Assisted living inside info – NCRO.org Q&A

Posted on 7 Oct 2018 Updated on 5 Jun 2020

Assisted living insider info – NCRO.org Q&A

Many thanks to Chuck Austin and Rich Brown from NCRO.org and Dave Robinson from Hospice of Michigan for the opportunity to speak at the September 2018 NCRO Long Term Care Issues conference and webinar.

I enjoyed the lively questions and appreciate your members coming out on a rainy day to discuss defining your wishes, options for palliative care and resources for after retirement.

After the seminar ended, one of your members wanted more info about questions to ask when exploring assisted living options for a parent.

Many people don’t realize that while anyone can call their senior residence “assisted living,” there are only two specific types of licensed assisted living providers and services vary widely.  Click here for a summary from the Michigan Assisted Living Association.

As a visiting healthcare provider since 2003, I’ve cared for patients in many assisted living settings. “Fancy” does not always equal “quality care.” While the amenities are important, there are other factors to consider:

• Is the facility licensed with the state and if so, which type?
  • An unlicensed facility may meet your needs, but know their status
  • Quality care can be provided in any setting, but the opposite is true as well
  • Licensing provides oversight and regulatory requirements, as well as a clear understanding of services provided

• Do residents pay for all services every month even if they do not currently use them? Or, is there an option add only what is needed over time?
  • Optional services may include meals, private duty for bathing, grooming, toileting, medication passing
  • My personal preference is a facility that allows flexibility over time to avoid paying for things not yet needed

• What kind of support is available after business hours for health needs?
  • Some buildings have only a 911 pull cord in the bathroom and living room, others have a security guard but no nurse support
  • Other buildings have clinical staff after hours (usually a nursing assistant who may or may not be certified) who can call a supervising RN 24/7 if a resident falls or has a health crisis
  • Rarely, some buildings have an RN on premises at all times

• Are health care providers part of the building or can residents bring in whoever they choose? 
  • Some communities sign exclusive contracts for each type of service, such as a private duty company, a visiting nurse/therapy agency, and a visiting physician practice
  • Others allow residents to use who they choose and change as desired
  • While “built in” care providers may sound convenient up front, I have seen residents have to use a hospice they did not want because the only physician in the building worked exclusively with them
  • The resident’s wife was faced with using that physician/hospice or seeking other living arrangements
  • I strongly recommend choosing a building that allows choice
  • Choice motivates all providers to maintain quality and keeps the resident and family in control

The other key is to research options far in advance.  Scrambling to find a place when  the hospital is discharging in a day or two is a common stressor.  Planning ahead will provide you with peace of mind and confidence if the need does arise.

Services like A Place for Mom (national) or Next Steps 4 Seniors (Southeast Michigan) are free to use and a great resource.  They work just like an apartment finder. The facilities pay them a finder’s fee – typically the first month’s rent.