Caregiving: What You Need to Know About Assisted Living

Reviewed by Celia E. Dominguez M.D. WebMD, January 2008.

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What is assisted living?
Assisted living is a type of housing for people who need various levels of medical and personal care. Living spaces can be individual rooms, apartments, or shared quarters. The facilities generally provide a home-like setting and are physically designed to promote the residents' independence. Services are offered to assist residents with daily living.

What services do assisted-living communities provide?
The services offered by assisted-living communities vary from facility to facility. Services often include:

• One to three meals a day
• Monitoring of medication
• Personal care, including dressing and bathing
• Housekeeping and laundry
• 24-hour emergency care
• Some medical services
• Social and recreational activities

How can I know what services I need?
Talk with your family and caregivers about what services are needed. Take time to consider what services are important to you before you visit assisted-living communities. This step will help ease your transition. Think about these questions:

• Why do I want to change my residence?
• What daily activities do I need help with (bathing, dressing, toileting, eating)?
• How often do I need help?

What should I look for in an assisted-living community?
The following checklist will help you and your family evaluate assisted-living facilities. Review the checklist before your visit to the facility and take it with you.

Assisted Living Consumer Checklist
General Concerns

• Does the residence meet local and/or state licensing requirements?
• What is the policy on insurance and personal property?
• What is the procedure for responding to a medical emergency?
• Are visitors welcome at any time?

Needs Assessment

• Is there a written plan for the care of each resident?
• What is the procedure for assessing a potential resident's need for service? Are those needs reassessed periodically?
• Can a resident be discharged for refusing to comply with a care plan?

Contracts, Costs, and Finances

• Is a contract agreement available to include accommodations, personal care, healthcare and support services?
• When may a contract be terminated and what is the refund policy?
• Are additional services available if the resident's needs change?
• How do you pay for additional services that are needed on a temporary basis (such as nursing care)?
• Are there different costs for various levels or categories of services?
• Are there any government, private, or corporate programs available to help cover the cost of services to the resident?
• What are the billing, payment, and credit policies?
• May a resident handle his or her own finances with staff assistance (if able), or should a family member or outside party be designated to do so?

Professional Staff

• Is staff appropriately trained?
• Did you receive a warm greeting from staff? Are staff members personable and outgoing?
• Is staff appropriately dressed?
• Do staff members greet residents by their first names and interact warmly with them?
• Is staff available to meet scheduled and unscheduled needs?
• Is staff available to assist residents who experience memory, orientation, or judgment losses?

Residents and Atmosphere

• Do residents socialize with each other and appear happy and comfortable?
• Do residents, other visitors, and volunteers speak favorably about the facility?
• Do the residents seem to be appropriate housemates for you or your loved one?

Facility Design

• Do you like the appearance of the building and its surroundings?
• Is the decor attractive and home-like?
• Is the floor plan easy to follow?
• Do doorways, hallways and rooms accommodate wheelchairs and walkers?
• Are elevators available?
• Are handrails available to aid in walking?
• Are cupboards and shelves easy to reach?
• Are carpets secured and floors made of a non-skid material?
• Is there good natural and artificial lighting?
• Is the residence clean, odor free, and appropriately heated and cooled?

Medication and Healthcare

• What is the residence policy regarding storage of medicines, assistance with medicines, and medicine record-keeping?
• Is self-administration of medicine allowed?
• Who coordinates visits from a nurse, physical therapist, occupational therapist, or other specialist if needed?
• Does a doctor or nurse visit the residents regularly to provide medical checkups?

Services

• Is staff available to provide 24-hour assistance with activities of daily living, if needed? Do daily activities include:
• Dressing
• Eating
• Mobility
• Hygiene and grooming
• Bathing, toileting, and incontinence assistance
• Using the telephone
• Shopping
• Laundry
• Housekeeping in unit
• Transportation to doctor, hairdresser, or other activities

Features of Individual Units

• Are different sizes and types of units available?
• Are units for single and double occupancy available?
• Do residents have their own lockable doors?
• Is a 24-hour emergency response system accessible from the unit?
• Are bathrooms private? Do they accommodate wheelchairs and walkers?
• Can residents bring their own furnishings? What may they bring?
• Do all units have a telephone and cable television? How is billing handled for these services?
• Is a kitchen area/unit provided with a refrigerator, sink, and cooking element?
• May residents keep food in their units?
• May residents smoke in their units? May they smoke in public areas?

Social and Recreational Activities

• Is there an activities program?
• Do residents participate in the neighboring community's activities?
• Do volunteers, including family members, come into the residence to conduct or help with programs?
• Does the facility require residents to undertake any chores or perform specific activities that benefit all residents?
• Are residents' pets allowed in the unit? Who is responsible for pet care?
• Does the residence have its own pets?

Food Service

• Does the residence provide three nutritionally balanced meals a day, seven days a week?
• Are snacks available?
• May a resident request special foods?
• Are common dining areas available?
• May residents eat meals in their units?
• May meals be provided at times the resident prefers or are there set meal times?