Finding Assisted Living for my parents. What do I need to know?
November 3, 2015 12:18 PM   Subscribe

My parents are in their early 80's. The time has come for them to sell their house and move to an assisted living type environment. This needs to happen sooner than later. If you have gone through this process what do you wish you had known before you started visiting places? What questions do we ask? What type of financial set-ups have you encountered?

I understand there are residential facilities within some living facilities that are small houses where can utilize the services of a more staffed environment and then as my parents needs progress they can move to a more care driven environment. Have you encountered this type of set-up? What accreditations do we need to look for? Is there a place to check for "reviews"?

My mom was an active women until a year ago when she broke her hip. Her health has declined. Her dementia has progressed to a point that she can no longer be left alone. My father is in his 80's and is healthy, but that could change. They currently live in a large house with about an acre of land. This is to much for my father to take care of. Also, it is two stories with only a bathroom on the second floor. Adding a bathroom to the first floor and moving my parents to the first floor is not an option.

Please understand the ONLY option is to move them to some sort of assisted living facility. The question I have is...what do I need to know to do this effectively and protect them for the rest of their lives.

This is in the Maryland area outside of Washington, DC if it makes a difference.
posted by Coffee Bean to Home & Garden (14 answers total) 31 users marked this as a favorite
Some places have a lifetime contract where one pays a large lump sum but then will continue to be covered even if one runs out of money. Others will take Medicaid if the funds run out. When you are looking at dementia care you can be looking at huge amounts of money annually.

If you can find a place where the level of care can be ramped up without having to move your parents from apartment to apartment it will be easier on them although someone with severe dementia may need to be in a specific area rather than regular assisted living. Go visit places - do they smell ok - clean, not like urine? Are there residents off doing activities or just parked in the hallway in chairs? How is the food? My MIL lived in a place for the last couple of years of her life that had excellent care, nice facility, good activities and pretty lousy food. She ended up there because they were the only local place that had a full rehab/nursing home as part of the facility with guaranteed beds available for residents. I still regret it although we supplemented with home food and meals out often.

You ideally want it to be a place you can get to easily enough to be present and involved and cultivate a relationship with the staff. You should be able to check the state's ratings of nursing homes/assisted living places online but I don't know how Maryland specifically is set up on that front.
posted by leslies at 12:37 PM on November 3, 2015 [1 favorite]

The one thing we learned with my father-in-law was to look for graduated care. As his health declined, the small, lovely assisted living facilty he was in couldn't manage his escalating needs. Once he needed more intensive care, our options to move him into a facility that could accommodate him were more limited because he hadn't "graduated" into the skilled care from the lesser-assisted living care from within the facility that provided the skilled care. (I hope this makes sense...)
posted by sarajane at 12:48 PM on November 3, 2015

What you are looking for is often called a continuing care retirement community. Typically, residents start off in a condo-like arrangement that is their home, and then they may gradually move through levels of care (a local community offers everything from on-campus detached homes to a locked memory care unit) as needed -- however it sounds like your parents may need a higher level of care right off the bat. These sorts of communities almost always have some sort of "dining hall" arrangements for meals, as well as a wide variety of entertainment and enrichment opportunities, and the fees you pay are sort of "all inclusive" - meaning that you pay a flat fee that includes meals, housekeeping, nursing care, social programming, etc.

Typically, residents will pay a significant up-front entrance fee (often funded from the sale of a home), and then will also pay a flat monthly "rental" charge. Some percentage of the entrance fee is often refundable after the residents pass away. Be sure to ask what percentage of the entrance fee is refundable (it can be 100%, a declining percentage based on how long the residents lived there, or a flat percentage), and understand what the specifics of the contract are (for instance, does the percentage of the entrance fee that is refundable change if a resident ends up needing skilled nursing or memory care).

Here is a little more info from AARP.

This Wikipedia article also has some good baseline facts.
posted by anastasiav at 12:55 PM on November 3, 2015 [4 favorites]

Listen to word of mouth. A family member just went through this search for her mother and found several places that looked great and the directors said all the right things, but she heard not good things from people who had put family there. So ask your friends, family, coworkers, etc. if they've heard anything good or bad about the facilities on your short list.
posted by cecic at 1:07 PM on November 3, 2015 [1 favorite]

Advice based on experience: my grandparents did this. It worked well for some things and not others most of which I'm not going to go into detail about because I'm still pretty angry about some stuff.

Something that turned out to be important: choose a location that is easy for family and friends to visit. My grandparents chose a place in an area where my grandmother had grown up - this was in a rural area with no public transit. They had limited nearby family and few friends and this meant that they had few visitors and when things started to get difficult, we weren't able to advocate for them in a medical setting.
posted by sciencegeek at 1:20 PM on November 3, 2015 [1 favorite]

Sent you a memail.

You can't easily compare communities financial set up. Each one does things differently.
posted by MichelleinMD at 1:38 PM on November 3, 2015

I agree with anastasiav: if you want to "protect them for the rest of their lives," and if they can afford the entry fee and monthly costs, a continuing care retirement community (CCRC) is what you're looking for.

My parents moved into one five years ago. They had an apartment with cleaning and laundry provided, meals in the dining room, and a la carte health care services. Mom didn't live long, but my dad was able to stay in "independent living" until just recently, when he moved to the nursing home building. Some couples live in the community separately, because only one requires care, but they're together as much as they like.

Is there a place to check for "reviews"?

Try the Maryland Health Care Commission's Consumer Guide to Long Term Care. It includes a search feature that will let you identify the facilities in the area with the services they need, and to see detailed information on quality measures, including federal Nursing Home Compare data from the Centers for Medicare and Medicaid Services.
posted by Snerd at 2:38 PM on November 3, 2015 [1 favorite]

Think ahead. As you check out places that offer continuing or escalating care, evaluate each of the various living arrangements individually. It's not at all uncommon for, say, the independent living aspect to have a wonderful reputation but the nursing home portion is widely reviled.

Also, ask about the guarantee that a resident will have access to other levels of care when they need it, as soon as they need it, and for as long as they need it.

You might also want to check out how they work with hospice care, should that become necessary. Some places have their own hospice or have an "arrangement" with a specific hospice. If so, you'll want to check the hospice out as well.

And just a word of caution, from someone who has been there: Get your parents as involved as they will tolerate in whole process. Perhaps you could narrow down the options to a few, then let them choose which they like best. If they have a positive attitude about giving up their home and moving into a far less isolated setting, it will make a huge difference.
posted by DrGail at 3:47 PM on November 3, 2015

Best answer: When I moved my parents into assisted living, I was told that the Continuing Care model was going away, fwiw.

Things I would recommend you do:

1. Compile all the information you can about their financial situation. Sit down with a lawyer who specializes in elder law and figure out how to manage their resources so that you will be able to pay their bills as they age and need more support. This might involve putting property into trust; at the very least you should get a Power of Attorney so you can do things like sell their land for them and access their bank accounts.

2. Get medical power of attorney so you can make decisions for them if necessary. Get an advanced directive so you know what decisions to make. If you have siblings, have them listed on the forms, in order of access & reliability.

3. Get permission from them to talk to their doctors, so you can get a clear sense of what their medical situation is. Particularly your parents' mental condition. (My mother had dementia, which we knew; we didn't realize how delicate my father's cognitive situation was until it was almost too late.)

4. TALK to them. What are the most important/valued elements of their lives? Independence? Safety? Family time? Walking the dog? Watching tv/knitting/reading? Write this stuff down: it will inform how you make your decisions. You may find a facility that has great food and a lovely physical setting, but not a lot of good activities, and how you rank that will depend on what your parents value. (My father doesn't do group activities but enjoys the poker game and being able to walk to the bank and Target.)

5. See if you can find a freelance elder housing coordinator. They will know all the facilities in your area, and if you give them a list of criteria, they will be able to drill down to a reasonable number for you. Don't neglect things like proximity to YOU; quality food; adequate numbers of staff; interesting in-house facilities; continuity of management. All the pretty lobbies in the world won't help if your parents don't like the food or you can't get there in less than 90 minutes. Or if the staff you bonded with when your folks moved in all got laid off four months later when the facility was bought out by an interstate chain.

6. Accept that your parents may not be willing to move. Or that moving won't solve all your problems. This is just the beginning of a long downhill slide, for you and for them. Moving is hard and stressful and scary and they probably won't react well, no matter how pleasant a facility.

7. Hire a company to help you move them: there are firms out there like Caring Transitions, that will sort, pack, and move seniors into smaller quarters. They may even sell the excess household goods in an estate sale for you, or stage the old house for sale. Don't get too attached to old family objects: you'll end up with them in your basement for the next 30 years.

8. Take care of yourself. Exercise, sleep (as much as you can), don't drink too much. Take responsibility, but ask for help, and remember that as impaired as they are, your parents made their own decisions and it's too late to change them now. (I have stopped trying to get my father to eat vegetables. He's 88, he's allowed to eat as much steak or bacon as he wants.)

9. Hang tight. Pick up a copy of Atul Gawande's Being Mortal, and then find a copy of Roz Chast's Can't We Talk About Something More Pleasant?, which will make you laugh, and cry.

Good luck.
posted by suelac at 3:49 PM on November 3, 2015 [5 favorites]

Depending where you live it can be very expensive. I know of a good place in Minnesota that is reasonable. 2 bedroom, 2 bath, balcony, etc.
Independent, assisted and memory care.
posted by Tullyogallaghan at 3:55 PM on November 3, 2015

What questions do we ask?

It's a bit dated, but I think this Washington Post article is a good starting point.
posted by invisible ink at 4:18 PM on November 3, 2015

Since you mention dementia... you will want to ask about security & memory care. As her dementia progresses, she may need a memory care facility or, at least, a locked unit so that she doesn't wander & get lost. Some facilities have a wing or floor designated. Some do not, or have long waiting lists.
posted by imbri at 5:17 PM on November 3, 2015

Ask about staffing. Is there a nurse on-site during the week? How about the weekend? What's the staffing level on the weekend? Is the facility licensed? Here in Indiana, facilities that are entirely private-pay don't have to be licensed.

Your mother's dementia may be a problem. Assisted Living facilities typically will not accept someone like that, just as they will have limits on how much physical assistance a resident requires (transfers and the like.) You'll definitely need to have a serious discussion with the management about that. Assisted Living facilities aren't normally lock-downs, which Memory Care units are. It's necessary for dementia sufferers.
posted by Thorzdad at 8:10 PM on November 3, 2015

Best answer: We are in the process of doing this right now.
1. There are four levels of continuing care: independent living (condo style, some housekeeping, services, option for a dining hall but no personal care) assisted living (apartment style, meals, activities, personal care but not nursing care), memory care (like assisted living but with extra security and support for memory loss) and nursing home care ( a room or shared room, real nursing care as well as personal care)
2. Each place is organized a little differently but we found that entering continuing care on the independent living level usually required an expensive buy-in but entering at the assisted living level did not (although fewer places are open since they give priority to people already in the community moving from independent to assisted living)
3. You will want to get feedback from their doctors and others who see your parents every day so you can be realistic about how much care they need. Independent living sounds good but they may be past that point. They will probably try to minimize their problems and may not even be fully aware of the little ways that they are already accomdating their disabilities.
4. If they are not already living near family, this is the time to make that big move. I've seen research that supported the idea that people in nursing homes with relatives nearby do better. If you wait too long, the move will be more stressful and confusing instead of opening new possibilities for the next stage of life.
5. We visited eight different places in person - I'm sure there are things we missed but there were obvious differences. A local expert suggested we start with the listings at We then narrowed it down to two that we liked best for the relatives to visit. Of those, one was a clear favorite and that is the one that we are going with.
6. Be prepared for waiting lists - just because you are ready doesn't mean you get a space in the place that you want. Waiting until you really need something will limit your options in a bad way.
posted by metahawk at 10:09 PM on November 3, 2015 [1 favorite]

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