Housing: Assessing Facilities & Services

Looking for the right senior living residence is a lot like looking for the right college. It will help to look at the marketing literature, to visit in person, and to talk to people who are there. You need to know yourself and your resources. In the end, your decision will be heavily influenced by your feelings as well as your reasoning. We have compiled these questions to help you evaluate your choices from a number of sources, as well as our own experience helping families.

Questions to consider when starting this journey:

What are my financial resources?

What are my health/physical needs?

What are my transportation needs?

What activities do I enjoy and want to continue?

Will I need to move again if my needs change?

What are the most important factors to keep in mind when making this decision? (proximity to family, social life, physical needs…)

Before visiting:

Look over the literature carefully, including floor plans, price lists, activities, and whatever is included in the package.

Talk to people who have had experience with the facility.

Review rating guides, state licensing reviews or other comparisons.

Review your finances.

Talk to your family.

Questions to ask when visiting residences:

Make sure you go on a tour and speak to residents and staff, as well as the marketing representative. Arrange to be there for a meal. Visit social and recreational activities. If possible, visit on both a weekday and weekend.

Living Arrangements

Is the location of the facility acceptable to you? (urban/suburban/rural, proximity to services, proximity to family)

Are the appearance and décor pleasing to you?

Were you greeted warmly? By staff and residents?

Are the layout and size of the apartment comfortable for you?

Are any furnishings provided?

Does a sample activity schedule for a week or month look interesting?

Does the menu look appealing? Do the eating options fit your lifestyle? Is the food nutritious and appetizing? Will they accommodate special dietary needs?

Are there formal/informal/private dining options? Set times? Dress code?

Are suitable transportation services provided?

Are you permitted to decorate your door, hallway, patio, or garden?

Can a person move between units at the same level of care at the facility?

What do residents like most/least about this facility?

Do residents consider it “home”?

Can you picture yourself living here?

Physical Facilities

Is the facility clean, orderly, and odor-free?

What measures are taken to help visitors and residents find their way around?

Is the facility well maintained? Indoors and out, in the corners?

Are there handrails, emergency pull cords, and door alarms?

Is there a sprinkler system? Smoke alarms?

Are the rooms a comfortable temperature? Is the ventilation adequate?

Is there good natural and artificial light?

Are floors covered with non-skid material and firm carpeting to prevent falls?

Are toilet and bathing arrangements safe, with suitable grab bars, and are they accessible to handicapped residents?

Is there a kitchen area? What appliances are provided?

Is there adequate storage?

Are comfortable areas provided for social and recreational activities?

Are there both indoor and outdoor opportunities for physical activity?

Is there a safe outdoor space for relaxing, visiting, walking?

Is there a private room available for family gatherings/celebrations?

What books and magazines are in the library?

What are the facility’s policies about assistive devices (i.e., scooters)?

Are housekeeping and laundry services provided?

What services are available onsite (hairdresser, bank, post office, etc)?

Can out-of-town guests be accommodated?

Can a resident move to a different unit if desired?

Social Atmosphere

Do you see residents interacting with one another in an engaging manner?

Do people congregate in common areas?

Do residents appear and report being content?

What can you observe about the informal (un-programmed) social scene?

Do you see residents actively involved in recreational and other activities?

Read the bulletin for activities, social news, and tone.

Is there an active Resident’s Council? What issues do they handle?

Have scheduled activities been cancelled? Why?

Is transportation off-site available? For what purposes?

Does the degree of expected social interaction suit your personality?

Are there pet, alcohol, and smoking policies?

Are there volunteer service opportunities?

Can you picture yourself feeling comfortable as part of this particular social community?

Medical Facilities and Services

What medical and nursing facilities and services are provided on the premises?

How often are doctors and nurses on-site?

Is there a social worker to coordinate care plans and help with transitions?

Is there a written medication handling policy (storage, administration, record-keeping)?

Does the resident have choices in selecting/keeping doctors?

How are medical emergencies handled?

What are the policies for Advance Directives and Do Not Resuscitate orders?

Is assistance available for scheduling medical appointments off the premises, and is transportation provided?

Can spouses with different needs be accommodated at this facility?

Can a person move into a higher level of care (such as assisted living) and then back to independent living if their needs change? To the same unit?

If you have a chronic ailment, how would the facility handle it?

What health care expenses are included in the fees? What health care expenses are not included, thereby becoming the responsibility of the resident?

What provisions are made for cognitive and/or memory decline, whether or not accompanied by other health problems? For vision loss?

Do any physical or mental conditions preclude eligibility for residence at this facility?

Under what circumstances may a family arrange for a helper to aid the resident on a one-to-one basis, and how is the helper selected?

Are the costs of medications covered by the facility?

Is it advisable to have a long-term care insurance policy once one becomes a resident?

How are medical claims to insurance companies handled?

What services are available on-site (e.g., physical therapy, podiatry, massage)?

How often are a resident’s needs assessed?

Is assistance with ADLs (activities of daily living) available 24/7?

Fees & Documentation

Is there a waiting list?

What are the entrance fees and monthly payments? What is the fee structure?

Beyond the monthly payments, do you feel that you have a full understanding of additional living expenses that you would incur?

Are there additional one-time fees at the time of the move?

Are there additional fees for phone, cable, internet service?

Prior to entry, what information does the facility require regarding your health status, and how will it collect such information?

Prior to entry, what information does the facility require about your financial situation, and how will it collect such information?

Are portions of the entrance fee and/or monthly fee deductible from your income tax as a medical deduction?

How are fees handled if spouses need different levels of care?

How are fees affected if a resident moves to the assisted living or skilled nursing facility, either temporarily or permanently?

Based on fee increases over the past several years, what increases in fees can be anticipated annually? What is the 10-year history of fee increases?

Is the entrance fee refundable to the resident’s estate, and if so, to what extent and under what circumstances?

What happens if a resident outlives his/her resources?

Are there any financial assistance programs?

Are residents required to obtain insurance for personal property?

Contracts

Make sure you read the contract, fees, and rules carefully before signing.

Do you understand the contract? Is the staff person patient and helpful in explaining it?

Is there a copy of the contract available for review?

What facilities, services, and amenities are provided within the contract?

Is a specific unit designated, and is it acceptable?

Does the contract clearly state the basic services and specific fees that will be charged on a regular basis?

What is the refund policy?

Administration

How is the facility owned, governed, and administered?

Which aspects of governance are in the hands of the residents?

Is the facility on stable financial ground?

How long has the facility been in existence and under the current management?

Are administrative personnel willing and available to meet with you?

Is the administrator a licensed professional?

Staff

Are staff members adequately trained and supervised? Certified? Licensed?

How often is a registered nurse on site?

How available is a physician?

Are enough staff members readily available during all hours of the day and night? On weekends and holidays?

Does the nursing staff answer call bells quickly and provide help at unscheduled times, such as for toileting?

Do staff members involved directly in patient care show sensitivity and communicate well with residents? Make eye contact? First name basis?

Do staff interact with residents when they don’t have to, e.g., in the halls?

Do staff members receive regular training in CPR, safety, and elder care?

What is the staff turnover rate? Do staff like their jobs and the corporation?

Care Plan

What is the process for identifying and addressing residents’ needs?

How often is the care plan reassessed?

How are the resident and the family involved in developing the care plan?

What role will the family play in implementing the care plan?

Who makes the decision about moving to a different level of care? Who explores appropriate options and makes arrangements?

How are transitions between levels of care handled?

Under what circumstances is the family contacted?

Transfer/Discharge

On what grounds might the facility terminate or discharge a resident?

What are the financial consequences?

Comparing Costs

Fees for residential care may be difficult to compare, as the rates are set differently in various facilities.

• Flat or bundled rate : Everyone pays the same rate, based on a calculated average need.
• Tiered rate : Rate levels are set based on the level of care needed.
• Flat rate plus hourly charge : Basic charges are covered by a flat rate, then any additional services are charged at an hourly rate (these can add up).
• One-time entrance or community fees : There may be an entrance or joining fee charged once or annually.
• Additional costs : There may be additional charges for personal assistance, home health services, health services, nursing, medication administration. There may also be additional charges for meals, housekeeping, laundry service, apartment amenities (phone, cable tv, window treatments, microwave and refrigerator), transportation, social/recreational activities.

To calculate your costs, add together the entrance fee, monthly rate, additional services, and any other personal spending (beauty shop, toiletries, clothing, etc.). Remember that the resident’s needs may increase over time and thus be more costly, and that there will be annual fee increases.

Licensing, Accreditation and Certification

There are regulating and/or certifying organizations for most levels of care and care providers. Holding this certification indicates meeting and maintaining a high standard of care. You can request to see the license or most recent review, which may assist you in selecting a quality care provider.

Continuing Care Retirement Communities (CCRCs)

Most CCRC’s are accredited by the Continuing Care Accreditation Commission (CCAC), an independent entity sponsored by the Council on Accreditation of Rehabilitation Facilities (carf.org). Because it is neither a governmental agency nor a state licensing body, its definitions and standards for continuing care facilities may differ from those of a particular State. Accreditation is done on a five year cycle. In addition, the assisted and skilled nursing units are licensed by the State. CCRCs are often also members of Leading Age (leadingage.org).

See Continuing Care Retirement Communities

Assisted Living Residences

Assisted Living Residences are licensed and inspected by the State of New Jersey Department of Health and Senior Services. See the Long-Term Care Assessment and Survey at state.nj.us/health .

See Assisted Living Residences

Nursing Home and Rehabilitation Centers

Nursing Homes are licensed by the State of New Jersey Department of Health and Senior Services. Most are also reviewed and approved by Medicare annually. Go to medicare.gov to see these reviews, or to the long-term care section of state.nj.us/health .

See Nursing Home and Rehabilitation Centers

Care Professionalshttps://www.princetonsenior.org/community-resources/home-care/

Nurses and social workers are licensed by the State of New Jersey Attorney General’s Office, Division of Consumer Affairs. Home health aides and case managers are certified in their profession. Home health care agencies are also licensed by the State and certified by Medicare. You can ask to see copies of licenses and certifications.

See Home Care Assistance.

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The Princeton Senior Resource Center does not endorse any of the resources listed on these pages. We collect and provide information from many sources as a service to those seeking services in the Princeton area. No listed provider pays to be in our directory.