Choosing assisted living: What families need to know

(Aging Untold) — Finding the right assisted-living community for a loved one is one of the most important decisions a family can make.

Many communities offer caring staff, active social programs and added safety that help residents thrive. But sometimes people might feel the journey can include misleading promises and hidden costs.

Understanding the difference between assisted living and nursing homes

Aging expert Amy O’Rourke said families often confuse assisted living with nursing homes.

“There’s a clear difference between the two and how you need to look at it as how dependent your person is on hands-on care,” O’Rourke said.

Nursing homes provide hospital-like care with two-bed rooms and medical equipment.

Assisted living offers different options, from small residential homes to apartment-style communities. Some provide medical care, while others specialize in memory care.

“And so, you look at your person and you say, ‘What’s the primary need?’” O’Rourke said.

“You want to be really, really careful that you’re looking at what the needs are and then where you’re going to move your loved one in,” O’Rourke added.

Types of assisted living options

Assisted living communities vary in size and services.

Smaller homes, sometimes called residential care facilities for the elderly (RCFEs) or board-and-care homes depending on the state, typically have six beds and are located in residential areas, Sam Cradduck, a gerontologist, said. Sometimes they are a little larger.

“Those are really good for our introverts or just people that like a little calmer, more intimate family feel. They’re also typically more affordable,” Cradduck said.

What to watch for during tours

Cradduck said that tours are designed to look appealing, but families need to look deeper.

“It’s like buying a house and then finding out the foundation is not good,” she said.

Cradduck recommended talking to residents about the food, which is the number one reason loved ones are usually unhappy.

Families should also check for bad smells, which could indicate problems with incontinence care and housekeeping, Cradduck said. Other warning signs include overflowing trash cans, residents sitting alone facing blank walls and disengaged staff.

“If the employees aren’t happy, your family member is not going to be happy there,” Cradduck said.

Look beyond appearances

The Aging Untold experts said aesthetics can be deceiving.

Some communities may look too fancy and unnerve potential residents, while others may not look impressive but provide excellent care and social activities, Katherine Ambrose, an aging-well coach, said.

“Really look beyond the aesthetics,” Ambrose said.

Questions about medical care and staffing

Dr. Rhea Rogers, a board-certified physician, emphasized the importance of understanding who administers medication and how mistakes are handled. Families should ask about staff-to-patient ratios, and which staff members are included in those numbers.

Families should also ask which physicians or providers visit the community and how dietary needs for conditions like diabetes or kidney disease are managed, Rogers said.

Practical considerations

O’Rourke suggested asking practical questions about daily life. Can the resident walk to the dining room, or is the apartment too far? Will staff bring breakfast to the room? How flexible are mealtimes?

Hidden costs to ask about

“Do they eat on a routine? Is that three meals that are considered, if they have other snacks, some hidden costs? What are the hidden costs?” Rogers said.

Many communities charge by levels of care and families need to understand the full fee structure, O’Rourke said.

“You have to ask, ‘How much are those levels, and what do they include and how often do they assess the person? And can you go down a level? Maybe you got better?’” O’Rourke said.

Families should request information on community fees on top of rent, Cradduck added.

Ambrose and Cradduck said some residents may need additional private care even at the highest level of community care, creating unexpected costs.

“So now you’re paying to be in a community with care, you’re paying for the highest level of care, but you’re having to hire a private agency to come in and do those things,” Cradduck said.

Assisted living tour checklist

• Ask about the food
• Observe smells and odors
• Housekeeping and cleanliness
• Staff and resident interaction
• Medication disbursement
• Food services and dining schedule
• Find out the full fee schedule