10 Things You Need To Consider When Choosing an Assisted Living Facility or Adult Care Home

There are many reasons why families make the decision to move a loved one into an assisted living facility.  Medication, treatment, food, safety, accessibility to nursing assistance, hygiene, mobility, and care partner burnout are just a few reasons that it’s time to make a change.

Beware! Not all assisted living facilities are created equally! We believe it’s important to be on the side of caution when evaluating an assisted living, memory care, or adult care facility. Use this list to make sure you select a supportive environment for your loved one.

Checklist for choosing an assisted living facility

1. The owners
2. The grades
3. The bookkeeping
4. The training
5. The meals
6. The ambiance
7. The living spaces
8. The price
9. The in-house healthcare
10. The location

1. The owner/s.

Assisted living facility ownership is a business. Business owners of adult care facilities come in many shapes and sizes. There are some owners that have one facility and they live in and manage it. Other owners have 10 facilities and employ managerial staff for the day-to-day management. Be wary of owners who want to maximize profits at the expense of hiring quality staff. I like to look for owners who put money back into their businesses and improve the quality of life for their residents. 

The best adult care homes I’ve seen are ones where the owners are also the managers, and may even live in the facility. These owners make a living from the facility but are also very engaged with their resident’s overall well-being. While you can find wonderful adult home care with non-owner managers, they’re just harder to come by. Take your time to investigate and ensure that the owner is in the assisted living facility business for the right reasons.

2. The grades.

Assisted living facilities are highly regulated at the state level. Depending on the state you reside in, every facility is investigated at least yearly and completed by your states’ health services or social services department. The yearly surveys are available to the public. Depending on your state, you may have to request a survey or you may be able to download it directly from the website. 

The main purpose of these regulatory programs is patient safety. State regulators check medication documentation for accuracy. Are medications given as prescribed to the appropriate patient at the appropriate time?  Additionally, they look for safety issues such as door locks and water temperature caps.  It’s definitely worth it to look up each facility’s survey to narrow down your options. It can be surprising how many deficiencies a facility can have before its licensing is jeopardized.

3. The bookkeeping.

Well-run assisted living facilities are fastidious about their bookkeeping. An example is having dozens of recorded events for each patient every day, including blood sugar results, medication administrations, vital signs, bowel movements, and meal consumption. To ensure medications are given appropriately, doctor’s orders must be carefully documented and stored. That’s why accurate bookkeeping is exceedingly important.

Ask to see the office and the storage of information to ensure it is accessible to staff and organized. Check the state survey results to look for deficiencies in information storage or inappropriate handling or recording of medications.

4. The training.

Ask about caregiver training. Most residents in assisted living facilities have some degree of cognitive impairment, many have dementia. Dementia causes angry outbursts, uncontrolled pacing, and resistance to grooming, showering, or cleaning. Many so-called “behavior and psychological symptoms of dementia” are manageable and greatly improved by behavioral modifications by skilled caregivers and trained staff.

Some examples of bad caregiver training are:

• bathing the resident only when they’re in a good mood (on the patient’s schedule, not the staff’s schedule)
• playing soothing music
• insisting on medications to “calm them down” which will inevitably lead to side effects, including confusion, falls, daytime sleepiness, and decreased appetite

One way to understand if trained properly is to inquire about employee retention. In most facilities, caregivers are provided training on a yearly basis. Unfortunately, if the turnover is very high it leaves new caregivers without proper training for months.

5. The meals.

Ask about meal preparation. 

• Do they provide home-cooked meals?
• Do they use fresh ingredients?
• Or do they mostly serve up canned soup and frozen or processed foods?

If the dinner menu for the day is roast beef with potatoes and your mother hates roast beef with potatoes, will they make her something else? Food isn’t a huge deal for everyone, but if it’s a big deal to your loved one, it’s definitely worth considering.

6. The ambiance.

Spend some time at the facility before you sign on the dotted line.

• What is the demeanor of the staff?
• Are the residents patronized or talked down to?
• Do the residents seem happy?
• Are there activities in the common area?
• Are many of the residents are sleeping during the day?
• Is the TV on? What’s on the TV?
• Most importantly, how do you feel?  

Ask for several tours of the facility at different times of the day. If you feel uneasy or unsettled due to the behavior of residents or stressful television content, your loved one will feel this way too. If he or she has dementia, that unsettled feeling and anxious energy will display itself with unsettled behaviors, such as angry outbursts, hitting, yelling, and pacing.

Residents of assisted living facilities have enough to contend with. Providing a calm living environment can go a long way in improving their quality of life.

7. The living spaces.

Check out the facility.

• Is it clean?
• Does it have ample space for visiting?
• Is there any natural light?
• Do residents have access to a secured outdoor area?

Ideally, you want a place that has access to an outdoor area to relax, sunbathe, or walk around. A common symptom of dementia is an abnormal sleep/wake cycle. In that case, the best treatment is to spend more time outside during the day, get plenty of sun, and exercise. 

Is the facility or home properly equipped with accessibility features:

• grab bars
• step-in showers
• shower chairs
• good bathroom lighting
• wide hallways for getting safely through walkers and wheelchairs

8. The price.

Cost is a tough one. First, ask your friends and coworkers if they have any idea about local price ranges.  Second, find out if the monthly price is all-inclusive.  Next, ask about the base price and any additional costs. Oftentimes, the base price may look reasonable only to receive a bill for routine vital signs and showers at an extra charge.

It’s worth a shot to go to your local council on aging or locate a social worker to inquire if your loved one is a candidate for financial assistance. Better yet, if they have long-term care insurance or VA benefits to pay for part of the cost.

9. The in-house healthcare.

What relationships does the facility have with insurance plans, doctors, podiatrists, dentists, beauticians, and optometrists?

Do you have the option of transporting your loved one to their current doctor’s office as needed?

More and more doctors and nurse practitioners are providing medical care and ancillary services in facilities. This option can be a huge relief for many patients and family members.

10. The location.

A facility’s location must be accessible to you. Try to find a facility near your house, close to your house, or close to another trusted family member or friend. The closer you live, the easier it will be to drop in regularly.  The more you are able to visit and keep an eye on your loved one, the less chance something untoward will go unnoticed.