By 2030, the U.S. Census Bureau estimates that 20% of Americans will be 65 or older. Folks have more longevity than ever, but getting older isn't easy, and families aren't always equipped to deal with aging parents. That's where resort-like mature lifestyle estates for active seniors and more modest and care-intensive assisted living facilities and nursing homes enter the picture.
Choosing where to place your elderly dad or mom is challenging, but if you know what to look out for and what questions to ask, you can make the best decision for their well-being.
The financial implications of long-term care are significant, so you need to know the nitty gritty. One of the first questions to ask a potential facility is whether they accept Medicaid or other subsidies and what financial aid routes exist. Medicare does not generally cover custodial care.
Next, ask whether the base rate covers services important to you, such as transport, or whether those are additional fees. A facility may have a tiered payment plan with differently priced packages featuring basic to more extensive services. It's also worth asking what costs continue if a resident is admitted to the hospital. Genworth’s Cost of Care survey showed that the base rate for assisted living in 2020 was about $4,300 per month.
Read the Admissions Agreement, or ask an elder law attorney to do it for you. An expert can help you make sense of the legal jargon and parse what's par for the course from what's worthy of a red flag. Alternatively, look at the American Bar Association's checklist for choosing a facility.
Liability waivers and the fine print on negotiated risk could mean you have no right to sue if something goes wrong. Facilities may be open to removing some clauses.
The long-term care ombudsperson in your area can provide some enlightening information. If a facility has violated state requirements, you can learn what the citations were for. For example, the maladministration of medication may have been a problem. Or regulations concerning staff numbers and qualifications may have been ignored.
You can then broach these topics with the facility or move on in your search.
Your elderly parent may be pretty independent now but develop issues with mobility or memory later on. Can the facility manage these situations, which may include round-the-clock assistance with ADLs? Or would you have to uproot your aging mom or dad to a new location?
Remember that a facility's claimed ability to manage these issues isn't the same as proven practice in doing so. Take a look at the resident population. Is there a range of ages and abilities represented?
Care communities differ when it comes to rules and limits. Perhaps your mom or dad has a beloved pet they want to take with them. Is the facility amenable, and what animals are allowed? There may also be rules about visiting times and personal decor. Could the home terminate services if the rules are broken?
During the daytime, you can expect the staff-to-student ratio to be one non-admin staff member to eight residents, but 1:5 is ideal. Most community members are asleep at night, so one staff member to about 15 residents is acceptable for the late shift.
The rules may differ depending on the state and can refer to mandatory direct care hours per day.
Ask if you're allowed to speak to residents or their family members. These chats can give you peace of mind or make you realize that a top contender might not be as great a fit as you'd hoped. You can enquire about staff turnover, how long it takes to handle complaints and whether management is accessible and friendly, quality of life, and any other concerns you may have.
One or two of these discussions could unearth pros or cons you didn't even think to ask about.
Care facilities do tours and show prospective clients the on-site amenities, but you may need to spend more time at the community to get a true feel for the place. Ask to stay for a meal so you can taste the food and observe how staff members interact with residents or how residents interact with each other. Will your parent fit in?
It's not uncommon to encounter six-month waitlists—there are more golden oldies than apartments at assisted living facilities. Private rooms have longer wait times due to their popularity. There may be limited beds for people on Medicaid, and ALFs have 33 licensed beds on average.
Ask how long you could expect to be waiting, and budget for a deposit of about one month's rent.
Long-term care is often not a one-size-fits-all solution. Assisted living facilities (ALFs) usually accommodate individuals who live in their own apartments or rooms but may need help with certain activities of daily life (ADLs). This is a good option for folks that don't require constant supervision.
Nursing homes involve more care and tend to focus on people with one or more mental or physical issues. Some facilities cater to patients with Alzheimer's, for example. Then there are Continuing Care Retirement Communities, which have a stepped-care approach. To find out more, call the Eldercare Locator at 1-800-677-1116.