Updated July 5, 2021 – If you are considering moving to an assisted living facility (ALF) either for yourself or a senior loved one, there are some specific interview questions that you should ask.
You can use these following questions to use as a starting point when you are speaking with the management. But I do urge you to also ask the staff questions as well.
If the facility’s management does not allow you to speak to the staff – read this as a Red Flag warning.
In this article, we’ll talk more about the different levels of assisted living care, whether seniors must qualify for them, and what goes into the often-high assisted living costs.
We’ve even provided a checklist that you can bring with you as you tour different facilities.
Following are questions that are worth asking when assessing whether an ALF is suitable for yourself or a senior loved one.
Note that many ALF communities will provide you with a packet of useful material. Go through that information which may end up prompting even more questions for you to ask.
1. How Does A Senior Qualify For Assisted Living?
Before we proceed any further, you should know that, in order to move into an assisted living community, the elderly person in your life needs to be eligible to do so. Many people don’t realize this.
How do they qualify?
Well, each day, people engage in self care tasks known as Activities of Daily Living or ADLs.
The main ADL’s that most assisted living facilities look for in a potential resident are:
- Leisure (able to participate in leisure activities)
Can the senior person perform these ADL’s for themselves or do they require assistance?
If at least two of the ADLs are difficult for your senior to do on their own each day, then they’re likely eligible for assisting living care under the rules of most facilities.
ADLs are also used to determine one’s candidacy for nursing home living, but there are further benchmarks to meet for those, since these facilities offer more care than assisted living.
Also note that some facilities require that the senior be continent in order to be a resident.
2. What Would Disqualify Someone From Living Here Any Longer?
When you interview an assisted living facility, an important question to ask is “Under what circumstances could possibly get yourself or your loved one kicked out?“
The regulations for kicking somebody out of assisted living have a lot to do with the state. There are only a few reasons that allow them to kick someone out, but they can vary by what happens in their home state. Different states also require different notice periods before they actually give you your eviction papers and get rid of you forever!
Some of the issues that a resident may be asked to leave an assisted living facility include…
- Requiring more care than the facility can provide. This often happens with illnesses such as Alzheimer’s, Dementia, etc.
- Non payment.
- The resident presents as a danger to the staff and/or other residents.
- Breaking some rule of the facility.
3. Are There Different Levels Of Assisted Living?
This type of question can help you determine if an ALF is the right fit for your needs.
While nursing homes may take over the majority of a senior’s care, assisted living is still anything but hands-off.
ALFs are intended for the elderly who wish to maintain some degree of independence, but require some medical staff to be around for care.
Depending on the level of assistance the senior requires, they may be located in either a level-1 or level-2 assisted living facility.
What Is A Level 1 Assisted Living Facility?
Level 1 care at an assisted living facility is considered lower level care.
The senior has a good degree of mobility, even if that means they get around using a wheelchair rather than on their feet. They also have no difficulties with speaking and communicating, and their memory is in good enough shape.
If the senior is on any medication, they can take it on their own, although they may not always remember to.
In level 1 care, some ADLs are hard for the senior and may even elude them. They might have trouble bathing themselves or getting dressed, for example, or have problems with incontinence or using the toilet.
The staff at the assisted living facility can fill in the care gaps so the senior has a good quality of life, but mostly thanks to their own efforts.
This allows them the most independence.
What Is A Level 2 Assisted Living Facility?
For the elderly who require a higher levels of care, there’s level 2. This is considered moderate care.
Senior residents in this category can often still walk and talk (although maybe to a lesser extent), but they need more monitoring than those in the level 1 (lower) level of care.
For example, a nurse may come by each morning, afternoon, and evening to help the senior take their medication because the person can’t do it on their own. Or, they could have a tough time with their ADLs and need an aide to help with bathing, dressing, or even eating.
Even though they may not be able to do many things, the senior can still do some daily tasks on their own in level 2 care.
There is however a 3rd level which is technically known as Memory Care. Residents here are suffering from some type of cognitive decline due to dementia, Alzheimer’s or other medical problem.
4. What Are The Costs?
Assisted living costs vary from state to state. According to after55.com…
The most expensive states are Delaware, Alaska, New Jersey, Massachusetts and Rhode Island.
The cheapest states are Missouri, Georgia, South Carolina, Arkansas and North Dakota.
Generally, assisted living costs range anywhere from $2,000 to $7,000 per month. That comes out to $24.000 to $84,000 per year.
5. What Is Included In Assisted Living Costs?
We talked before about how much money you may spend a month or annually on your senior’s assisted living, but what does that money go towards?
All sorts of things, such as:
- Private transportation and/or shuttle use
- Weekly housekeeping and laundry services
- Apartment repairs and maintenance
- Snow removal and landscaping
- Room and board
- Care via an aide or nurse
When you consider what you’re getting, the higher monthly prices of an assisted living facility make much more sense.
6. Are There Added Fees For Services / Activities?
Make sure to ask if there are fees for additional services or if there may be any hidden fees.
You’re likely also paying for the senior’s utilities, including Internet, phone, cable, water, and electricity. While some facilities include these charges, many do not.
You may also pay extra for excursions, transportation to and from the doctor and other places and maybe even if you have an overnight guest (if that’s allowed).
7. Are The Fees Negotiable?
You may find that most assisted living facilities do not negotiate their fees. But – having said that – some may waive their “community fee”.
This is basically a deposit which reserves your selection of apartment and it can be as high as a few thousand dollars.
8. Are Their Community Fees Refundable?
Not all facilities refund their community fees so you want to make sure to ask if this particular place that you are interviewing will do that.
One of the top reasons for a refund are if you or your senior loved one is not able to move in for whatever reason.
9. What Kind Of Apartments Are There?
Most apartments in assisted living facilities have a kitchenette, a bedroom and a bathroom and a living area. Some also have an outdoor porch.
You certainly want to take a tour of the type of apartments that are available and what each type offers.
You may need an apartment close to the elevator or perhaps you cherish a view of a garden or trees. Or maybe you want a two bedroom apartment. There are many options to look at.
10. Are Overnight Guests Allowed?
Some facilities allow overnight guests, some do not. It may depend on whether it’s a family member.
If you live far away and you want to visit your elderly parent a few times a year you may want to ask the place you are interviewing if you are allowed to spend the night in your parent’s apartment.
11. When Are Visiting Hours?
It’s important to know what the visiting hours of this facility are for all family members and friends who will want to come by and visit the resident at different times of the day and night.
The facility may also have specific hours for when a resident is to return from an evening out with friends and family so you’ll want to know what their rules and regulations are.
Know that oftentimes these rules are put in place for the security of the residents.
12. Are Pets Allowed?
It used to be years ago that most retirement facilities did not allow pets but things have changed for the better!
If you or your loved one has a loving pet, the emotional toll of leaving that ball of fur can be devastating and I personally have seen it be fatal.
So make sure to ask if pets are allowed and to search for such a facility that can accommodate your loving companion.
13. What Is The Meal Plan Like?
The number one issue you will hear most residents of any facility complain about is the food. It’s almost impossible to please everyone’s palate but some facilities are better at it than others.
You will want to know how well they can accommodate your or your loved one’s dietary restrictions and if the food they serve you is edible for you.
Plan to have a few meals at the facility before you commit to moving in.
14. Can Family and Friends Come For Meals With The Resident?
When my aunt was in her late 90’s she lived in a beautiful ALF and we often went to visit her during meal time. It was great to sit and have dinner with her and catch up with her list of activities.
I have visited many assisted living facilities as an Occupational Therapist and I can’t recall one where friends and family were not allowed to come for a meal but that does not mean that there aren’t a few.
So, make sure to ask!
15. Is There Housekeeping and Laundry Service Available?
In general, most ALF’s provide housekeeping and laundry but not all provide that service for the monthly cost so you want to know if that is not only available, but if it’s an extra cost.
You also want to know if the resident is allowed to do their own housekeeping and laundry.
16. Can This Facility Provide Care For Your Specific Needs?
If you or an aging loved one needs assistance with basic tasks like taking medication, insulin management and blood glucose testing then assisted living might be your best bet.
However, it’s important to know that these facilities aren’t allowed to admit residents requiring 24/7 care! A nursing home or at home care would be more appropriate for individuals who need continuous care 24/7.
Speak to the ALF facility about the details of any medical conditions that are currently being treated and any symptoms that you may be experiencing or notice in your loved one. This information will be useful for them to determine whether or not they are a good placement.
17. How Does The Facility Manage Medications?
85% of the residents require assistance with management of their meds.seniorcare.com
Some ALF facilities use a certified medication aide to help the residents with their medications. Other facilities use nurses or other staff members.
You’ll want to ask where are the medications stored and who is responsible for refills and dispensing them.
If you are unsure of any ALF facility you can check with an attorney to research if there have been any lawsuits or other legal actions brought against the ALF and for what reason.
In an assisted living facility, assistance with prescription medications can only be provided to residents with a doctor’s order. Once this assistance is provided, it is the caregiver’s responsibility to keep a record of the assistance.pegcoinc.net
18. Are Residents Allowed To Self-Administer Their Medications If They Want To?
Generally speaking, residents in an ALF facility who are able to take care of their own medication management issues are allowed to do so and can also keep these medications in their room.
After all, their room is their home and most assisted living facilities do their best to make sure that their residents feel “at home.”
But – having said that. If the ALF staff notice some irregularities such as pills on the floor or some behavioral changes in the resident, they are obligated to report it.
19. How Does This ALF Manage Specific Behaviors?
All individuals have their own specific personality traits and oftentimes they can become exaggerated as one gets older. Even more so if the older person has to adjust to a new home.
It’s certainly not uncommon for older adults to display behaviors such as aggression, anger, agitation, verbal and physical outbursts, etc. This can be seen often in elderly who are stubborn and refuse to accept help, medication, shower, etc.
The question to ask is how do they manage this? Do they simply distract and redirect? That’s honestly not what well trained staff should do. (That’s more what a family caregiver is told to do.)
20. Are Therapy Services Provided On Site?
I don’t recall any ALF’s that I visited and worked in that did not provide therapy services on the premises but that’s not to say that there aren’t some out there.
In my experience, there is always a gym of sorts in the facility that can be used by a physical therapist, an occupational therapist or a speech therapist.
Oftentimes, these therapists are contracted from a third party company and not directly employed by the ALF company.
21. What Activities Are Provided?
Most every ALF I’ve ever visited and / or worked in had a calendar of activities for their residents. But not every ALF had a recreational therapist (RT) trained to work with the different skill levels of each resident during an activity.
A well educated and experienced RT can bring out important skills in each resident to help them feel purposeful, engaged and active.
You will want to know what types of activities are provided. Are any of those activities of interest to you or your senior loved one?
22. Is Nursing Care Available 24/7?
An assisted living facility is meant for older adults who need “some” assistance and/or supervision. They are not often equipped to provide 24/7 care on any level.
So, oftentimes there is no nursing care available 24/7. If a medical emergency were to happen during the time when no nurse is on site, the ALF will call 911.
I went over some of the different levels of care at an ALF above but here’s a little more information.
Basically, there are 3 levels of care in an ALF:
- Low assisted living care – these residents are mobile either walking or using a wheelchair. They can speak, have minimal to no memory problems and pretty much do most everything for themselves.
- High assisted living care – these residents may struggle with mobility and self care tasks and early signs of dementia or Alzheimer’s may begin to show.
- Memory care – these are residents who have dementia or Alzheimer’s or any other type of condition that is impacting their cognition.
23. Is There An In-House Physician?
Most ALF’s that I’m familiar with do not have an in-house physician. Instead, they have contracts or are associated with a physician or a physician’s group. Note that this may come at an additional cost to the resident.
Most residents in an ALF continue to see their own doctors.
Before you sign the contract with an ALF – check with your doctors to make sure that they will continue to see you if you move to an ALF. For some reason, there are physicians who do not retain their patients once they move to either an ALF or a nursing home.
24. How Does The Facility Manage Changes In Their Residents?
Most senior adults who enter an assisted living facility will change as time goes by.
They may end up requiring more care, or end up needing to use a wheelchair or they may develop dementia or Alzheimer’s while they are living there. They may even fall and fracture a hip.
You will want to know how often do the staff members meet to re-evaluate the residents. Do they create care plans for them? How do they manage these types of changes?
25. How Many Residents Live Here?
Having an idea of how many people live in the building(s) can give you an idea of how much attention can be paid to each resident and the types of activities that may be provided.
Smaller ALF’s can be like moving to a small town. Everyone knows everything about everyone else! But at the same time, it can create a very close-knit group of individuals who all look out for each other.
Whereas larger ALF’s may make it harder to make friends and join groups. Think of it as entering a very large high school!
26. What Hospitals and Hospice Programs Are They Affiliated With?
If you weren’t yet aware – hospice nurses can come to an ALF just as if they were coming to someone’s home. But – you will want to know which hospice program this particular ALF is affiliated with?
The same goes with hospitals. If anything were to happen – what hospital would you or your loved one be sent to? Do you have a choice?
27. Are There Specific Visiting Hours?
For security reasons, all assisted living facilities have visiting hours and all guests must sign in and out. You will want to know what these hours are to help you plan your visitations.
This is especially important for a new resident who will need to see their loved ones.
28. What’s The Training Process That The Staff Go Through?
From my experience, the training of all staff members in an ALF facility normally includes basic lifesaving skills such as CPR and first aid.
Other than that – individual occupations within the staff receiving their own training depending on the department they are employed in. For example the kitchen staff receives training specific to their duties in the kitchen.
Simply asking what type of training they all go through will give you an idea of the depth of commitment the company has on providing the best care for its residents. After all, the staff at an assisted living community are potential caregivers for the residents.
29. What Is The Ratio of Staff To Residents?
We all know that nursing homes have a terrible reputation of being understaffed. But is that the same for assisted living facilities?
I can tell you that in my experience the answer is No – but that does not mean that the ALF you are interviewing is not understaffed.
The ideal ratio is 1:5 but oftentimes it’s 1:8 or more.
You also want to know if the ratio changes per shift? This often is the case as the night shift is usually staffed with less employees (which can make sense depending on the type of residents they are caring for).
30. What Kind Of Security Is There In The Facility?
The ALF that my elderly aunt lived in had a security guard and gate at the entrance. In order to get in the vehicle had to have a specific sticker on the windshield and the person with the driver’s license had to be listed as a “visitor” for a specific resident.
In addition, there was someone at the front desk at all times and in order to get past that desk, the visitor had to sign in and then again, sign out when they left.
Of course, every ALF will have it’s own level of security but you will want to know how they manage it.
31. Is There Transportation Services Available?
I do have to say that not all ALF’s offer transportation services. Some have their own vans where they can take residents grocery shopping, to doctor’s appointments, to the mall, etc.
Others use an outside company to supply transportation services and this is often at an additional cost.
Yet other ALF’s leave the transportation for each resident and their families to deal with.
32. Can I Speak With Other Families With Residents Here?
There are three great ways to REALLY get to know an ALF.
- Spend a day and a night there – some facilities will allow you to spend a day and a night there to “get the feel” of what it may be like to live there. This is a great way to assess the “people skills” of the staff.
- Volunteer – if you really want to know what an ALF is like you can volunteer there for a few months or more.
- Speak to residents and their family members – getting the inside scoop from residents who live there and their families will give you some great insight into the pros and cons of this particular ALF. Think of it as conducting your very own focus group interviews.
33. Do They Provide Any Veterans Benefits?
Does the ALF provide any additional service or aid for veterans? If not, do they have the ability to help you with working with resources that may?
34. How Did The Facility Respond To Covid-19?
Many ALF’s and nursing homes faced immediate challenges due to the Covid-19 pandemic and they continue to do so.
How did they respond to this? What did they learn from the experience and how will they respond to future pandemics?
Checklist For Touring Assisted Living Facilities
As promised, here’s a handy checklist with even more specific questions for you. You’ll want to keep this close when you schedule a tour at an assisted living facility. Don’t schedule a tour without it!
Print Out A PDF Version Of This List Here
- How many people work as staff members of the assisted living facility? What are their qualifications?
- How many years has the staff worked here? Do most employees stay long?
- Are employees subjected to a background check before they’re hired?
- Is the staff available 24/7?
- Do all staff members go through a drug screening and how often?
- When do residents eat? Is it at select times or at the senior’s choosing?
- Where does a senior eat? At the cafeteria or dining hall? Can they eat in their room or have meals brought to them if they are sick?
- Are there enough seats in the cafeteria or dining hall for all residents to eat at once?
- Are the cafeterias or dining halls kept clean between meals? How so?
- What kind of food are the seniors fed? Are these meals balanced and nutritious?
- Can the seniors eat snacks in between if they get hungry or are these not offered?
- If a resident has a special diet, such as food allergies, will they be accommodated?
- Are meals offered only on weekdays or every day? How many meals are offered per day?
- Is the senior allowed to keep a pet? If so, which type of pet and how big? Will the staff help care for it if necessary?
- What kind of activities are offered to residents? Do these change daily, weekly, or monthly to keep things interesting?
- Are seniors taken off the premises for field trips and activities or are they confined to the facility only?
- What do the common areas look like? Are the gardens tended to? Are the games and televisions in good condition and working order?
- Does the senior’s room come with phone, Internet, and cable?
- Are appliances included or will these have to be provided?
- Do the doors lock? Can the residents lock the doors themselves or will staff do it?
- Is storage space offered? If so, is it adequate?
- How big are the rooms? Are larger (or smaller) ones available?
- Does a senior get to choose the size of their room or the type of room?
- Do the rooms include a bathroom? Do the bathrooms have options for the handicapped?
- Are the exits easily accessible to all staff and residents?
- What happens in an emergency? Does the facility ever test for emergencies?
- Does the facility have fire extinguishers, sprinklers, and smoke detectors?
- Are the floors carpeted or non-skid?
- When a senior has a medical emergency, how do they get in touch with staff? Can they do so from their room? Who will respond and how fast?
- How often does medical staff visit residents? Who will visit? Will be it a doctor or nurse?
- Can seniors take medication on their own if they’re able?
- Who will remind them to take medication, if necessary, and how?
What Should I Look For In An Assisted Living Facility?
Before you sign any admissions agreement, take it home to look it over, ask another person to also look it over to make sure that you understand everything that you are signing.
Once your senior has qualified for residency at an assisted living facility, you’ll want to be sure you choose a place they’ll be comfortable and even happy in.
To meet this goal, what are the features and amenities that you should look for in the assisted living facility?
A Good Culture
Assisted living is a community filled with semi-independent seniors. Like any community, big or small, it will have its own culture.
You’ll only get a very small glimpse of this culture by reading about it online. So we recommend that you visit the ALF a few times – with your senior – to see if it’s a good fit for them, if they mesh with the others at the facility.
Also know that some assisted living facilities will allow you to spend a night or two. This little “stay” can help you to fully see what living in that building and culture could be like.
Affordably Priced (For You And Your Loved One)
In our recent article on assisted living, we wrote about how these facilities can cost anywhere from $2,000 to $7,000 a month according to 2020 data. At that rate, you may pay upwards of $84,000 a year.
Some of the cost can be covered by long-term care insurance so if you have that, mention it to the ALF manager.
Prices are even higher in some parts of the United States, although in many states, the annual costs might run between $42,000 and $48,000 a year.
Whether these prices are too high will differ from person to person. Assisted living is not necessarily cheap, even if it costs less than most nursing homes.
Obviously, it’s important to choose a facility that’s within your budget.
Options for More Care
Your senior may need low-level care now, but what if something changes in six months or a year? What are their options?
Besides the level 2 care we discussed above, many assisted living facilities also offer an even higher level of care. Under this type of care, seniors with chronic pain or a propensity to slip and fall will be supervised in order to reduce incidents.
Also, memory care for seniors with cognitive issues or who have been recently diagnosed with dementia or Alzheimer’s can allow for some independence while still accommodating for the elder’s memory changes.
Should a senior’s physical or mental health degrade past even what’s offered at the assisted living facility’s highest level of care, you’d likely have to move them to a nursing home.
We know you wouldn’t want your senior to get bored in assisted living, so be sure to check on the amenities within the facility. They should be plentiful.
For instance, maybe the facility offers a wellness program with its own in-house gym, dining at a cafeteria, field trips for able-bodied seniors, and weekly activity nights in an entertainment hall.
Activities and amenities are beneficial both mentally and physically.
Researchers have found that many LTC [long term care] residents are inactive and alone up to 65% of their time. Inactivity and social isolation contribute to strength loss, depression, and insomnia, with the highest rate of decline in those with dementia.
If the assisted living facility has checked all the boxes for you, so far, the last point to consider is its location.
This won’t matter as much to the senior as it does to you. After all, you’re the one who will have to come all the way out there to see your loved one, as will other members of the family.
Try to find a facility that’s close if you can, but don’t disqualify a good option if it’s 20 or 30 minutes away – unless you absolutely can’t go that far.
All of these questions are important and of course, you’ll have your own specific questions to add to the list as well!
But if this seems too overwhelming for you or you simply do not have the time or you are not close enough to a senior loved one to do this for them, the best way to manage this is to hire a senior care advisor or geriatric care manager to do the job for you.
Someone with this type of training can ask all the right questions to help you make the best decision possible.
Red Flags To Watch Out For
The following are some Red Flag moments that may indicate that this may not be the right facility for you.
- The management does not allow you to speak directly with the staff.
- The management hand picks the staff members that you can speak with.
- During the tour, you hear more about levels of experience of the staff vs. amount of training or credentials.
- The staff to resident ratio is 1:8 or higher.
- The cleanliness of the facility is not up to your standards.
- You notice cluttered and/or dirty spaces and rooms in your tour.
Assisted living allows your senior to hold onto their independence while still receiving the medical care they need.
If your senior is eligible for this level of care, you’ll want to thoroughly check out any potential facility. Be sure to ask plenty of questions, in order to choose the best facility.