A couple of years ago you posted a long but valuable series of questions to ask when contemplating moving into an assisted living community.  I believe your cousin provided the material.  Do you have access to that information?  Can you post it again?  I think the new people and some of the old might be interested.

Iris L.

I just wanted this myself for someone I answered on Solutions.

Here it is

I have been observing the senior care spectrum long enough to know  the different strengths -- and tradeoffs -- inherent in the many exciting options now available to seniors who need supportive housing. Consumers can do a quick search at the Assisted Living Federation of America website (www.alfa.org) to find a list of assisted living and senior living communities in their geographic area, but  there is no national "ranking" of assisted living and senior living communities because the sector is so diverse. Unlike nursing homes, if you've seen one senior care community, you haven't seen them all. In other words, there is no cookie cutter model like there is with nursing homes that would make comparisons across the industry easier. This is both a bad thing and a good thing. The bad thing is that it's harder to compare communities (at least "on paper"). The good thing is that there is a wide variety of choices out there to accommodate different consumer preferences.  I would advise seniors and their families to ask tough questions of any senior care community that they are considering, in order to ensure they know what they are walking into and to minimize surprises down the road. Even with a large company that has a strong national reputation, there will always be stronger and weaker communities within a given company's portfolio, so it's very important to evaluate each community on its own merits.

ALFA is the trade association for owners/operators of senior care communities. It is a good place to start, because it represents so many of them, and it has an excellent downloadable checklist for consumers to use when evaluating an AL community. Beyond the obvious (and important) questions, such as how a given community might accommodate an older person's current needs, here are a few key longer-term considerations: 

1. CARE LIMITATIONS. Assisted Living is a wonderful option for someone who wants to remain independent in ways that nursing homes cannot always accommodate. Because AL is regulated by states, not by the federal government, it remains a more residential, flexible option than the highly regulated nursing homes. (Nursing homes are so highly regulated and, as an industry, have been the target of so many lawsuits, that the care there can feel more restrictive). Because of the fact that there are fewer restrictions and a more residential approach in AL, however, it's important to find out how well each community under consideration will be able to accommodate an  older person's needs as they become more complex. For example, a would-be resident who already is very frail would not  want a place that sees itself as basically a glorified hospitality setting and that's about it. A question to ask any AL community you visit: What kinds of care are they NOT allowed to provide? At what point/under what scenario would a resident be required to move out? For ex., are residents allowed to use home health care and hospice on the premises so they can age in place even when their health goes markedly downhill? What about Alzheimer's/dementia care? Is there a point at which someone with that condition must, under state law or company policy, be required to move to a higher-care setting? You might want to avoid multiple moves -- one relocation is a big enough deal to go through (!)   

2. FEES. It's important to understand the fee structure of whatever place you consider moving into. There are several types of fee structures. Most freestanding assisted living places are akin to monthly rentals. The fees will go up as needs increase (because service usage will increase), but residents can move out without much trouble. On the other end of the spectrum are continuing care retirement communities (CCRCs). These are usually large campuses that offer independent living, assisted living, and nursing care.  They have much higher entry fees  plus a monthly fee. As a resident's needs increase, he/she may be relocated to a different part of the campus where nursing care can be provided, but the community will know the resident and the resident will know the community and that sometimes eases transitions. Most CCRCs are nonprofits. The website for finding out more about nonprofit CCRCs, including a directory of them, is www.aahsa.org. In between freestanding AL communities and CCRCs are hybrid communities, which might have, for example, assisted living plus Alzheimer's care, or independent living plus assisted living, or assisted living plus nursing care. The most important question regarding fees for ANY community you visit is how the fees are structured (a la carte, or bundled deals, or something else), how much the fees tend to automatically increase per year, and what is NOT included in the regular fees (i.e., what would cost extra).   

3. QUALITY ... Start with visiting (or having a relative visit) the community at various times of day and different days of the week, so as to get an idea of how well the place is run. Are there caregivers running around? Are the residents in the dining room looking frustrated about getting help? Is everyone sitting around, or are there activities and people who look engaged in something? Ask the community what the state regulations require for staffing levels and training (is there 24-hour access to a nurse, for example) and then ask them what they do to EXCEED that standard. You can check with the state about any inspection violations a given community may have had, and use references where possible.  

3. ALZHEIMER'S.... There have been many advances  in therapies over the past few years, and savvy senior care providers are incorporating some of them, such as "brain fitness" activities. Some senior living companies specialize in Alzheimer's/dementia. Seniors with dementia should ask providers about how much experience they have with Alzheimer's/dementia -- i.e., that they didn't just open their first Alzheimer's wing yesterday  -- because it's such a complicated condition. I recommend asking every provider about their "philosophy" regarding medications (some AL companies are especially proactive about coordinating with doctors to avoid over-medication) and how they handle difficult periods (such as "sunsetting").  Security is important (such as a secured perimeter) but so is having a safe place to wander freely. What sorts of activities does the community offer for residents with Alzheimer's? How are families supported?  

   One of the true failings of our current long term care system (besides issues of reimbursement and affordability) is that there is a huge disconnect between care settings when a person needs to transition from, say, a hospital to a nursing home or assisted living. Communication is always a challenge, to ensure the resident's medications, transcripts, and doctor's orders are moved seamlessly from one setting to another. When my father-in-law was in declining health, he kept having to be admitted to the hospital, where he received excellent care, would rally and do well. Then he'd be moved to a nursing  home, and his care would deteriorate because they did not communicate well with the hospital. So he would go downhill to the point where he'd be sent back to the hospital to get acute care again. Then he'd rally and be sent back to the nursing home, where he would deteriorate. And so on, and so on, until he got hospice care at home and broke that cycle (he never qualified for assisted living because he was bed-ridden). 

When it comes to assisted living, each state has its own regulations, and each AL company has its own policy, for how move-outs are managed. It's important to understand in advance the circumstances under which an AL community would no longer be able to care for a resident, and how much notification would be given to the resident. Find out, too, how the senior care company manages day-to-day customer complaints, and whether there is an anonymous hotline or similar system for handling employee complaints. If there is a proactive system in place for handling complaints, that's always a good sign.

Thank you, Mimi, this is valuable information that shouldn't be lost. 

Iris L. 

Yes, thank you Mimi! Thank you Iris for asking for the information again for the new site.

My computer crashed about the that we switched to the new boards.  I lost all of my Alzheimer's information that I collected and saved on it!    Devastating day!  So it's great to be able to start my collection again.