Questions to ask while touring an assisted living community

Touring an assisted living community may seem like a simple task on the surface. But when you’re viewing multiple locations and trying to find the best living situation for yourself or your loved one’s next stage of life, you should come prepared with a list of questions.

After all, once you get on-site and start doing tours and talking to various people, it can get overwhelming fast, says Mary Sue Patchett, a Tennessee senior living expert with more than 40 years’ experience and a board member of Guardian Pharmacy Services. This is why it’s important to do your research in advance so you have clear expectations and goals. Ideally, you will “walk in with your questions and some areas that you may want to start looking at,” Patchett adds.

To get you started, here are some things to contemplate and questions to ask when choosing an assisted living community. Make sure you take your time, ask many detailed questions and if possible, try to bring a trusted friend or family member with you during a visit or consultation.

Questions to ask assisted living about financials and fees

Something that may come as a surprise to many people when they’re touring assisted living  facilities is how often there are separate charges for various amenities or services. To avoid being blindsided by, say, utility charges, ask these questions.

• Does the contract disclose all the health care and supportive services available and all the fees attached to them?
• How often are rate increases done, and how much notice will you be given of a rate increase? Ask what their average percentage increase has been historically and if there is a cap on it.
• Is there a tiered payment plan? If so, what kind of services are included in each tier?
• Are there additional charges for services? For example, are utilities, TV/internet and/or monitoring systems a separate cost?
• What are the admission and discharge procedures and fees? How much notice do you need to give? If you’re moving internally (say from a larger unit to a smaller one), verify whether there are there fees or other requirements and if refunds are available.
• If the resident is admitted to the hospital or is away temporarily, what fees continue to apply? Since they are no longer using utilities and services during that time, ask whether it may be possible to get a discount.
• What kind of payment does the community accept?
• Does the community accept Medicaid, or other low-income subsidy programs, as a form of payment for services?
• How does the community bill its residents? Does the community generate a paper bill or are electronic payments allowed?
• Can you get on a waitlist if you’re not ready for assisted living yet? Be sure to check whether there are any fees to join the waitlist.

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Questions to assess health and wellness services 

In addition to assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) — such as dressing, bathing, help with mobility, meals, shopping and housekeeping — Lori Newcomb, a board-certified geriatric pharmacist and clinical consultant pharmacist with Guardian Pharmacy Services in Atlanta, says a big reason people move into assisted living is because they can’t manage their medications independently anymore. And this is where having central systems for medical care (such as visiting medical professionals) and medication management provided by the assisted living community can help streamline care.

Here are some questions to ask an assisted living facility to ensure you or a loved one would receive the best health care.

• How does the community determine what services are needed for the resident?
• Does the staff perform periodic assessments, and how often do they occur? Many facilities have semi-annual assessments but this time frame varies.
• How will the resident or family member be notified if there’s a change in services? Ask for a fee schedule and who decides the level change. Additionally, ask if you can change/dispute any added service fees.
• Does the residence provide periodic medical services? If so, which ones and how often are the services available? 
• Is there a visiting primary care physician or nurse practitioner, should you want to move your care in-house, rather than traveling to your primary care provider? If so, what hospital system are they connected to?
• How are medications ordered and replenished? Does the facility handle this or is the family expected or allowed to assist with this? If medication is handled by the facility, does it come in pre-sorted packaging? 
• Does a pharmacist oversee the medications? In some states, this may be a requirement for operation. If medications are being prescribed by multiple physicians, it’s important that someone has a 360-degree view to ensure there aren’t adverse reactions. 
• Are there therapies (like occupational, speech and physical) available on site?
• Are there rules (like behavioral conditions) that the resident needs to comply with? Can the community terminate services if these conditions are not met?

Find a community where “love, patience, respect and dignity” are central values.

— Sondra “Sam” Cradduck, gerontologist and psychologist

Questions about general amenities in assisted living

Because each community will be different, they will have their own unique amenities, as well. Here, it’s vital to know what’s important to you or your loved one — for example, someone who is more social may need plenty of opportunities to commune with others, while someone who is more reserved may have different priorities. 

Below are some questions about assisted living amenities to get you started on finding the right fit.

• Is there 24-hour assistance with ADLs? 
• Is transportation provided to nearby stores or doctor’s offices?
• What kinds of social activities are available? Ask to see the activity calendar.
• What are the meals like? Taste the food, if possible. 
• Does the kitchen accommodate special dietary or religious needs? Ask to see the menus and ask residents what they think of the food, if you can.
• Does your loved one have to be in the dining room at specific times to eat, or are there flexible hours?
• Are there religious or cultural services and programs?
• Are pets allowed? If they are, is there a yearly or monthly fee? Are there breed/size requirements? What paperwork is required? And are there additional services for a fee, such as walking or feeding a pet?
• Is there any additional storage outside of the apartment for things like seasonal items, holiday decor or your winter clothes or summer clothes? If so, is there an extra cost?

Questions to ask assisted living about atmosphere and staff

While certain amenities can be very enticing, Sondra “Sam” Cradduck, gerontologist, psychologist and owner of The Living Room, a non-medical senior home care agency in Phelan, California, emphasizes the importance of finding a community where “love, patience, respect and dignity” are central values. After all, she adds, “The nice pool or spa area looks great, but if it’s a sink or swim mentality in the community, the nice amenity is of little to no real value.”

By asking the following questions, you can get a sense of the atmosphere and community you or your loved one will experience.

• Do you like the initial look and feel of the place?
• How does the exterior and interior of the building look? Is the décor dark and drab or bright and attractive?
• What are the demographics of the facility? Will you (or your loved one) feel like they fit in, and will the staff be sensitive to any non-traditional family arrangements?
• Is there an orientation process? How will they help your loved one get used to a new home and routine?
• Ask about a recent moment when a resident’s dignity was at risk — how did their team handle it?
• How do the residents interact with one another? Try sitting in on a scheduled activity or eating a meal with the residents to soak in the atmosphere. Or, ideally, visit during the evening, when there is less supervision, to get another angle.
• What is the staff- to- resident ratio? Make sure this number does not include administrative staff or other staff members who aren’t directly involved in resident care. In general, the fewer residents per staff member, the better.
• How do the staff seem to interact with the residents? Are they friendly? Talkative? Do they address each resident by their name? Are residents parked in wheelchairs facing walls or TV, or are they engaged in activities?
• What was the direct-care staff turnover rate in the last 12 months, and how do they keep caregivers feeling valued? If a community has a lot of employee turnover, it can be indicative of a poor environment.

Does the community cultivate a culture of inclusion and welcome guests and new members with kindness?

— Sondra “Sam” Cradduck

Questions to assess community layout and maintenance

It seems like a no-brainer that the layout of an assisted living community should be ideal for those with mobility needs, but that’s not always the case. If a location is older, you may find that doorways inside apartments are not wide enough for wheelchairs or walkers, or that there isn’t sufficient space in bathrooms to move from the toilet to the shower, says Patchett.

With that in mind, here are some questions to ask at assisted living facility tours to assess the layout and maintenance of potential assisted living communities.

• Is the layout of the residence easy to navigate?
• How many rooms are available? What are their sizes?
• How many residents live there?
• Are the rooms, doorways and hallways large enough for walkers and wheelchairs, including both in the communal areas and in the apartment?
• Are there elevators?
• What can you fit in your room? Can you bring some of your own furniture?
• How are the closets and bathroom in the rooms?
• Are the community spaces and rooms light or dark? Is there natural sunlight or enough lighting?
• Is the community clean? Any odors? Strong or lingering odors could indicate that staff is not providing adequate care.
• How is the temperature? If you’re visiting a community in the summer, is the air conditioning set too low or high?
• How does the residence maintain security?
• Do you lock the doors at night when the receptionist or concierge goes home? If so, can family members visit in the evening, and what is that process? 

One final expert tip when touring assisted living facilities

Now that you know what questions to ask when you arrive for your assisted living tour, Cradduck offers a final piece of advice: Pay attention to how the staff treats you and your loved ones (if they attend the tour with you).

“Are they engaging to be polite, or are they reaching out to your loved one with true concern? Does the community cultivate a culture of inclusion and welcome guests and new members with kindness?” Pay attention to this initial impression as it can forecast future staff interactions.