By Carolyn Spence Cagle PhD, RNC-E
With an aging society, there is an increasing need for long-term environments that offer care to those persons unable to fully care for themselves but deserve a quality living environment. One option for care is an assisted living facility where 24-7-hour staff help older persons with mobility, toileting, bathing, eating, dressing, medication delivery (the six activities of daily living, ADLs). Generally state health departments or similar agencies regulate at a minimal level privately owned assisted living facilities; federal regulations do not currently exist. Most residents are private pay with no Medicare reimbursement and limited Medicaid payment that varies by state. Long term care insurance may cover costs after a waiting period. Geographical location affects the cost an assisted living facility, but the average yearly cost is around $54,000. Most assisted living facilities employ CNAs (certified nursing assistants) and only high-cost ones employ doctors and RNs on site. The average age of an assisted living resident is 84 years and has several chronic health issues needing management by diverse discipline staff.
I visited an assisted living facility with my 94-year-old mother earlier this year to evaluate how it might meet her future needs (a good strategy I’ve heard). Here are some of the questions I asked the facility administrator to help me, my siblings, and my mother in our decision-making:
Does the facility meet my loved one’s physical, mental, spiritual, social and transport needs?
- Do new residents undergo a physical exam and assessment of their ADLs within the first month of residency to identify their needed level of care (and cost of their care)?
- What level of staff do you employ? How are they trained and evaluated for competency to meet resident needs? What is your CNA:resident ratio to meet resident needs? How do ratios vary during day and night hours for safe resident care?
- Do residents have access to transportation for medical. church services, and facility outings? What is the cost of that service?
- How do you meet residents’ mental, spiritual, and social needs for their overall health (outings, daily programs, etc.)?
- What is your visitor policy to maintain family/friend connections for resident well-being?
- What is your daily activity plan that addresses residents’ holistic health? How do residents know and participate in that plan?
- How do you handle some residents’ special dietary needs?
- What other services are on-site (PT, occupational therapy, dietary consulting, etc.) to meet resident special needs?
How good and safe is the care?
- Do you have a doctor on call or physically present here? If not, who handles medical emergencies often occurring a night? How do residents get quick and appropriate care with current number and preparation of staff?
- What practices do you have for safe resident medication administration?
- What policies and practices do you have to prevent resident falls?
- What is your COVID employee and resident vaccination and booster rate? Do you have an infection control professional on staff to respond to infectious disease outbreaks?
- Do you have a resident council to respond to resident needs and concerns?
- Do you have residents that we could speak to about their experience here?
- How do you ensure and evaluate delivery of resident quality care?
- Are you licensed or regulated by the state or other quality assessment entity to provide residential care services?
What will be the cost of care?
- How do you price various resident rooms? What provided services are part of that cost (utilities, tv, laundry, housekeeping, internet, etc.)?
- Do fees change mid-year or when a resident returns from hospitalization or acute care or after a fall?
- What is your entrance fee? Is that refundable if one decides to enter your facility?
- Can we have a copy of the resident contract to more fully understand legal ramifications of placing a loved one here for care?
In the end, after conferring with my four siblings, we hired a recommended caregiver to help our mother with laundry, bathing, and nutritional issues three times a week. This arrangement makes our mother happy and provides another “set of eyes and ears” to alert us of problems. Occasional sibling visits, and connections to our mother via cell phone, FaceTime, and email allow us comfort with keeping our mother in her home now.
References Cited:
American Health Care Association/National Center for Assisted Living. https://www.ahcancal.org/assisted-living/Policy/Page/state-regulations.aspx.
Assisted living regulations. https://www.hhs.texas/gov/providers-long-term-care-providers/residential-care.
Gurnon, E. & SCAN Foundation). questions to ask before moving your parents to assisted living. https://www.nextavenue.org/assisted-living-facilities-future.