By the year 2030, there will be over 61 million people aged 66 to 84, according to the National Institute of Health. The Baby Boomer generation is aging, which means that in several years, many of them will need more care than their children — who are busy with jobs and families of their own — can provide. If your elderly parent is dealing with the death of a spouse or has dementia or Alzheimer’s, those needs can be even more intense.
The challenges associated with caring for an aging parent are significant, and that’s where assisted living comes in. But what does “assisted living” mean? Are the benefits worth the high cost? And how do you go about choosing the best facility for your parent?
Let’s take a look at the ins and outs of assisted living and what you need to know to help your parent make the best choice.
What Is Assisted Living?
Assisted living, retirement community, nursing home — these are all options for aging parents. The difference between these options is the level of care they provide.
Retirement communities are apartment complexes, communal living, or even gated communities for people aged 55 and older. These communities are for active, healthy seniors who don’t need assistance with daily living activities. There are no nurses or caregivers on site unless they’re hired privately by residents.
Assisted living facilities offer more care for older adults who may need help with daily tasks, such as bathing, dressing, toileting, meals, housekeeping, or medication. The facility also provides transportation to doctors’ visits and grocery stores if needed and organizes recreational activities and events.
In assisted living, residents are, for the most part, active, independent, and able to be on their own for most or all of the day. Residents usually have their own apartments, townhouses, or cottages. However, in assisted living, meals are cooked and served for residents, and there are caregivers and nurses on staff to help with daily needs.
In a nursing home, residents need constant care for almost every aspect of daily living. They have a private or shared room and require regular medical attention by the doctors and nurses on staff.
Benefits of Assisted Living
Assisted living has come a long way. Most of today’s assisted living facilities are vibrant, welcoming communities that provide a higher level of care than can be found at home.
This is especially important when there is no primary caregiver available. For example, when children work full-time and have families of their own, it’s difficult if not impossible to care for aging parents at the level they need. In these situations, it’s important to talk to your aging parent about assisted living to find out how they feel about it, go over its benefits, and address their concerns.
So, what are the benefits of assisted living?
1. Hot, Nutritious Daily Meals
At an assisted living facility, your parent will have hot, nutritious meals cooked for them daily. Some facilities provide restaurant-style dining for breakfast, lunch, and dinner to residents who can’t cook at all, while other residents may choose to eat dinner in the community dining room.
2. Safety & Security
Most traditional homes are not designed with aging in mind. There are steps to trip on, door handles that are impossible to open if you have arthritis, and shelves that can’t be reached without the risk of falling. Assisted living facilities are created to answer these concerns, which means they’re safer than most homes.
Most facilities also have a security team onsite for added peace of mind.
3. Intellectual Stimulation
Assisted living facilities offer a wide variety of activities to keep residents engaged and stimulated. These might include book clubs, art classes, adult education classes at a local college, cooking demonstrations from local chefs, discussion groups, music therapy, group outings to performances and museums, or classes on writing a memoir.
4. Physical Stimulation
Another major benefit of assisted living facilities is that they work hard to keep residents physically active. This not only helps residents maintain better health; it also benefits their happiness and well-being.
Physical activities might include swimming or yoga classes, walking clubs, Wii sports like dancing or tennis, or group T’ai Chi. Many facilities have workout rooms, and some have personal trainers who specialize in senior fitness.
5. Social Stimulation
As people age, it’s harder for them to get out and maintain friendships like they used to. As a result, many seniors are isolated and spend much of their time alone. That can lead to depression, as well as physical and mental decline.
In assisted living, residents have plenty of opportunities to socialize with their neighbors. They can meet and chat over dinner in the dining hall, get involved in volunteer opportunities, participate in scheduled activities, or simply start up a conversation with someone as they’re walking down the hall.
Assisted living puts people together so that it’s easy to form friendships and stay engaged, which is enormously important for successful aging.
What to Look For in an Assisted Living Facility
When you tour an assisted living facility, it’s easy to get swept away by its outward appearance and all the bells and whistles that might come with a residency there.
However, it’s important to look at the details and do your research. Some facilities are less than scrupulous, putting on a good show to attract new residents but not following through on their promises of quality gourmet meals or weekly outings to the museum. Too many children tell heartbreaking stories of their parents not getting the care they were promised and even suffering abuse and neglect at the hands of staff members.
There are many factors to consider before you and your parents make a final choice, and you want to make sure you choose a community that truly cares about its residents. Here are a few things to look for as you tour assisted living facilities.
Tip: As you tour each facility, take notes. Write down what you like, what you don’t like, and any red flags you want to research after you get home. You might think you’ll remember it all, but over time, the details will start to fade. Taking notes as you go, or once you’re back in your car, will make it easier to choose the best facility when you’re ready to make a decision.
1. The Personality of the Community
Assisted living facilities are no longer the dreary, listless places they once were. Some of today’s facilities feel like resorts, with beauty parlors, fountains, swimming pools, and extensive gardens. Others feel more like home, with cozy reading nooks by fireplaces and community coffee shops where residents can mingle. Some communities are located in a towering apartment complex right in the heart of a bustling city, while others are out in the suburbs or even the country.
It’s important to tour as many facilities as possible. Each community is unique, and it might take some time to find a facility with a personality that fits your parent well. Keep in mind that a fancy or well-appointed facility doesn’t always equal excellent care.
When you’re touring facilities, remember that you’re helping choose a community for your parent. Your goal is to find the best community for them. You may like one community better than another, but if your parent doesn’t prefer it, it won’t be a good fit.
2. An Engaged Activities Director
Activities can make or break a facility. A great activities director who truly cares about the residents can do a lot, even with a small budget. However, an activities director who doesn’t care and is just “phoning it in” will severely limit what’s possible for residents.
When touring communities, ask to meet the activities director personally, if possible. Find out what their budget is, and get a list of the events that are organized weekly and monthly. Ask about their goals for the community and what they’re doing to achieve them.
Next, look over the events with your parent. Which of these activities would your parent actually be interested in doing? How many are they capable of doing at this stage in their life?
3. Staff-to-Resident Ratio
Just like parent-to-student ratios in schools, the staff-to-resident ratio directly affects how much care and attention your parent will receive. Facilities with a larger staff will be able to provide more attention to residents, but costs will be higher. Find out how many people are directly involved in resident care. Don’t include support staff like the kitchen crew, housekeeping, or grounds maintenance crew in this number.
Understaffing is a common problem at assisted living facilities. Consumer Reports states that many facilities only have one or two direct-care staff members for every 15 residents during the day and one or two for every 20 residents at night. Often, this just isn’t enough, especially when that mix includes residents who need a high level of care.
As you tour the facility, pay close attention to the behavior of the staff. Do they seem friendly to visitors? Are they happy and engaged with residents? Do they really listen when residents talk to them? Do they treat residents with respect?
You’ll also want to find out about the training and certification requirements for staff members. What courses and training are they required to go through each year, if any? If your parent needs to be placed in a dementia or other memory care unit, it’s especially important to ask about training. As of June 2018, only 16 states require a license or certification for dementia care units, which means that in some states, these units are staffed by people being paid minimum wage who have no training at all. HealthCare Interactive has an interactive map where you can find out more about your state’s dementia care requirements.
Last, ask about employee turnover. High staff turnover might point to low pay, lousy benefits, or a dysfunctional management team, all of which spell trouble in an assisted living facility. Your tour director may not share this information or be honest about their turnover rates, so try to talk to some current residents on your own to find out.
A good assisted living facility will look and smell spotlessly clean. As you tour the facility, look past the fresh bouquets of flowers and sparkling windows. Instead, peek under furniture in the community room, check out the baseboards, and examine the switch plates. These “hidden areas” can give you important clues about how much the staff cares about cleanliness.
Also pay attention to smells. Strange or unpleasant odors in one room or part of the facility might indicate a recent or temporary incident, which happens at any care facility. However, if you notice strange or unpleasant smells throughout the entire building, it could indicate a lax attitude toward cleanliness.
Make sure you ask about housekeeping services for residents. How often does the housekeeping staff come in to clean? What cleaning duties are they responsible for? If there’s an issue with a resident’s apartment, how quickly does staff respond?
5. The Quality of the Food
Some assisted living facilities employ talented chefs who take enormous pride in creating a restaurant-quality menu and dining experience for residents. Other communities employ cooks who serve up diner-style food that might not be as tasty or as healthy as you’d like.
That’s why eating a meal at each facility is so important. Sure, you want to check out the quality of the food, but it’s also a great chance to get a feel for the dining room experience, which will be an important part of your parent’s stay there. An additional bonus is that you’ll be able to talk to residents and find out how they like living there.
When you tour each community, ask about dining room hours and what happens if your parent doesn’t want to come down for a meal. Are there options for eating alone elsewhere in the community, or would they have to eat in their room or apartment?
6. Safety Features
Safety and security is a big concern for both seniors and caregivers. As you tour apartments, look closely for potential hazards. Are there any steps or ridges in the flooring that could pose a tripping hazard? Are doors easy to open and close? Are grab bars easily accessible in the bathroom?
Most facilities were designed with seniors in mind, so you might not find any hazards in a new building. However, communities in older buildings might still be grappling with design flaws that haven’t been addressed.
You also need to look carefully at each community’s security practices. For example, are doors that lead to the outside kept locked? Who is allowed to enter the building? Do visitors have to check in at a front desk? Is there video monitoring in place?
Next, ask about staffing patterns. For instance, are there registered doctors and nurses on staff just during the day, or 24/7? What is the staff-to-resident ratio at night? If there’s an emergency in the building, how many staff members will be available to help residents evacuate? If there’s an emergency in your parent’s apartment, how will they contact staff for help?
7. Personal Care
Each resident in assisted living needs a different level of care when it comes to their activities for daily living (or ADL). Some residents need help with bathing, getting dressed, and taking medication, while others simply need to have their meals cooked at the end of the day.
Ask about the level of care that staff members provide and find out when this care is provided. For example, if your parent likes to be in bed very early and needs help putting on pajamas, when can a staff member come by to help them go to bed?
8. Future Health Needs
As your parent ages, their health needs will change. Look at each facility in terms of what your parent needs now and what they might need in the future.
For example, many seniors in the early stages of Alzheimer’s function just fine. But in a few years, they will require more extensive care. It’s important to look at a facility’s memory care unit, if they have one, in addition to their apartments for independent living.
If you know your parent will require specialized care at some point in the future, make sure you address those needs with the facility director and ask how they’ll be met. It would be stressful and traumatic to have to move your parent to a new facility after they’ve made friends and settled in because they have new needs that can’t be met at their facility.
You can’t predict the physical changes or illnesses your parent will experience in the years to come, but you can keep those potential changes in mind and look for communities with specialized care units.
9. Local Standards & Regulations
Assisted living facilities are regulated in all 50 states, but unlike nursing homes, which are regulated at the national level, standards and licensing requirements for assisted living facilities vary widely. For example, some states require that assisted living facility staff have extensive training in senior care, while other states don’t require any training at all.
State transparency levels differ too. Some states provide excellent public access to assisted living facility records, making all records and incident reports available online. Other states only provide very basic information. If you live in a state with only basic access to these records, you may have to file a Freedom of Information Act request to obtain records.
You can get detailed information on your state’s licensing standards by visiting AssistedLiving.com. You can also find information on each’s state’s records accessibility, as well as detailed information on how to obtain records on assisted living facilities for each state, at A Place for Mom.
It’s incredibly important to research any facility you’re considering signing a contract with because there is no federal oversight, and most states have only limited regulatory requirements. And abuse and neglect, including elder financial abuse, can and does happen. Consumer Reports states that over 55,000 complaints were filed against assisted living facilities in 2015, a 10% increase over the year before. The main causes for complaints were understaffing, delays in responding to calls for assistance, and threats of eviction.
How Much Does Assisted Living Cost?
As you might imagine, the cost of assisted living varies widely depending on the community’s location, the type of residence (apartment, cottage, or townhouse), and the level of care and services provided. According to Genworth Financial’s 2017 Cost of Care survey, the national average cost for assisted living is $3,628 per month.
Location plays an enormous role in costs. Facilities in major cities will cost more than those in more rural areas. While your parent might want to be in the hustle and bustle of a large city, Caring.com reports that choosing a facility an hour away could cut costs by 25%.
You can also save significantly by relocating to a neighboring state. For example, the average cost of assisted living in California is around $4,600 per month. In Arizona, however, it’s around $1,000 less per month. You can find detailed information on costs for your state by using Genworth Financial’s state-by-state locator. Their site also lets you compare the costs for home health aides, adult health day care, homemaker services, and nursing homes.
Another way to save is to time your move-in. Assisted living facilities are a business just like a car dealership or hotel, which means they have to meet budgets and residency quotas. If possible, time your move-in for the end of the month, end of the quarter, or end of the year. You might find the facility is more willing to negotiate lower fees and rent during these periods.
Most of the time, assisted living costs less than hiring a full-time aide to care for an aging parent at home. A Place for Mom has a senior care calculator that can help you determine which option would make more financial sense for your situation.
As you go through this process for your parent, you might be a bit shocked at the high cost. It might even cause you to rethink how much you need for your retirement. Not saving enough for retirement, especially for assisted living and nursing home needs, is a common retirement planning mistake.
The Best Time to Tour a Facility
Many seniors are reluctant to consider assisted living for a wide variety of reasons. Some don’t want to leave their homes and all the memories tied to them. Others feel that moving into assisted living means giving up their independence, while still others don’t want to accept that they might need assistance with daily living.
You can help your parents overcome their reluctance by visiting a community when it’s having a social event. Most communities organize several social events each month; these can range from large family dinners with children and grandchildren to performance art or inter-generational events involving local preschools or Scout troops.
One of the benefits of touring a community during a social event is that your parent might feel less stress and pressure. They will see residents talking together and having fun, and it might take away the fear that they’ll be alone or neglected. It will also be an easy way for your parent to meet some of the other residents.
When you’re ready to start touring communities, call ahead and ask the director to mail you an events calendar. You can then schedule your tours during an event your parent might be particularly interested in seeing.
It’s also important to visit the facility on your own, without your parent, unannounced. Look carefully at the staff and residence when it’s not an official “tour day.” Showing up unexpectedly can give you a crucial look at the real day-to-day experience of the community.
Mistakes to Avoid
Choosing an assisted living facility is an emotional process for both aging parents and their caregivers. Because of this, it’s easy to make some big mistakes that can cause additional stress for the entire family.
Mistake #1: Choosing a Community Because It’s Nearby
Yes, you want your parent as near to you as possible to make daily or weekly visits easier. But it’s a big mistake to choose an assisted living community simply because it’s a few miles closer to you.
You need to find a community that’s a perfect fit for your parent, even if that means you’ll have to drive further out of your way for visits. Remember, your parent is the one who will be spending every day at this community. It’s their new home, so it needs to be a perfect fit.
Mistake #2: Thinking Your Role Is Over
Even though your parent will be cared for by others, this doesn’t mean that your role of caregiver is over. It’s simply changing form.
Your parent needs you now more than ever, and this means that you still need to carry on the role of their caregiver. Regular visits to stay connected are essential.
It’s also vital that you, and the rest of your family, keep a close eye on your parent’s health and well-being to make sure they’re being well taken care of and that their needs are being met. If they’re unhappy or their health is declining, you need to find out why and take steps to resolve the situation.
Mistake #3: Not Reading the Contract
Read each contract carefully so you’re not hit with additional fees or unexpected charges you aren’t prepared for.
For example, some facilities charge separate amounts for room and board and help with daily activities. Others might raise rent rates annually when you renew your contract or charge a steep “application fee” they didn’t tell you about on the tour. They might also charge additional fees for medical supplies, laundry services, or other needs.
The best time to ask about fees and rent increases is when you’re touring the facility. Ask for a copy of the contract before you leave so you have plenty of time to look through it on your own.
Mistake #4: Making a Rash Decision
Sometimes, a parent’s declining health can be sudden and unexpected, which means caregivers have to make a quick decision.
To avoid getting stuck in this situation, start your search early if you can. Doing research now and having a short list of options prepared can help you make a better decision if your parent’s situation changes and you have to move them out of their home suddenly.
Mistake #5: Not Getting Help
Transitioning your parent to this new phase of their life can be an overwhelming and emotional process. That’s why you need help.
If you’ve been the primary caregiver for your parent, ask your siblings for help in the decision-making process. Even if they live too far away to tour communities, they can still research them online and do phone interviews to help narrow down your list of options.
There are also several companies that can help you find a community that fits your needs and budget. A Place for Mom is one such service that’s free of charge. You can also get help through Eldecare.gov, a public service run by the U.S. Administration on Aging.
Assisted living can be a great option for aging parents. These communities encourage friendships and socialization, help keep residents active and ensure that they get hot meals, and provide a safe and secure environment for added peace of mind.
While choosing an assisted living community for your parent may seem overwhelming at first, following these tips can help make the decision easier. Take the time to do your research and weigh your options, and you can find the perfect fit for your parent’s needs and budget.
Is your parent in an assisted living facility? What has your experience been like? What do you know now that you wish you’d known when considering facilities?