Assisted living has become big business in America, and it’s going to get a lot bigger. Today, there are 750,000-plus elderly people living in more than 30,000 assisted-living facilities across the nation. These numbers are expected to grow significantly as the baby boom generation continues to age. According to the Administration on Aging, there will be 72 million Americans aged 65 and older in 2030 (compared to 41.5 million in 2011). Assisted living is an attractive option for aging boomers who want to maintain their independence while getting help with the activities of daily living, including preparing meals, dressing, bathing and housekeeping.
But consumer advocates are concerned that uneven regulations are endangering assisted-living residents, especially an increasing number who are more seriously ill and require a higher level of care. “Most states set the entry bar low for facility workers, requiring little in the way of education or qualifications,” said the authors of a recent investigative report for ProPublica and “Frontline” titled Life and Death in Assisted Living. “In Minnesota and 13 other states, administrators don’t need high school diplomas. Caregivers can be as young as 16 in Illinois.” The report goes on to note that only 14 states set minimum staffing levels, and assisted-living facilities are not inspected as often or as rigorously as nursing homes.
Quality care in assisted living is available. According to a 2013 survey by the National Research Corporation (download here), overall satisfaction was rated “good” or “excellent” by 91 percent of residents and 92 percent of families in the 1,500 facilities surveyed. Here are seven tips from ProPublica to finding quality care:
- Understand Your Needs. Assisted living might look like a great option, especially when promoted as an alternative to nursing home care. But some facilities may not be capable of caring for people with complex medical conditions. Familiarize yourself with the basic services provided by different assisted-living facilities and learn how to compare one to another. Download the free Guide to Choosing an Assisted Living Residence from the Assisted Living Federation of America. The Alzheimer’s Association, Caring.com and LeadingAge.org offer state-by-state directories as well.
- Visit … Often. Visit prospective facilities often, and at different times of the day. Take time to talk to the residents and staff. And ask tough questions. For example: What is the ratio of caregivers to residents? How many staff work overnight shifts? What type of nursing care is provided? What is the turnover rate? Checklists of what to ask or look for when visiting an assisted-living facility are available from several organizations, including the AARP, the Alzheimer’s Association, California Advocates for Nursing Home Reform and the Assisted Living Consumer Alliance, among others.
- Know Whether the Facility is For-Profit or Nonprofit. The pressure to earn profits can impact staffing, food and available activities. That doesn’t mean you should dismiss for-profits, as there are good and bad facilities in each category, but do your homework.
- Know the True Costs. Assisted living can be expensive, averaging $3,550 per month, according to a 2012 survey by MetLife. Also, note that the base price may not reflect fees for additional services, from meal delivery and laundry to bathing assistance and medication management. These costs can add up quickly.
- Watch that Admissions Agreement. The devil’s in the details when it comes to admissions agreements, which are often lengthy and complicated. Many assisted-living facilities and nursing homes now include forced arbitration clauses in admission contracts, thus protecting themselves from accountability in an open court of law. If any part of the agreement is unclear, consult an elder care attorney.
- Choose Quality Care Over Location. Sure, it’s easier to visit a loved one if the facility you choose is located near friends and family. But experts warn that your first criteria should be quality care and a facility that is a good fit for the prospective resident.
- Check Public Records. Look for reports that present less than flattering news. Check the property’s regulatory history and complaint record for the past five years. Your state’s health department or long-term care ombudsman will have that information.
You might also consider hiring a geriatric care manager to choose the best facility for your loved ones. According to the National Association of Professional Geriatric Care Managers, professionals in this field typically charge $80 to $150 an hour to find the most appropriate facilities for families.
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