What To Do Before Selecting a Senior Living Facility

Nursing homes (and in some states, assisted living facilities) are required to undergo a survey process annually or when a complaint is logged by a patient or family. Summaries or prior surveys are often available to the public on Medicare’s Care Compare site.

While the survey process can be arbitrary in some states, a history of chronic problems in one or many areas should raise questions. This doesn’t necessarily disqualify a facility, but should have you asking questions of its leadership.

It’s essential that you understand the expertise and history of the owner and operator of the facility you’re about to enter into an agreement with. Key questions to get answers to are:
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→ How old is the facility?
→ How many of these facilities does the management own or run?
→ How long have you been in business?

As you evaluate facilities, you want as much detailed information as possible around the financial health of the entity. Think about it: If this were any other form of insurance, you’d want to know about the financial solvency of the company issuing the policy.

In the same way you’d get references for a contractor renovating your kitchen or a babysitter taking care of your kids, it’s also important to get feedback from people who are actually living in the facility you’re evaluating. Speak to them (and their family members, if possible) and ask specific and probing questions about what they like and what they don’t like. Share your concerns with them. Ask about other facilities they may have looked at and how they came to this choice. In the case of assisted living facilities or life care communities, it can also be helpful to ask if people have opted in for higher-level amenities (like more assistance, more housekeeping) and if they’re actually using them.

One of the most difficult issues in long-term care is deciding when frailty has created care needs that exceed the facility’s ability to provide a safe level of services. If and when this happens, there may be a disagreement between the facility and the resident, which can produce difficult consequences. It’s important to understand exactly how these types of decisions are made up front. Who decides when additional care is needed? How is the facility set up to provide that care? Run through as many scenarios as possible.

It’s critical to know exactly what you’re paying for, from meals to medical services. You need to identify everything the facility says it’s going to provide for your money.

Are you getting a double room or a single room? Are there transportation services, and if so, who pays? Who’s responsible for housekeeping? Who manages medications? Be as thorough as possible to identify potential gaps in services and clarify how they are covered.

Medicare and Medicaid may supplement some costs (such as doctor’s visits and ambulance rides), especially in a nursing home, but many costs will likely be out of pocket. If you have long-term care insurance, this may cover some costs. Figure out beforehand what will be covered and what won’t be.

Some facilities require a substantial upfront payment and then a monthly fee for ongoing service, with the promise they will care for you no matter what happens — unless you develop a disability. If this is the case, you should have an eldercare lawyer look at your contract, especially as it relates to questions of what constitutes a disability or needing more care.

Even with the best due diligence, sometimes you find yourself in a facility that just isn’t the right fit. Before committing to a facility, you should know the repercussions if it doesn’t work out. In a pure rental model, you should be able to walk away without any financial encumbrances, but this is more challenging in a long-term care situation where you have paid money upfront to secure a lifetime spot. What happens there? Does your “investment” have value that can be bought and sold to the next customer? Some families choose to hold on to an older adult’s previous home for several months before their loved one has definitely “settled in.”