Of course, it is important to understand the costs involved in assisted living. The majority of assisted living communities are private pay meaning that the resident is fully responsible for the cost. While Medicare and Medicaid do not usually cover the cost of assisted living services, long term care insurance does. Veterans and their spouses should also ask about VA Aid and Attendance.

Ask, up front, about how costs are paid at the assisted living you or a loved one are considering. Look beyond the glossy brochures and ask specific questions about the cost of living there. A reputable community will always have a written contract, so ask to see one. Be sure that they clearly differentiate between the cost of the apartment and the cost of any services provided.

It may be a good idea to have a calculator with you when you tour so that you can have a running total of the costs. Find out if services are bundled or itemized, when provided. Ask for a listing of any other fees that might be assessed. Assisted living communities vary greatly with regard to the amount of the security deposit, “buy-in” fee, endowment fee, or move-in fee that might be assessed. Also, there can be variance in the timing of rent and fee charges. So, be sure to ask about each of these cost items.

Leaving the home you have been in for years is difficult. However, if an assisted living facility provides a variety of services and amenities, it can significantly help the transition to a new environment. The key is to match your loved one’s current personality and interests to the services that would be most beneficial. For example, an assisted living community offering a pool, tennis courts, or a community center will only benefit you or your loved one if you actually swim, play tennis, or throw parties.

Conversely, if you or your loved one no longer drive, then an assisted living community with transportation to medical appointments, shopping, and excursions would be very useful. So, with respect to services and amenties, consider a wide array of possibilities including activities, opportunities for socialization, visiting hours and policies, dining options, housekeeping and maintenance services, transportation, safety, and “special touches.”

• Ask for a copy of the assisted living’s activity calendar.
• Find out how often the activities change or how the community incorporates resident suggestions into the activities.
• Does the community offer both onsite and offsite activities?
• Do the activities address your social, emotional, physical, and spiritual needs?
• Do volunteers or family members get involved in running some activities?
• What are the policies regarding visitors?
• Can you have guests in your apartment and for what length of stay?
• Can you and your guests use the common areas in addition to your apartment to socialize?
• What times of day or night can you receive visitors?
• Does the assisted living facility have a process for checking visitors who come and go a the community?

You should expect the care provided in assisted living will meet your needs or those of your loved ones and be provided in a timely manner.

When touring an assisted living facility, you should find out about assessments, planning for your care, and the processes for care change, handling emergencies and discharges from the assisted living community. Ask how the initial assessment of your level of care is completed. In Virginia, it is a requirement that an assessment be completed prior to your admission to an assisted living facility. Who will do the assessment and how will you be told of the outcome? If you do not agree with the assessment, what recourse do you have?

Once the assisted living facility has determined that it can meet your needs or those of a loved one.

• Ask how the plan for that care is implemented?
• How soon after you move in will the plan be in place?
• Who has input in the plan?
• How often is the plan reviewed and modified?

When you decide to move to an assisted living community and your care needs change, ask in advance what happens when you need more care.

• Can you stay in your apartment or do you need to move to somewhere else in the building or somewhere else on campus?
• How does the assisted living facility handle emergencies?
• Under what circumstances can the resident refuse service?

Most importantly, you need to know before you decide what process the community has in place for discharves.

• Is this process in writing?
• You will want to know if the community will inform you prior to issuing a discharge and if so, how far in advance? All of these questions will provide a complete picture of the type of care you can reasonably expect in assisted living.

As you tour different communities, understanding differences in staffing is an important factor. After all, it is the staff that provide the care for you or your loved one.

First, ask about the nursing staff since staffing requirements vary among communities and may be regulated by the state. You will want to know how many nursing staff are scheduled for each shift. You should reasonably expect that the higher the level of care offered the more staff are available.

Find out how many hours per day a nurse (LPN or RN) is scheduled on-site. This will give you an idea of the level of supervision provided.

It is also important to know that if your doctor calls to change a medicine or the type of care, there is someone at the community who can respond to the doctor’s orders. Ask who is responsible for administering medications and completing care assessments.

Also, you will want to know about the turnover rate for staff and the tenure of key employees. Besides the nursing staff, find out what other support staff are available and what their responsibilities are. Does the community have dedicated staff to implement activities, provide dining services, complete housekeeping and laundry chores, and do routine maintenance or do staff take on multiple responsibilities?

Note how all staff interacts with residents. Do they greet residents by name and seem to know about their level of care? Ask how staff is assigned to care for residents and who supervises what care is given. Be sure you are comfortable with the staffing before deciding on which assisted living community you choose.

Assisted living residences vary dramatically in size. You can find small, home based living housing only a few residents to large campuses housing thousands. Each type will have different options in size of living space as well.

You’ll first need to consider the size of facility that you or your parent or loved one would be most comfortable in. A larger community may offer more socialization, but that aspect would not interest someone who has been an introvert with a small, close group of friends. Larger residences may offer care in different buildings. If so, ask about when and how a resident moves from one level of care to another.

Many residences only offer rooms, while some offer private condos or apartments. Some have shared living areas where 2 or more residents may sleep or live. You may find apartments or living spaces that are furnished. In this case, you can personalize the living space to make it feel more like “home”. Sizes are definitely a personal matter, but remember that bigger is not necessarily better and smaller does not guarantee more care.

Quality can be determined by a number of factors. Having information about each can give you a picture of the total quality that a community provides. Therefore, find out about licensure, length of stay, complaint resolution, and support services. Every state has different regulations governing assisted living communities.

In Virginia, all assisted living communities are licensed by the Department of Social Services. One determinant of quality care is the type or length of the license, but quality extends much further beyond.

You should also find out how long an average resident stays at the community and why. Short term stays can be indicative of a community that accepts more frail residents who move on quickly to higher levels of care. Or, a short stay may mean that the facility accommodates residents who only need services temporarily until they are strong enough to go back home.

Complaints are inevitable any time a group of diverse people are living together. The key to a quality assisted living community is their ability to resolve disputes. Ask for a copy of a grievance procedure or inquire specifically about how complaints are resolved.

Finally, high quality assisted living communities have access to support services such as rehabilitation, specialized medical services, and multi-denominational clergy, to name a few. Find out which services the assisted living you are considering provides.

When considering a tour of an assisted living community, its ambiance should be more than a feeling. It should encompass the staff interaction, apartment choices, and accessibility of home-like amenities. As you enter the community, the vibe should be warm and welcoming. The entire place should look, feel, sound, and smell inviting.

Take note of staff members’ interaction with you and with each other. If staff members are calling residents by name and interacting in a friendly manner with them, then you’ll have a critical clue about the quality of care.

Ask to see all the apartment styles available. Be sure to view both furnished and unfurnished apartments. Note the amenities within the apartment – does it have a full kitchen or a kitchenette? Is the bathroom handicap accessible? Is there storage? What type of view is there from the windows? Is it well lighted? Are the carpeting and window treatments clean? Most importantly, picture you or your loved one and his/her belongings in this space – would it suit them?

Finally, a part of the ambiance of a community is the resident’s accessibility to common areas. Ask about the use of common living rooms, libraries, computer rooms, dining rooms, patios, and porches. Do you see any residents using these amenities during your tour? Observing residents actually using amenities can tell you about how comfortable and functional these rooms can be to residents.

The old adage of “location, location, location” definitely applies to assisted living. In this instance, “location” considerations should include both distance and surroundings. If you are looking for assisted living for a loved one then, maintaining your relationship with them and developing a good relationship with the assisted living community, will require the ability for frequent visits. So carefully consider the driving time and distance to the community.

Also, consider the distance of the assisted living community from both your home and work. Are you most likely to visit during the week, on the weekend, or both? What happens when you are contacted in the event of an emergency? How quickly would you be able to get to the community? If you are looking for a place for yourself, you will want the place you choose to be near friends, family, and quality medical services.

In addition to the driving distance, also consider the surrounding neighborhood in which the community is located. Is it in a rural, urban, or suburban location and what would fit your needs? What are the traffic patterns like? Will there be any new building construction? Is the community well landscaped and well maintained? Is there adequate parking? Determine how all of these factors compliment your personality and needs or those of your loved one.