance in evaluating assisted living residences. Here's a sampling: • Assisted Living: Weighing the Options (D17051) and Navigating Your Way to a Quality Assisted Living Facility (D17037). Available from AARP at 800-424-3410, on the Web or by mailing a request to AARP Fulfillment Department, EEO1506, 601 E Street NW, Washington, DC 20049. The first is an introduction to the concept; the second offers tips for visits and understanding the contracts. • The American Association of Homes and Services for the Aging, comprised of 5,600 not-for-profit facilities, has helpful Web-based resources, including how to choose an assisted living facility, frequently asked questions and contact information for state associations. • "Assisted Living Guide and Checklist," an industry group brochure listing facilities in each state and containing a consumer checklist for evaluating them. A rosy overview but with some good questions to consider. Available from Assisted Living Federation of America, 11200 Waples Mill Rd., Fairfax, VA 22030 (include a self-addressed, stamped envelope); 703-691-8100, extension 204; or online. • "The Guide to Retirement Living," published three times a year by a subsidiary of The Washington Post, provides comparative cost and service charts for senior housing options in the Washington, Baltimore and Philadelphia areas. Succinct comparison by some basic measures, together with locator maps and contacts for senior agencies. Available by calling 800-394-9990 or on the Web. • "Checklist of Questions to Ask When Choosing An Assisted Living Facility," available on the Web site of the Consumer Consortium on Assisted Living, an Arlington-based nonprofit advocacy organization. Telephone 703-533-8121. Thorough list of about 100 questions organized by topic (cost, personal care, meals, etc.). Local Government Resources Maryland and Virginia both license and inspect assisted living facilities, and ombudsmen – citizen advocates who receive complaints and comments from the public – in both states also cover assisted living. In D.C., a law passed in
February 2000 authorizing the licensing and inspection of assisted living
facilities has not yet been implemented. A task force is developing
recommendations. The long-term care ombudsman for D.C. covers assisted
living facilities. The District Office on Aging: 441 Fourth Street NW, Suite 900, Washington, DC 20001; 202-724-5622. Long-term Care Ombudsman: 601 E Street NW, Fourth Floor, Building A, Washington, DC 20049; 202-434-2140. D.C. Department of Consumer and Regulatory Affairs: 941 North Capitol Street NE, Washington, DC 20002; 202-442-4400; Web site. Better Business Bureau of Metro Washington D.C., 1411 K St. NW, 10th Floor, Washington, DC 20005-3404; 202-393-8000; Web site. Maryland Office on Aging: State Office Building, Room 1007, 301 West Preston Street, Baltimore, MD 21201; 410-767-1102. Long-term Care Ombudsman: State Office Building, Room 1007, 301 West Preston Street, Baltimore, MD 21201; 410-767-1100. Maryland Office of Consumer Protection: 200 St. Paul Place, 16th Floor, Baltimore, MD 21202; 410-576-6550; Web site. Better Business Bureau of Greater Maryland, 2100 Huntingdon Ave., Baltimore, MD 21211-3215; 410-347-3990; Web site. Virginia Department for the Aging: 700 East Franklin Street, 10th Floor, Richmond, VA 23219: 804-662-9333. Long-term Care Ombudsman: 530 E. Main Street, Suite 428, Richmond, VA 23219: 804-552-3402 or 804-644-2804. Virginia Department of Agriculture and Consumer Services: 1100 Bank Street, Richmond, VA 23219; 804-786-2373; Web site. Better Business Bureau of Metro Washington D.C.: 1411 K St. NW, 10th Floor, Washington, DC 20005-3404; 202-393-8000; Web site. |
