How to Choose an Assisted Living Community
Last updated May 2019
Our ratings of assisted living facilities report the percent of each community’s surveyed residents (or families of residents) who gave it a “recommended” rating (as opposed to “not recommended”) on our surveys of area consumers (we regularly survey Checkbook and Consumer Reports subscribers, plus other randomly selected individuals). Unfortunately, we have so far received a limited numbers of reviews for most assisted living operations in the area.
Once you’ve identified a handful of prospective communities, call them and ask a lot of questions. There’s much at stake, so you need to choose smartly. Some require buy-in options, sizeable financial commitments that are typically difficult or impossible to back out of. Even if you choose a residence that charges only monthly rent, there are usually a lot of upfront moving costs and a minimum one-year lease. “In many ways, it’s like buying a car—there’s the sticker price, but when you finally sign on the dotted line, it has nothing to do with the final amount you’ll pay,” says Susy Elder Murphy, owner of Montgomery County, Maryland, Aging Life Care Management company Debra Levy Eldercare Associates.
What to Ask Assisted Living Communities You're Considering
Below are initial questions to ask. Further down, we discuss how to tour your top picks.
What type of care is offered by your location or campus?
Is there independent living, assisted living, skilled nursing, memory care, hospice? At some places you can shift into more care-intensive housing when your needs change.
How many units? How many residents? What is the occupancy rate?
A high occupancy rate can indicate customer satisfaction. Larger communities may be better able to address health issues, provide more services and amenities, and offer the prospect of more people to socialize with. Smaller communities can sometimes provide more personalized home-like care. A smaller home-like place, however, is more likely to shutter suddenly, forcing residents to find other digs.
What types of housing units are available?
Some offer only semi-private rooms (residents have a roommate or share a bathroom with another unit); others offer a range of options, up to large two-bedroom apartments with fully equipped kitchens. The bigger the unit, the bigger the bill. If you think you or your loved one will be spending lots of time in common areas, a smaller space may be fine.
Is there currently a waitlist for the type of unit I want? How long is the wait?
You don’t want to zero in on a community based on immediate need and find out there’s a long wait.
Do the units have kitchens or kitchenettes?
Many, but not, all units will have kitchenettes, usually with a microwave and small fridge. Full kitchens are generally reserved for independent living apartments.
Is it for-profit or nonprofit?
A nonprofit must have a public mission, and any extra revenue collected stays with the community. Many people prefer to deal with elder care organizations that have the overall goal of looking out for their residents, rather than providing profit to investors, but some for-profit places offer great service.
What are the residents’ rights?
Many communities operate as democracies of sorts, with board meetings and votes on everything from menu changes to remodeling plans; others operate with little structured input.
Can residents be evicted? On what grounds? What happens if I run out of money?
Some require residents to move out when their needs exceed what they can pay for. Many, but not all, will evict those who stop paying due to financial hardships. It’s vital to ask about these policies.
What is the caregiver-to-resident ratio?
As at a school or daycare center, the higher the staff-to-resident ratio the better. But make sure any figures you get count only those providing direct care to residents, not cleaners or admin staff. Look for something between 1:1 (ideal, but rare) to 1:4, but know that having a lot of staff around doesn’t mean much if they’re lousy at their jobs. Our researchers had a really difficult time getting reliable answers to questions about staffing ratios.
What medical staff and facilities does it have?
Ask about availability of an on-site clinic, nurse, geriatrician, or other primary care doctor, dentist, nutritionist, dietician, personal trainer, physical medicine specialist, physiologist, physical therapist, occupational therapist, and pharmacy. Some assisted living places have on-site staff and facilities with regular hours, some call in care as needed, and some only provide transportation to medical help. Also, what choices of medical-care providers are available? Do you have to use only those affiliated with the community?
How much training is required for staff?
Ask especially about staff who provide direct care to residents. You’ll likely find a wide range of requirements among communities. Places with some trained nursing staff may be better choices for frail or ailing persons.
How are assisted living services provided?
In many cases there are different levels of care, from minimal (medication reminders, meals) to maximal (assistance with dressing or showering, incontinence aides, memory care), with progressively higher fees for each level. While some communities provide and bill these services a la carte, others provide them as needed via aides, paid at an hourly rate.
Are residence floors mixed between assisted living and independent living?
If you move in under an independent living arrangement, it’s better if you don’t have to move if your care needs increase.
Is each residence equipped with a medical alert system that is monitored on-site 24/7?
Are pets allowed?
A vital question if you or your loved one has a furry pal—or severe allergies.
Is the heating or cooling controlled in each unit or by the building?
Are units furnished or unfurnished?
It’s more common to find unfurnished spots, but fully equipped units can be a good option if someone is moving across the country or downsizing.
Are there accommodations for guests?
Many offer inexpensive or free overnight lodging options.
What public spaces does it have?
Some have gardens, common rooms, fitness centers, indoor pools, dining facilities, hair salons, and grocery stores.
What kind of social activities are offered?
Many offer book clubs, movies, game nights, professional entertainment, religious services, and exercise or art classes. In general, big communities boast the most activity options, but some small spots organize a lot of off-campus fun.
If there is a skilled nursing facility on-site, does it accept Medicare?
If your plan is to move into a community that offers continuing care, check whether it accepts Medicare. It won’t pay for long-term skilled nursing, but Medicare will cover up to 90 days of care.
You wouldn’t purchase a home without making an in-person visit. It’s the same for zeroing in on assisted living: Tours are mandatory. “And don’t just look for the prettiest, nicest place out there,” says Dr. Michael Wasserman, a geriatrician and board member of the Health in Aging Foundation. “You need to look for the humanity in the leadership and staff. Dig in and let your gut tell you if these are good people who really care.”
Here’s our advice on how to thoroughly evaluate a potential place.
Take along friends and relatives.
Getting opinions (or gut reactions) from others can help you decide whether it’s a dud or a diamond.
Visit during mealtimes and try the chow. Imagine eating nearly all of your meals at the same restaurant; you’ll understand why the experts and assisted living residents we spoke with said that quality of food served should be among the most important considerations. Is everything tasty? Are there lots of choices?
Talk to residents.
At the best places, it will be easy to gather feedback from residents: They’ll happily come up to you and extoll the community’s glories. If they don’t, it’s cause for concern.
Do residents seem happy? Are staffers interacting with them? In addition to dropping by during mealtimes, also try to visit during an activity—glee club practice, mahjong hour, yoga class, whatever interests you. Don’t bother participating in staff-arranged interviews; you want spontaneous feedback from people you encounter, not a canned ambassador who might not share prevailing negative opinions.
“Assisted living places can really safeguard against loneliness,” says Wasserman. “It can be like going off to college and living in a dorm, except for seniors. There’s a sense of community.”
Interact with staff and interview caregivers.
Get to know the staff, especially the caregivers. Do you think you’ll feel comfortable getting help from these folks for incredibly personal tasks like housecleaning, bathing, and dressing? List your daily needs and ask how they can meet them.
Check out ALL of the facilities.
Ask to see everything, from available living units to workout rooms to the dining hall to, well, anything offered. And especially if there’s a requirement for a big up-front financial commitment or you’re considering a long-term or life-care contract, view the kind of unit you or your loved one would need both now and later.
Make sure they cover the basics.
In residence units:
- Walk-in showers with no raised lip, a bench or seat, and controls and water that can be accessed from a seated position.
- Built-in health-alert systems. Many properties also have residents wear personal alert devices.
- Bathroom or kitchen sinks at wheelchair height.
- Locking doors and windows for security and privacy.
Throughout the community:
- ADA-compliant door frames and spaces wide enough to accommodate wheelchairs and walkers.
- Good lighting to protect against falls and slips.
- Lever doorknobs.
- Roller light switches at wheelchair level.
- Easy-to-navigate floors and campus.
- Generator for backup power.
Be a snoop, and go with your gut.
As you tour the property, check on cleanliness and maintenance. Is stuff out of order? Is it freshly painted? Well-decorated? Well-lit? Do you get an overall positive or negative vibe?
Tour, tour again.
Think you’ve made your choice? Tour it again, perhaps multiple times. Take your time. Still, don’t inundate the potential resident. “Try to narrow the field to two or three properties,” says Murphy. “Older people can get overwhelmed by too many choices.”
Consider a test run.
“Respite stays are a great way to test drive an assisted living facility,” says Murphy. “Many seniors are more willing to try it if it’s not a forever choice. Some consumers even try a few before making a final decision.” Some communities offer one or two furnished units for respite stays (usually 30 days or so). This means your loved one can commit to just a short-term stay to figure out if it’s a good fit.
Obtain inspection records.
Though assisted living businesses aren’t subject to the same government oversight and rules as skilled nursing facilities, they are licensed by the District, Maryland, and Virginia.
In the District, to obtain an assisted-living license, operators must meet a long list of requirements including proof of solvency, proof of insurance coverage, program statements, staffing standards, care standards, and 24-hour supervision and oversight of patients. D.C.’s Intermediate Care Facilities Division is responsible for inspecting properties. Certification must be renewed every 12 months, which includes additional inspection. You can obtain reports at: https:// dchealth.dc.gov/service/assisted-living-survey-reports
In Maryland, assisted living communities are licensed by the Maryland Health Care Commission to provide three levels of care: Level One, provider is authorized to take care of residents with low-care needs; Level Two, provider is authorized to take care of residents with moderate care needs; and Level Three, the provider is authorized to take care of residents with high-level care needs (as well as the lower two levels of care needs).
To receive licenses, communities must complete a Uniform Disclosure Statement describing their services and policies. That disclosure form must include fee information and must be filed with the Office of Health Care Quality as part of the application for licensure. Inspections for health and safety issues are done every 15 months. To search for reports and violations by property name or location, visit mhcc.maryland.gov/consumerinfo/longtermcare/SearchPage.aspx?qs=AL#viewCountyList
The Virginia Department of Social Services licenses two levels of assisted living: residential living care (minimal assistance) and assisted living care (moderate assistance). Facilities that care for adults with serious cognitive impairments who cannot recognize danger or ensure their own safety or welfare, must meet additional requirements; these requirements apply whether the community serves only such individuals or when the resident population is mixed. Communities licensed for 10 or fewer residents, or that house no more than three residents with a serious cognitive impairment, are exempt from the requirements.
To obtain licenses communities must provide three reference letters, credit references, annual operating budgets, a certificate of occupancy for the building to be used, and indications of plans for the structure, and submit to an investigation of the activities, services, and facilities in question. The applicant must submit reports of health and fire inspections, and submit to inspections (once a year for existing communities; before opening and more frequently for new ones). The state has a relatively easy-to-use database of communities and inspection reports at dss.virginia.gov/facility/search/alf.cgi, searchable by city, county, or ZIP code.