Our common sense and intuition are good indicators for selecting a residential care facility. But beyond what your “gut” tells you, there are important questions to ask. Some can be taken care of by telephone, but the best way to gauge whether a facility fits your needs is to visit. Try to visit more than once, and try to visit at least three. Make an appointment when you need in-depth information (such as for your first visit), then come unannounced on a different day & hour of the week just to observe.

(The following questions would certainly apply to retirement communities, assisted living facilities, adult family homes, or nursing homes)

Key questions to ask:

1. Is there space available now? For someone looking ahead, is there a waiting list? In case of a vacancy, what happens if you’re not ready yet (name drops to the bottom or stays where it was?)?

2. What is the cost structure and extra charges? Many facilities charge based on each person’s care requirements according to a “points” system. The more points, the more expense. Others charge the same price to everyone. Expect the price to go up a little each year — ask about its history of price increases.

3. Does the facility accept Medicaid? Medicare (if a skilled nursing home)?

4. Ask for references of several family members of residents whom you can call.

5. Is a representative from the Long-Term Care Ombudsman’s Office assigned to the facility to help resolve problems? A negative answer may mean nothing, since there are not enough volunteer Ombudsmen to serve all facilities. But, if an Ombudsman does visit, he/she can often be proactive in stopping problems early.

6. If your relative has special needs, such as a diabetic or low salt diet, be sure to ask if these needs can be accommodated. Ask what happens to people who:

• are incontinent and can no longer take care of themselves
• are unable to bathe or dress alone anymore
• are confused and need redirection or have socially inappropriate behavior?
• need help with injections or other medications
• need to use a wheelchair
• are unable to walk unassisted or get in/out of bed
• need nighttime help ** probe on this**
• are dying

7. What causes residents to be asked to leave? Does the facility help with placement?

8. Pay attention to the activity schedule, if activities are important – and check to see if they actually happen.

9. Ask how care needs are assessed over time, how often, and whether you are invited to attend these meetings.

10. How is medical care provided – does a physician or nurse practitioner come to the facility? Does the facility provide a van to take residents to doctor appointments? Are residents required to use the pharmacy selected by the facility? (In adult family homes, family members may be required to take their relative to appointments.)

11. If the facility is licensed by the state (it is if it provides hands-on-care, in which case it will be licensed as a “Boarding Home,” adult family home or a nursing home), ask to see its recent state survey or inspection report (it may be in the lobby for you to review).

12. For adult family homes, how does the caregiver take a break and how does she/he provide for back-up?

13. What happens if a resident goes temporarily to the hospital?

14. For residents who are confused, how does the facility prevent them from wandering away?
As you Observe:
15. Use your senses – eyes, ears, nose, taste and touch. Does the place smell? Does it seem clean? Is the furniture where the residents sit clean? Are the call bells being answered? Do you hear haste and irritation in the voices of staff? This may indicate staff shortages and overwork. Have a meal if you can and decide if it’s tasty.

16. Sit in the living room awhile and observe: Is there a sense of camaraderie and friendliness between residents and staff? Consumer Reports calls this the “warmth index.” Get a feel for how friendly the staff is with residents (and vice versa) and with their peers. If you can, talk to residents about how they like the place.

There are two other very important categories of questions that are rarely asked — yet will start a revolution if more people think about them:

Management – who’s the boss?
The history and reputation of any company in the eldercare business tells a lot. Just as we develop brand loyalty for other items we buy (Sears, Nordstrom’s, Target, etc), we need to know the corporate history of care-providing businesses to predict their quality. Who’s in charge? What are its values? How does it treat staff? How does it treat residents? Is it in the business of taking good care of people and making money or just making money??

To learn as much as you can about the history and reputation of a company that provides care, start with these questions about the management outfit that operates the facility (there’s often a different owner):

• Who manages (/owns) the facility? (Company name or individual)
• What is its history of caregiving? How long has it been in this business?
• Where else does it do business? What is its reputation and history there?
• When has it been in trouble, if ever, with the authorities, and Why?

It’s often hard to find answers to these questions. Some marketing people can answer some, many can’t. It’s also not available through Senior I & A or other government agencies, so it can take some sleuthing. Keep track of bad providers in tv and newspaper reports. You can call the Ombudsman’s Office for a list of complaints against specific facilities.

Staffing patterns
Long-term care services are, by definition, heavily labor intensive, and the staff who provide the care determine its quality. Rapid, high turnover is widespread throughout the industry – for reasons that have to do with the general job market, but also with historically poor management practices, poor wages, poor benefits, sloppy hiring, non-existent career ladders, and poor working conditions. Ask questions about staffing practices. Older people need
consistency and gentleness and a caring attitude from the staff who care for them. The best companies in eldercare are likely to be the best bosses, so these issues ought to be part of the decision-making process. For example:

• What do you do to retain your employees?
• What are the qualifications of your caregiving staff and managers?
• How long has key staff worked there (including the person you’re talking to)? This includes the administrator, marketing, social worker and head nurse
• Does staff receive benefits, such as health insurance, vacations, sick leave?
• What is the staff-to-resident ratio?
• Is staff insured for on-the-job injuries?
• What are the company’s Quality Assurance mechanisms? When someone complains, what happens?
• How are staff’s competence and skills tested?
• Is ongoing staff training required?
• Does the company obtain reference checks on new staff? Does this include a criminal background check?
• Is staff up-to-date with their TB test, CPR?
• If you’re seeking care in a dementia unit, what is the staff’s training in caring for people with dementia?

Families don’t need to ask all these questions, but it’s important to ask some. Then try to check out the honesty of the answers. Remember: your intuition and common sense are probably pretty good antenna!

Provided by:  2001 Aging Deliberately,
Licensed by University of Washington

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