Some assisted living facilities are specially equipped to work with dementia and Alzheimer’s patients. This means that the environment is designed to be friendlier to residents with these conditions and that staff has been trained to meet their specific needs. How do you know if a facility that claims to specialize in these conditions is really right for your loved one? The only way is to visit. You’ll want to start by looking at our checklist of things to consider when visiting an assisted living facility, but you should also be alert for how the facility performs in each of the following categories. Environment Alzheimer’s and dementia patients are aided by routine and can easily become over-stimulated. The environment should be calm and peaceful, and the daily schedule should be consistent. Another sign that the facility is friendly to Alzheimer’s and dementia patients is cues that enable them to get around and complete tasks on their own, such as personal mementos that make it easy to identify a resident’s room and color-coded guides to common areas. Safety Facilities that cater to Alzheimer’s and dementia patients should have motion detectors or other monitoring systems to alert staff when there might be a problem, such as a resident wandering off. There should be systems in place to insure residents get the right medicine at the right time. Also pay attention to how disruptive behavior and outbursts are handled. The staff should not be using physical restraints or sedation. Staffing First and foremost, the staff should have the compassion to make your loved one feel comfortable. Ask about their training and experience, and consider how many staff members work each shift. Make sure there is adequate staff on weekends and holidays. The facility should also seem to be a pleasant place to both live and work. What does management do to prevent staff burnout? If staff turnover is high, this can be disorienting to residents. Quality of Care How much information does the staff request about your loved one, and is that information then used to design a detailed care plan? Are they taking comfort and psychological well-being into account in addition to health and safety? How many of the residents have dementia or Alzheimer’s? Ask what the staff does differently for these patients. Policies One of the most important things to note is how the facility handles the progression of the disease. How is it decided when additional care is necessary, and to what extent is family involved? Find out what happens when a resident needs to go to the hospital. Will his or her place in the community be reserved, and what are the fees in this situation? In general, what additional costs does the facility charge for care of dementia or Alzheimer’s patients? Watching for how a facility performs on the above categories can help you find a place that is truly suited to your loved one’s needs, and not just marketing a specialization that they don’t really have. Your loved one deserves quality care.
More and more, you’ve been worrying about an elderly parent or loved one who lives alone. Do they need more help? Are things really just fine, or are they in denial and trying to hang on to living on their own longer than they should? These signs can help you determine whether it’s time to have a talk with them about moving into assisted living.
  • Has your loved one become forgetful about important things, such as medical appointments, paying bills and when to eat?
  • Has your loved one experienced any weight change? This could indicate that he or she is having trouble shopping for and preparing proper meals.
  • Is there a lot of expired food in the refrigerator or is it empty?
  • Is your parent following the proper medication regimen? Can your parent tell you about the different medicines and what they’re for?
  • Are you worried about your parent’s ability to be behind the wheel? Have they had a recent traffic incident or are there scratches and dents on the car that weren’t there before?
  • Has your loved one had a fall recently?
  • Is your loved one hiding bruises, cuts or burns from you, or does he or she not know how they happened?
  • Has your parent had a problem with small fires?
  • Does your loved one wear the same clothes all the time?
  • Does your loved one seem to be keeping up with his or her hygiene? Do they have strong body odor, or do you smell urine in the house?
  • Are they continuing to maintain their home and the yard or have they neglected tasks that they usually take care of?
  • Is your parent able to stand from a seated position with relative ease? Can they maneuver as they need to?
  • Does your loved one tell you that he or she hears noises at night?
  • Does your parent seem to be isolating him or herself and spending more time alone?
  • Has your parent become unusually suspicious or fearful?
  • How does your parent react in an emergency?
  • Is your parent behaving strangely or uncharacteristically in any way? Has he or she been expressing any disorientation?
It is difficult to confront seniors about such matters, as they often want to stay independent and don’t realize how seriously they need help. Your parent needs you at this time to step in and express your concerns, before a terrible incident takes place. If you have decided to take action, your next step is to do research to determine what your loved one needs, seek out a geriatric assessment, and research facilities. There is a lot of work to be done at this stage, so finally don’t forget to seek out help and support for yourself too. You can only care for others once you’ve cared for yourself.
There are many misconceptions about assisted living floating around out there due to the complexity of senior care. How senior care is offered has also changed, so someone who hasn’t had any contact with this area in recent years may have ideas that are out of date. Finally, negative perceptions tend to get repeated more often both among acquaintances and in the media. Let’s examine some of these misconceptions. An assisted living facility is the same thing as a nursing home. Assisted living facilities actually have come about relatively recently, and they are distinct from nursing homes. Assisted living is designed to address the needs of the senior who may need help with some things, but is otherwise independent and healthy. In contrast, nursing homes are for those who need to have skilled medical care available around the clock. Assisted living facilities encourage seniors to be as active and as independent as possible. They focus on allowing seniors to feel that they’re living on their own and not burdening their families, but that help is still close by. Medicare pays for assisted living. Unfortunately, as many seniors learn when they investigate assisted living, this is false. While nursing homes are able to accept Medicare, assisted living facilities cannot. Medicare only pays for medical expenses, and assisted living facilities do not provide medical care. Usually, people pay for assisted living with long-term care insurance or private funds. There are some assisted living facilities who will accept Medicaid, but these residents may not best be served by assisted living communities. The food in assisted living facilities is lousy. At least at Raya’s Paradise, that’s not true! Our residents savor delicious home-cooked meals and snacks. Seniors with Alzheimer’s won’t be accepted into an assisted living facility. Some facilities, such as Raya’s Paradise, offer specialized care for residents with memory problems, including Alzheimer’s. Assisted living facilities have poor resident to caregiver ratios. Out of all the types of senior care, assisted living actually has the best resident to caregiver ratios. Raya’s Paradise has one caregiver for every three residents. In comparison, nursing homes sometimes have one caregiver tending to 20 or even 30 residents. Assisted living is expensive. Different types of senior care use different pricing models, so you’ll have to carefully compare what level of care you’re getting at a particular rate, and consider whether a certain level of care is necessary. Generally, assisted living facilities are cheaper than nursing homes, which offer constant medical care to seniors with serious problems. Assisted living offers a solution for seniors who are independent in some ways but need help in others. It often can be a way for seniors to make the most of the time they have left and feel secure. It allows them to maintain their quality of life, which everyone can agree is the goal.
Just because an assisted living facility doesn’t have fifty beds or more doesn’t mean it’s inferior in any way. Small homes need to meet requirements in order to be licensed, just like larger facilities do, and this insures a certain standard of care across the board. In fact, smaller homes are quite likely to be better! Customized and Responsive Care In smaller facilities, the staff can get to know the residents well and better understand their unique needs. The staff is also much more likely to notice and address any problems immediately. There is probably a smaller staff-to-resident ratio, insuring thorough care and quicker help. Smaller facilities tend to do a lot more for their residents. The rate of staff turnover is also likely to be low. In smaller facilities owners and the management feel a sense of pride about providing a well-run home for the seniors living there. Think for example of the better service you receive at a mom and pop store or a small boutique, compared to a large impersonal corporation like your cable company or a huge bank. As with any large institution, it takes a lot to run the bigger assisted living facilities. They require a large staff to keep on top of things, and a large staff requires another layer of management on top of that. To keep order there are likely to be rigid schedules and routines. It takes so much effort just to keep everything running smoothly that the individual residents living there can easily get lost and not experience the flexibility they need. Smaller facilities can instead adapt to the residents and their wants and habits. Ease of Communication Smaller facilities are able to communicate with residents and their families on a more personal level. When you call, you will likely be able to speak to someone in a high-level position of responsibility quickly. If you have a concern, you can be confident that you can easily reach someone who can help. Intimate and Less Stressful Environment A smaller facility is much more likely to feel like a home rather than an institution. It may, in fact, even be located in a house. Close bonds are formed both among the residents and between the residents and the staff. And we all prefer home-style cooking to that served by a big cafeteria! The small environment can be easier for seniors to adapt to and navigate, especially seniors with Alzheimer’s or dementia. With larger hotel-style facilities, it can be a challenge for residents just to find their rooms! The less stress residents experience due to their environment, the more they can enjoy their stay.   If you value having a responsive, caring, and comfortable facility, make it a priority to seek out smaller assisted living homes.
Making the mistake of choosing a bad assisted living facility is a nightmare scenario for seniors and their families. Imagine living in a place where there are all sorts of hidden dangers to your safety that make it more likely you will have an accident, where the people around you are indifferent or even hostile, where you have no control or say in how to live. Your calls for help go unanswered, and when your family tries to advocate for you they get mired in arguments with the management. No one wants to make such a large commitment and then realize that they are stuck, even temporarily, in horrible living conditions. Some bad facilities can be spotted right away due to their deteriorating physical conditions and clearly depressed residents. But in facilities that on the surface seem just fine, there are other smaller signs you should look for that could be clues to larger problems. Many of them are listed below. Any facility that takes pride in providing excellent senior care should have these items covered.
  • Is the facility’s state license and a Resident Bill of Rights displayed in the lobby?
  • Where are smoke detectors located? They should be in rooms, hallways, and community areas.
  • Do the windows have safety locks?
  • Is there an emergency generator or some other way to provide electricity if the power goes out?
  • Does the facility have fire drills and are emergency plans easy to find?
  • What is the crime rate in the neighborhood where the facility is located?
  • Will the carpeting in the rooms prevent residents from moving easily with walkers or canes?
  • Handrails should also be plentiful throughout the facility.
  • Does the bottom step on stairs have recessed lighting or colored tape to make it more easily seen?
  • Have area rugs wandered so that they’re sticking out over the top step of the stairs?
  • Is the light in the facility adequately bright?
  • Is there a way to call for help in the bathrooms? Are there non-slip mats and handrails near the toilet and inside and outside of the shower? There should be a shower and not a tub, and the shower should have a seat where residents can sit if they need to.
  • Are there strong smells? A heavy cleaning chemical smell could indicate that the facility is trying to cover something up.
  • Ask to see an occupied room. Is it clean?
  • Is there a big difference between the atmosphere of the lobby and common areas and the rooms?
  • Try to listen to how the staff addresses and talks about the residents. Are they using the residents’ names?
  • How does the staff treat you? Are you acknowledged or ignored?
  • How does the staff speak to residents or to one another? If they are polite to you and to residents when in your presence, but rude to each other, that may be a sign of how they treat the residents on a daily basis. People can only be on their best behavior for so long, and if you don’t like how they act with people they are comfortable with you probably won’t like how they act once you’ve signed a contract and paid the entrance fee.
  • Do calls for help seem to be answered quickly?
  • Are there residents sitting alone in wheelchairs with no one to help them?
  • Are residents eating all their food at mealtimes?
  • Do residents seem happy, active, and social?
  • Is their appearance clean and well-groomed?
  • Are common areas being used?
  • Does the facility seem chaotic or crowded?
  • Does the facility seem open to visitors during your tour? Are you able to speak with residents?
  • If a parent and adult child are visiting the home together, does the tour guide make an effort to include the senior in conversations as well?
  • If you stop by unannounced, will the staff let you in?
  • What do you find when you research the facility through the Better Business Bureau, local agencies, or online? How does the agency respond when you ask them about negative feedback? Have they responded to negative feedback left online?
  • Look over the contract carefully. When can residents be evicted? What happens when they run out of money?
When evaluating an assisted living facility, be sure to not just take the official tour, but also make unannounced visits. First, stop by during dinner to observe how the residents interact with each other during the meal and whether or not they like the food. Then make another surprise visit on the weekend. During this time, you’ll be able to meet family members of the residents either in the common areas inside or the parking lot. You can get their candid opinion on how their loved one has been treated. Try to sit for awhile in an area that has a lot of foot traffic but is away from offices where the marketing staff or management might be. Just observe what goes on around you.
The biggest fear many have when making senior living decisions is what it will cost. The fees for assisted living facilities at first glance may seem quite high. Keep in mind though all that assisted living covers: housing, at least some meals, and help with your daily needs. Beyond assisted living and your medical expenses, you will likely need to spend very little, if anything. Assisted living is usually paid for using long-term care insurance, personal funding, or veterans benefits. These funds may be supplemented by social security. Long-Term Care Insurance Long-term care insurance covers services that help people who need medical or non-medical care over a long period of time. It will cover assisted living if you cannot perform two or more “activities of daily living” (ADL), such as walking, using the bathroom, or getting dressed. You may have to have an examination by a doctor chosen by the insurance company to be sure that you qualify. The benefit is often structured so that the policy has a daily limit, usually $100-$150, and a lifetime maximum, for example $250,000. Some policies have an elimination period, an amount of time during which you must pay for your own care (similar to a deductible). As you grow older, your premium is likely to rise since the older you get the more likely you are to require long-term care. If the premium rises beyond your ability to pay, the insurance company will likely offer a lower premium in exchange for reduced benefits. In some but not all plans, you no longer have to pay your premium once you begin using the benefit. Personal Funding Money to pay for assisted living may come from retirement funds like Individual Retirement Accounts (IRAs), pensions, or 401k plans. People also use the funds from the sale of their home. A home purchased 40 or 50 years ago will yield quite a bit of equity that can go towards senior care. If you are unable to find a buyer by the time you need to move, you may be able to get a bridge loan to help pay for your care. This loan provides immediate funding, which you then pay back when your house does sell. You can usually gain at least a few extra months to sell your home before you need to start making payments on the loan. If you don’t want to sell your home, there are other options available. You may be able to rent it out, thus giving you a monthly income. You may also be able to take out a reverse mortgage, where you receive money drawn against the equity you have in your home. You can receive this money as a lump sum, monthly payment, or revolving line of credit. Keep in mind that your spouse (or someone who owns the home with you) must still be living in your home for you to qualify. Also, the starting costs associated with these loans can make them quite expensive. With any of these financing options, if you have relatives who are in a position to lend you money in exchange for equity in your home, you may be able to come up with a similar arrangement privately, rather than borrow from a bank or other company. Consult with a lawyer to learn more about this option. Veterans Benefits Veterans benefits may be able to help you finance care in an assisted living facility, if you or your spouse served in the military. This is the Aid and Attendance tier of the Improved Pension offered by the Veteran’s Administration. You do not need to have any sort of injury related to your service, though you must have been on active duty at least 90 days and one day during wartime. You also must have less than $80,000 in assets. You’ll need to file the Veteran’s Application for Compensation and/or Pension (VA Form 21-526, Parts A, B, C, and D). A Note on Medicare and Medicaid First, you should know that some assisted living facilities, including Raya’s Paradise, only accept long-term care insurance or private funding. Also be aware that Medicare does not pay for assisted living as assisted living is not medical care but rather assistance with your daily needs (Medicare will pay for medical expenses incurred during the time you are in the assisted living facility, such as your prescriptions or visits to the doctor). Medicaid might pay for a limited stay (often 90 days or fewer), but even then, coverage is limited. In some states Medicaid pays for the personal care services you receive, and in others it pays for room and board as well. Medicaid does not currently pay for assisted living in the following states: Pennsylvania, South Carolina, Alabama, Kentucky, and Louisiana, though it is likely that there will be national coverage in the coming years. Finally, you may be eligible for tax deductions that can also help pay for senior living expenses by reducing your tax liability. You can learn more by doing research at on the Elderly and Disabled Tax Credit and Medical Expense Tax Deductions, and on your state’s elderly care tax credits. You may also find it helpful to talk to an accountant.
Your selection of an assisted living facility should involve both tours of the places you are considering and extensive conversations with those running the facility. Comparing different facilities to one another can seem overwhelming. Use the checklist of questions below to help you notice important details that can reveal the true quality of a facility and aid you in the selection process. Note that if you are evaluating assisted living facilities on behalf of a loved one, you should try to involve them in the process and get as much of a sense of their desires as possible. He or she is the one who will actually be living in the facility, and his or her comfort, happiness, and satisfaction is the most important outcome. In General
  • What is your gut feeling about the assisted living facility both at the beginning and end of your visit?
  • Do the current residents seem happy and satisfied?
  • If you are able to talk with residents or their families about their experience, what do they say?
  • What do you learn when you research reviews and other information about the facility online?
  • Is the facility clean and free of odors?
  • Is the temperature appropriate?
  • Does the environment feel attractive and comfortable?
  • How many units are in the facility?
  • Does the assisted living facility offer private or shared rooms, or a mix?
  • What common areas are available?
  • Will any features of the community pose a problem for your condition?
  • Are the rooms large enough to meet your needs comfortably?
  • What are residents allowed to bring with them when they move in?
  • What are residents allowed or not allowed to do within their own rooms?
Nature and Quality of Care and Services
  • Does each resident have a written care plan? How often is it reviewed and revised?
  • Who is involved when assessing the resident’s needs? How much say does the resident have?
  • How does the assisted living facility adapt as the resident’s needs change?
  • What services does the facility offer and how often are they provided?
  • Is staff available to assist the residents 24 hour per day?
  • Are special care units available, for example for dementia patients?
  • How often are meals served, what times, and where?
  • How much variety is there in the menu?
  • Does the kitchen accommodate special needs and requests?
  • Is the facility well lit and does it have clear signage?
  • Are there call buttons in the rooms?
  • Are there safety locks on the windows and doors?
  • Are there handrails in the bathrooms and elsewhere in the facility?
  • Is the carpet firm to assist with walking, and are there non-slip materials on the floor?
  • Is there an emergency generator or another plan in place for power outages?
  • What do the assisted living facility’s fire safety and security systems consist of?
  • What is the plan if a resident wanders off?
  • What is the plan for a resident’s medical emergency?
  • What is the hiring process for new employees? Is there a background check?
  • What are the policies about elder abuse and neglect?
  • Would you or your loved one get along with the assisted living facility’s current residents?
  • How does the staff treat you?
  • How does the staff interact with the current residents? Do they seem to have a good relationship with them and know their names?
  • How do staff members treat each other?
  • Are residents chatting with one another during meals?
  • What organized activities are on the schedule? What activities do you notice taking place? Are they well-attended?
  • Are residents encouraged to attend activities?
  • How much interaction do residents have with the outside community?
Fees and Policies
  • Are you allowed to examine a contract? Does it clearly lay out all services, fees, and policies?
  • How much is the entrance fee and security deposit? Is the deposit refundable?
  • What is the monthly fee?
  • Is long-term care insurance accepted?
  • How does the assisted living facility bill for services?
  • What is the policy on late payments?
  • How are rate increases handled?
  • What if the resident runs out of money?
  • What are the rules for when residents must leave the facility? What are the most common reasons why residents leave?
  • How are refunds and transfers handled?