How do I properly vet senior retirement facilities
January 5, 2024 12:23 PM Subscribe
My siblings and I are working to help our mother move into an independent living facility/retirement home/senior community/whatever the current terms of art are. I have been charged with helping to vet the available facilities in the area in order to winnow the choices down to a reasonable number that we can visit in person when we come to town. I have very little idea about what questions I should asking and what sources I should be checking to begin proper due diligence. More details ahead ...
1) Mom is 80 years old.
2) She is eager to make the transition and has provided the names of 3 local facilities where she has friends.
3) She does not need full fledged assisted living service at this time, but given her health we expect that she will likely need this in the not-distant future and so would like a place that allows independent living for as long as possible with the option to transition into more assisted living as time goes on.
4) We need to get her moved as quickly as possible, because there are serious issues with her current living situation. So we don't have the luxury to spend many months making a decision.
5) She wants to stay in the city where she currently lives, as she has friends in the community there. None of us lives in the area, so we will only have limited days to schedule visits to check out facilities in person and assist with the move.
6) We have enough money collectively that we shouldn't have to settle for any place that is crappy, unsafe, or uncomfortable. But we may not have enough for a top-of-the-line luxury facility. (Or maybe we will. It's an area with a lower than average cost of living and I haven't checked out all the options yet to know how high the prices might run. But it's likely that we won't necessarily be able to afford the most expensive place.)
7) Mom lives in Georgia, USA.
If there are any more details I should supply to help respondents offer advice, let me know.
I'm hoping to get a good start on reaching out to facilities this weekend and would like a list of questions that I should be asking and the sort of answers I should expect. If there are websites or searches that I should be checking to discover any red flags or warnings about specific facilities, please point those out as well.
1) Mom is 80 years old.
2) She is eager to make the transition and has provided the names of 3 local facilities where she has friends.
3) She does not need full fledged assisted living service at this time, but given her health we expect that she will likely need this in the not-distant future and so would like a place that allows independent living for as long as possible with the option to transition into more assisted living as time goes on.
4) We need to get her moved as quickly as possible, because there are serious issues with her current living situation. So we don't have the luxury to spend many months making a decision.
5) She wants to stay in the city where she currently lives, as she has friends in the community there. None of us lives in the area, so we will only have limited days to schedule visits to check out facilities in person and assist with the move.
6) We have enough money collectively that we shouldn't have to settle for any place that is crappy, unsafe, or uncomfortable. But we may not have enough for a top-of-the-line luxury facility. (Or maybe we will. It's an area with a lower than average cost of living and I haven't checked out all the options yet to know how high the prices might run. But it's likely that we won't necessarily be able to afford the most expensive place.)
7) Mom lives in Georgia, USA.
If there are any more details I should supply to help respondents offer advice, let me know.
I'm hoping to get a good start on reaching out to facilities this weekend and would like a list of questions that I should be asking and the sort of answers I should expect. If there are websites or searches that I should be checking to discover any red flags or warnings about specific facilities, please point those out as well.
There are consultants who are familiar with what's on offer and can find a place that has what you are looking for. I had a friend do this for her mom in another city and it was very helpful with the short timeline.
posted by *s at 2:41 PM on January 5 [1 favorite]
posted by *s at 2:41 PM on January 5 [1 favorite]
I am also starting to look at these places with my father. Here are a few questions to ask and aspects to consider.
* When ever your mom does need assistance, will she need to move to a different wing of the facility, or can she stay in her same apartment?
* If the possibility of Alzheimer's or other dementia is a concern, does the facility offer memory care? If so, how secure is that section? How often do residents leave the facility?
* Are taxes included in the quoted prices?
* Is any deposit refundable? Under what circmstances?
* What are the full financial arrangements? Such as -- Is it a rental or a buy-in? What are the up-front fees and the monthly fees? What is covered by the various fees? (Often if the apartment, light housekeeping, laundry of linens, two or three meals a day, certain transportation, many activities, all or most utilities). Ask about fees also for assisted living.
* You will probably be given the following. If not, ask to see them -- floor plans, activities calendar, menu. Ask whether the menu changes, and how often. Consider visiting during meal time. You might ask, or they might invite you to, a meal.
* Check out the different apartments and the various amenities, such as outdoor area, etc. Consider whether there is a little store on the premises, for when your mother's mobility becomes limited.
* Ask whether any medical people are independent, contracted or employees of the facility.
* Consider this material from U.S. News.
* When visiting, try to pay attention to mood and demeanor of residents and staff, and any interaction between them.
Note that many places are not upfront and very transparent about costs. I am not yet sure how much weight to give that.
posted by NotLost at 4:18 PM on January 5 [3 favorites]
* When ever your mom does need assistance, will she need to move to a different wing of the facility, or can she stay in her same apartment?
* If the possibility of Alzheimer's or other dementia is a concern, does the facility offer memory care? If so, how secure is that section? How often do residents leave the facility?
* Are taxes included in the quoted prices?
* Is any deposit refundable? Under what circmstances?
* What are the full financial arrangements? Such as -- Is it a rental or a buy-in? What are the up-front fees and the monthly fees? What is covered by the various fees? (Often if the apartment, light housekeeping, laundry of linens, two or three meals a day, certain transportation, many activities, all or most utilities). Ask about fees also for assisted living.
* You will probably be given the following. If not, ask to see them -- floor plans, activities calendar, menu. Ask whether the menu changes, and how often. Consider visiting during meal time. You might ask, or they might invite you to, a meal.
* Check out the different apartments and the various amenities, such as outdoor area, etc. Consider whether there is a little store on the premises, for when your mother's mobility becomes limited.
* Ask whether any medical people are independent, contracted or employees of the facility.
* Consider this material from U.S. News.
* When visiting, try to pay attention to mood and demeanor of residents and staff, and any interaction between them.
Note that many places are not upfront and very transparent about costs. I am not yet sure how much weight to give that.
posted by NotLost at 4:18 PM on January 5 [3 favorites]
If she already has some ideas of where she'd be excited to go, I'd definitely start there. It seems like it would be much easier for her to settle in with friends around.
Would you have time to take your mom on brief visits to her friends at the 3 different facilities when you go there? You could take a look around for anything blatantly not right and also talk to her friends about the best and worst parts of living there.
posted by Eyelash at 4:28 PM on January 5 [3 favorites]
Would you have time to take your mom on brief visits to her friends at the 3 different facilities when you go there? You could take a look around for anything blatantly not right and also talk to her friends about the best and worst parts of living there.
posted by Eyelash at 4:28 PM on January 5 [3 favorites]
And someone should ask her friends what they think of their facilities.
posted by NotLost at 4:42 PM on January 5 [2 favorites]
posted by NotLost at 4:42 PM on January 5 [2 favorites]
Oh, also, about the costs, in Albuquerque, for example, a studio starts in the lost 3 thousands, and one-bedrooms start around $3500, both for independent living. At least that is my research so far.
posted by NotLost at 4:47 PM on January 5
posted by NotLost at 4:47 PM on January 5
Definitely look for a senior housing consultant in your area. These people are typically paid by the facility that gets chosen, with no cost at all to the new resident. We were in a hurry-up situation when my mom went rapidly downhill in the fall of 2019, and our consultant found two good choices in about a week, one of which has proven to be ideal, and the service didn't cost my mom a cent.
The facility my mother was in prior to this had independent living (where my mom was) and assisted living. When she moved in about five years previously, there were plans to build memory care as well, but that didn't happen. When her dementia made it unsafe for her to live independently, there were no assisted living units available for her...and when she moved into assisted living at a new facility, she was only there a month or two before she needed to move into memory care. So be cautious if you're looking for a place that appears to be able to serve all three of these senior living situations -- try to stay alert for early signs of a need to move the next tier up so you have time to wait for availability or need to go looking again .
posted by lhauser at 4:51 PM on January 5 [3 favorites]
The facility my mother was in prior to this had independent living (where my mom was) and assisted living. When she moved in about five years previously, there were plans to build memory care as well, but that didn't happen. When her dementia made it unsafe for her to live independently, there were no assisted living units available for her...and when she moved into assisted living at a new facility, she was only there a month or two before she needed to move into memory care. So be cautious if you're looking for a place that appears to be able to serve all three of these senior living situations -- try to stay alert for early signs of a need to move the next tier up so you have time to wait for availability or need to go looking again .
posted by lhauser at 4:51 PM on January 5 [3 favorites]
Something my elderly aunt was adamant about when I was visiting facilities in her general area is which hospital 911 would take her to if she needed emergency aid. Our area is thick with medical systems, and she had definite ideas about where she wanted to be taken, namely the system where her doctors practiced. If this is something your mother would care about, it's something to inquire about. In the end she didn't move from her home, which she should have, but the thought of paying $4000+/month, and likely more, paralyzed her with financial fear. We are in the NorthEast, and perhaps costs are lower in your region, but that figure was the minimum, and escalated quickly to more $5500/month, with plenty of extras charges like cleaning and laundry. I'd agree that you should ask every possible question about what is charged for. I have heard that in some facilities there is a monthly cost for the (required) personal panic alarms residents wear, and a cost to deliver a meal to her apartment if she did not travel to the dining room. You can see how the costs escalate quickly. Memory care is several thousand dollars a month more because of the cost of attendants and level of constant care. I also used "A place for mom" and found the counselor to be helpful in identifying potential facilities and setting up appointments.
posted by citygirl at 5:07 PM on January 5 [3 favorites]
posted by citygirl at 5:07 PM on January 5 [3 favorites]
On what the different forms of assisted living are
("One of the potentially confusing things is that a given institution or organization have more than one of these facilities, sometimes even under the same roof...").
and on questions to ask when scoping them out.
posted by brainwane at 3:33 AM on January 6 [4 favorites]
("One of the potentially confusing things is that a given institution or organization have more than one of these facilities, sometimes even under the same roof...").
and on questions to ask when scoping them out.
posted by brainwane at 3:33 AM on January 6 [4 favorites]
Once you do select a place don't expect her to be able to move in right away. The best places have waiting lists.
posted by mareli at 5:50 AM on January 6 [2 favorites]
posted by mareli at 5:50 AM on January 6 [2 favorites]
Be wary of A Place for Mom. They claim to be independent but they are not; they’re affiliated with a couple of large chains. As a result, they wouldn’t even show me the independent - and much nicer - facility where my aunt ended up. They were also very hard sell and the phone calls kept coming for, literally, years - long after my aunt had passed away.
I would start with the places where your mom has friends. Honestly, I might not even look any further - just compare those and pick the one she likes best. Having friends will ease the transition tremendously.
posted by mygothlaundry at 10:08 AM on January 6 [5 favorites]
I would start with the places where your mom has friends. Honestly, I might not even look any further - just compare those and pick the one she likes best. Having friends will ease the transition tremendously.
posted by mygothlaundry at 10:08 AM on January 6 [5 favorites]
ProPublica has a nationwide database of nursing home inspection reports designed to help compare options.
posted by sapere aude at 11:50 AM on January 6 [7 favorites]
posted by sapere aude at 11:50 AM on January 6 [7 favorites]
Always check out the information available at the what ever department of the state government oversees the licensing of nursing homes. In Georgia, it look like these fall under the heading of "personal care homes" and you can find out more about the licensing status here.
Your mother may want a bigger community that provides more services, but as my mother's health decline, we found she did much better in a smaller home (just six residents) that offered warm, consistent and attentive care. These are hard to find on your own but they show up in the licensing reports. Everywhere has some complaints filed but there was a very big difference in the rate of complaints per resident between the best and worst places.
posted by metahawk at 3:27 PM on January 6
Your mother may want a bigger community that provides more services, but as my mother's health decline, we found she did much better in a smaller home (just six residents) that offered warm, consistent and attentive care. These are hard to find on your own but they show up in the licensing reports. Everywhere has some complaints filed but there was a very big difference in the rate of complaints per resident between the best and worst places.
posted by metahawk at 3:27 PM on January 6
You might find this previous question helpful. And this one. My advice is to just start visiting the places on your mom's list. You may quickly find out that some of them don't have current vacancies or require a waiting list. You may also find that particular features start to stand out for you right away. Is your mom clear about what she wants, in terms of space and amenities? You can go around and collect a list of prices and floor plans, and you can discuss together with her. Places we looked at for my dad varied in terms of offering studio-only or options for 1-BR, and some had a full kitchen including a dishwasher while others had only a sink, fridge and microwave.
What worked well for us was I compiled a short list and did a bit of online research about each place, and my partner and I went for an initial visit to the top 3, to view options, see the community, and ask questions. Even after the first visit, I already felt like I was a much more educated consumer, so it made it more efficient to review the other options and consider others on the list. When we found a couple of options that we liked, then we took my dad to see them as well, but only when we had a small set of choices curated for him.
When we first moved my dad, he was a perfect fit for independent living, but we specifically chose a place that had continuing care options, with assisted living and nursing care in the same facility. What we discovered later is that it was possible to layer on additional support services without necessarily needing to move him to assisted living right away. In other words, he was able to stay in independent living longer than we expected, and the cost of bringing in external supports was the same or less than assisted living, but he had the stability of staying in a familiar place and maintaining his sense of independence longer.
Eventually his dementia progressed to the point where he did need full-time supports of assisted living, but because he began to be prone to wandering, he couldn't be accommodated at the same facility, because their assisted living didn't have a locked-ward and they wouldn't accept the risk. So something to keep in mind, when asking questions about facilities. We eventually moved him to assisted living at another facility, which wasn't ideal, but it worked out fine in the end, and so all that research we did the first time around came in handy again!
Things to explore and ask about:
*dining options: my dad's first place had far superior food quality compared to the second one; this became a major downside of the experience; this made him much more reliant on me ordering Amazon Fresh deliveries for him, and Uber Eats
*transportation: although it was promised that he could get a shuttle bus to do shopping, the bus would quickly fill up and so he often wasn't able to go when he wished, and because he didn't belong to the dominant catholic or baptist churches, they wouldn't schedule the shuttle to take him to his nearby lutheran church (the transportation piece was hugely disappointing, as it was one of the selling points for us in the original choice)
*on-site amenities and services: having a hair salon on site is super-handy, and my dad's place also had a number of doctors and medical providers on rotation, so he was able to see a podiatrist on-site to take care of his toenails, for example, and have someone repair his hearing aid.
*activities and pastimes: the first place my dad lived was a much larger community and had a lot more activities to choose from; while he didn't utilise many of them, the variety made sure there was more things he could try. There was also a bigger campus, so he could take a nice walk without going out on the street.
*cleaning services: my dad's first place changed out the sheets and cleaned weekly, and the same cleaner came each time and so got to know him and his habits and became a good extra set of eyes for us; the second place cleaned regularly, but with different staff rotating through.
*security: both places provided a call button for my dad to wear (though he was very reluctant to wear it or use it)
*laundry: in independent living, there were washers and dryers available, or you could pay extra to have your clothing washed. For my dad, this was a nice activity for him, though it eventually became too hard with the dementia. In assisted living, they washed his clothes for him.
*internet: this is super-important, and just because they have wifi doesn't mean it works well. Neither of the places my dad lived had any kind of on-staff tech support, and there were frequent outages that often required re-booting. Assess your mom and your family's needs and don't assume it will just work, even in this day and age. For us, being out of state and during covid, it was our lifeline. One of the places used Privatel for their internet/phone/TV setup and it was appallingly dysfunctional.
Some of these things may be less critical if you live nearby and can visit frequently.
posted by amusebuche at 12:14 AM on January 7 [1 favorite]
What worked well for us was I compiled a short list and did a bit of online research about each place, and my partner and I went for an initial visit to the top 3, to view options, see the community, and ask questions. Even after the first visit, I already felt like I was a much more educated consumer, so it made it more efficient to review the other options and consider others on the list. When we found a couple of options that we liked, then we took my dad to see them as well, but only when we had a small set of choices curated for him.
When we first moved my dad, he was a perfect fit for independent living, but we specifically chose a place that had continuing care options, with assisted living and nursing care in the same facility. What we discovered later is that it was possible to layer on additional support services without necessarily needing to move him to assisted living right away. In other words, he was able to stay in independent living longer than we expected, and the cost of bringing in external supports was the same or less than assisted living, but he had the stability of staying in a familiar place and maintaining his sense of independence longer.
Eventually his dementia progressed to the point where he did need full-time supports of assisted living, but because he began to be prone to wandering, he couldn't be accommodated at the same facility, because their assisted living didn't have a locked-ward and they wouldn't accept the risk. So something to keep in mind, when asking questions about facilities. We eventually moved him to assisted living at another facility, which wasn't ideal, but it worked out fine in the end, and so all that research we did the first time around came in handy again!
Things to explore and ask about:
*dining options: my dad's first place had far superior food quality compared to the second one; this became a major downside of the experience; this made him much more reliant on me ordering Amazon Fresh deliveries for him, and Uber Eats
*transportation: although it was promised that he could get a shuttle bus to do shopping, the bus would quickly fill up and so he often wasn't able to go when he wished, and because he didn't belong to the dominant catholic or baptist churches, they wouldn't schedule the shuttle to take him to his nearby lutheran church (the transportation piece was hugely disappointing, as it was one of the selling points for us in the original choice)
*on-site amenities and services: having a hair salon on site is super-handy, and my dad's place also had a number of doctors and medical providers on rotation, so he was able to see a podiatrist on-site to take care of his toenails, for example, and have someone repair his hearing aid.
*activities and pastimes: the first place my dad lived was a much larger community and had a lot more activities to choose from; while he didn't utilise many of them, the variety made sure there was more things he could try. There was also a bigger campus, so he could take a nice walk without going out on the street.
*cleaning services: my dad's first place changed out the sheets and cleaned weekly, and the same cleaner came each time and so got to know him and his habits and became a good extra set of eyes for us; the second place cleaned regularly, but with different staff rotating through.
*security: both places provided a call button for my dad to wear (though he was very reluctant to wear it or use it)
*laundry: in independent living, there were washers and dryers available, or you could pay extra to have your clothing washed. For my dad, this was a nice activity for him, though it eventually became too hard with the dementia. In assisted living, they washed his clothes for him.
*internet: this is super-important, and just because they have wifi doesn't mean it works well. Neither of the places my dad lived had any kind of on-staff tech support, and there were frequent outages that often required re-booting. Assess your mom and your family's needs and don't assume it will just work, even in this day and age. For us, being out of state and during covid, it was our lifeline. One of the places used Privatel for their internet/phone/TV setup and it was appallingly dysfunctional.
Some of these things may be less critical if you live nearby and can visit frequently.
posted by amusebuche at 12:14 AM on January 7 [1 favorite]
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Just so you have an idea of costs, I think the lowest priced facility was $3000 per month (this is in the North East) fora studio at assisted living, $4000 for a one bed, with all meals, laundry and light housekeeping included. If your mom is looking at Senior Living instead, the costs start at about half that.
posted by DarlingBri at 12:45 PM on January 5 [4 favorites]