9 Things to Consider in Your Search for an Assisted Living

As people age and need more help with daily activities, such as bathing or taking medication, moving to a facility that provides some assistance, without sacrificing independence, may be an option. This type of environment, known as assisted living, has emerged in the past two decades as an increasingly available option for housing and long-term care. In 1999, one third of the facilities that offered assisted living services had been in existence for less than five years, and 60 percent had existed for less than a decade, according to research published in January in the journal Health Affairs. The growth of assisted living facilities has leveled off in recent years, however, as the economic downturn hampered new construction and occupancy rates. In 2007, there were approximately 38,000 assisted living facilities nationwide, serving about 975,000 residents. The overwhelming majority of assisted living residents in the United States are female, according to the National Center for Assisted Living. One of the most common types of facilities that provide assisted living are called community care retirement communities, which offer a stepwise approach to care, says Kerry Peck, an elder law attorney based in Chicago. The concept is you age in place, meaning you never have to leave the grounds for housing, he says, You buy an apartment or cottage, and then as your health declines, the facility agrees to provide continuing care. Some of the most successful centers have independent living, then assisted living, then a nursing home for acute care. But much like deciding whether a nursing home is necessary, the decision to move into an assisted living facility is not an easy one. So what factors should you consider when looking for a place to move to? First, think about what activities you or your loved one need help with. People residing in assisted living facilities may need assistance with any number of daily activities, such as bathing, dressing, using the bathroom, cooking, or eating. About 87 percent of residents need help preparing meals, for example, and 81 percent need help with managing or taking their medications, reports the NCAL. Most residents come from living in private homes or apartments; fewer come from living with adult children or other family members, from nursing home facilities, retirement or independent living communities, or another assisted living or group home. For some people, however, assisted living may not be an option, mostly for financial reasons. Assisted living facilities cost an average of $34,000 annually in 2009, compared to about $74,000 per year for a nursing home, according to research published in January in Health Affairs. How this expense is paid varies. Residents can buy into a facility by paying a large, upfront sum of money, followed by smaller monthly assessment fees. Or if the resident opts for a facility where he can rent instead, he would pay monthly for the cost of housing and care. The facilities are also mostly located in areas where home values are higher and people nearby have higher incomes. Because of this, people with low incomes, minority groups, and those living in rural areas do not have much access to assisted living facilities, the study reports. Also, some states are home to more assisted living facilities than others. Minnesota, Oregon, and Virginia each had more than 40 facilities per 1,000 elderly residents, according to the research, while Connecticut, Hawaii, and West Virginia each had fewer than 10 facilities per 1,000 elderly. If you are contemplating an assisted living facility for yourself or a loved one, here are 9 considerations to help guide you: Reflect on what is most valuable in you or your loved one's life. What gives your life purpose and meaning? Keep that in mind when choosing your living environment, says Linda Fodrini-Johnson, president of National Association of Professional Geriatric Care Managers. Think about where your doctors, your church, your children, and grandchildren are located. Is the assisted living facility near the things and people you hold dear? Will you have transportation to get where you need to go? Choose a place that can keep you connected to your medical team, church, clubs you belong to, your family, Fodrini-Johnson says. You want to keep as much of a social network as you can. Think about your current and future needs. If you have a progressive illness such as Parkinson's disease, for example, look for a facility that can accommodate you as your mobility changes, Fodrini-Johnson advises. You might ask questions like: What are the levels of care that you offer? How long can a resident stay? Will you be provided with wheelchair escorts to the dining room? Are there ramps located throughout the facility? Is your room or apartment fully accessible if you require a wheelchair in the future? Also, if you have dementia and you eventually become at risk of wandering off, does the facility offer a secure unit that they could transfer you to? That helps you narrow down your choices, Fodrini-Johnson says. Assess the financial stability of the facility. Although assisted living occupancy rates remain stable industry-wide, some newer facilities and locations that attempted to expand during the recession have struggled to fill their beds, according to the Health Affairs study. And because many prospective residents use the profit from the sale of their homes to pay for their assisted living stays, the downturn in the housing market has hurt facilities located in parts of the U.S. where home values were hit hardest in recent years. Because of this, some assisted living companies have filed for bankruptcy;which can be problematic for residents who have paid a lump sum up front that they expected to cover their housing and care for as long as they're able to live there; if the assisted living facility goes bankrupt, the resident may be out that money, says Craig Reaves, an elder law attorney based in Kansas City, Mo. Make sure the facility is licensed to ensure it meets your state's assisted living regulations. To confirm this, check with the agency that licenses assisted living facilities in your state. The agency tasked with doing so varies by state. In Maryland, for example, the Maryland Department of Health and Mental Hygiene's Office of Health Care Quality is responsible. To find the appropriate agency in your state, start by searching http://www.eldercare.gov/ and drilling down by Zip code. Also, check with the Better Business Bureau to find out if there are complaints against the assisted living facility you're interested in. Get referrals. Go to people you know who have done the search before you, advises Joy Loverde, author of The Complete Eldercare Planner (Random House, revised and updated, 2009). Also, contact your local agency on aging or a geriatric care manger to find out if they can provide a list of facilities they'd recommend in your area. Ask if there is a waiting list when you make first contact with the facility. Most of the good assisted living communities have a waiting list,; Loverde says. Don't assume that there's going to be room when you need it. So start your search early and get on the list if you find a place you love. Visit a few times before you agree to move in. Stop by the community at least twice;once during the day and once at nighttime, Loverde advises, and go on at least one guided tour. Show up unannounced for your other visits, experts say, so you can see what happens when they're not expecting visitors. The nighttime visit is especially important because most of the staff has likely gone home. That's when you can get a good sense of who is left in the evening shift she says. Observe whether the evening shift is aware of the needs of the residents. Ask current residents if they've had problems at night such as not being able to get assistance in the wee hours due to low staff levels. Talk to current residents. Talk to residents you meet during your on-site visits and ask if they've experienced any problems at the facility. Probe them about issues with the facility's staff, quality of meals, and on-site thefts, for example. Also, ask the facility if they have a resident council, and ask to talk to the resident in charge of the council to find out what complaints, if any, occupants have about the facility, Loverde suggests. Get a copy of the contract and show it to a lawyer. The contract or written agreement should detail how the facility handles residents as they age or become sicker, and should include a staff-to-resident ratio, and information about any costs associated with leaving the facility—such as how much of your money you will be refunded and in what time frame. An elder law attorney can help you understand the contract and may advise you to ask the facility for changes that may work to your benefit, Loverde says, such as negotiating future rate increases—especially important for those on a fixed income. Still, many times, assisted living residents do not get their contracts reviewed prior to moving in. "People underestimate [the] need to have contracts reviewed," Reaves says. "It depends on the facility, but there can be some provisions in those contracts that you may not want," and the facility may be willing to remove them if asked, he says. For example, some contracts allow facilities to kick a resident out if he runs out of money to pay for continuing housing or care. This can be negotiated before the contract is signed, so that a resident can tap into Medicaid, for example, to help cover the costs, Reaves says.