Insider Tips on Choosing Residential Elder Care

Here’s some advice, some of it straight from my (still very verbal) 74-yr. old mother, currently living in memory care, as to what to look out for when choosing a place to live.  Plenty of these guidelines also apply to those looking for independent living, assisted living, or skilled nursing care.  I’ve elaborated and also changed the wording of Mom’s spicy comments a bit!

  • What you see is not always what you get, especially if you set up a tour in advance. 

-Find out from the business office if it’s okay to “pop in” without an appointment when you’re in the neighborhood.

-Try to connect with a family already involved in the residence, so you can get the scoop, and maybe even get an unofficial tour. 

There are obvious reasons that such facilities protect residents’ privacy and safety, which can mean locked doors in some cases, but you need a way to see what a typical day looks like, and seeing a “bad” day is even more useful.  Explain this desire to the sales person/tour giver, and find out if and if there’s any way you can get an unannounced view of things.  If they’re proud of what they do, they’ll understand your concerns and will often find a way.

  • Be savvy (and a bit sneaky) when checking out staff quality and activity programming. 

-If you can only get in with a scheduled tour, try to stray from the planned out path. 

-Ask to see/speak with residents not in view, and to observe staff in action.  Talk to a few of the staff and notice how you feel around them.

-Stay for a meal.  Does it reflect the variety and quality listed on the sample menu you received in your packet? 

-Go to an activity that’s posted on the daily calendar. (Ignore the “sample calendar’ in the sales packet.) 

It may not seem polite, but if you don’t prearrange to stay for a meal and don’t ask to attend the activity before you arrive, you will get a much better education than you would otherwise.  It’s the nature of any business to “show off” and try to make your visit exciting.  You want a view of a normal day.

Is the activity led by a real person, or is it led by a TV?  Unfortunately, many residences now use videos or TV for their programmed activities, but don’t say so on the activity list.  What may read as “exercise”, “church services”, and sports “parties” may only involve a TV and a group of residents staring at the program and understandably not participating in any active manner that would provide the stimulation they need. 

  • Ask the hard questions, get all the details, and write them down.  Go over all your expectations for care within the price quoted before moving in, submit them in writing, and ideally, have them signed, with a copy for both you and the director.

My mother happens to like daily showers in the morning.  She feels they wake her up and get her “blood moving” in the morning.  When we asked if she could have help showering daily, we got an enthusiastic yes.  Once she moved in, the reality turned out to be that unless she pays a much higher fee for many more hours of one-on-one care, she only gets help showering once per week, like everyone else.

I like to believe that sales people don’t intentionally mislead potential new families, but I believe they are too often removed from day-to-day realities of the direct caregiving staff, and they want to believe that there is much more one on one attention than actually can happen.  A typical staff to resident rate in my state is 1:8, which will not get you the individualized care we all wish for, UNLESS there’s an extraordinary director who makes it happen through careful, thoughtful planning.

-Don’t worry about looking like you mean business, or appearing “hard-core”.  The more a potential residence knows that you’re serious about getting the quality your loved one deserves, and that you are going to be on top of it and documenting it, the more you both will be able to honestly communicate about whether the place in question is a good fit.  You need to cut right to reality of their daily operations, not their ideals.  You’ll have plenty of opportunities to relax, do nice deeds, and joke around with the staff once you know your parent is in good hands and you’ve chosen the best place within your abilty.

Many of you reading this have already been through this process at least once.  How does this list resonate (or not) with your experience?  What, if anything, do you wish you had known before you paid the first month’s rent?

This entry was posted in caregiver stress, support, and respite, dementia, legal issues, memory care and residential options and tagged , , , , , , . Bookmark the permalink.

2 Responses to Insider Tips on Choosing Residential Elder Care

  1. Marti Weston says:

    So interesting that you talk about showers and bathing. We adored the assisted living community where my husband’s mother lived and know how lucky we were to find it, yet we were continually dealing with the showering and bathing scheduling. People arrived at various times of the day, unannounced, sometimes at a good time for mother or sometimes at other unexpected times she disliked. It seemed like they could not really focus on scheduling, but instead inserted baths around other responsibilities, so we could never really get things nailed down.

    And just a bit of change, regularity really, would have caused immense positive changes in Mother’s outlook. I believe that many care and caring communities have idealistic goals — the administrative and marketing people sell these — but it does not always connect with the reality and the demands on the caregiving staff. Old-fashioned and detailed attention to scheduling key — and to illustrate any teacher can point out how a school environment improves when attention is paid to scheduling around student needs rather than administrative.


  2. Hi Marti,

    You’re sure right about the timing. They like to try to do Mom’s shower at night, her worst time of day, and she will have none of it. Fortunately, she’s still a pretty good self-advocate.

    I find it really interesting that these places all tend to stick to 1:8 staffing, and all seem to be making a nice profit. Why wouldn’t a place with 1:6 staffing be even more popular and make plenty of profit? I guess I’m not a business person, but there must be a way.

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