A Careful Checkup for Assisted Living

Finding the right facility means digging deep, looking past nice décor to examine staff training, quality of care, and costs

By Ellen Hoffman

Whether you need a new home for yourself as you get older, a spouse with Alzheimer's disease, or a widowed mother who has had a stroke, you should look for a facility that offers superior care, not glitzy decor. The task may prove trickier than you would think.

Surf the Internet for a list of facilities, and you'll encounter such details as "home-like atmosphere," "fresh flowers," "gracious dining," "catered care," and "solarium and card room." Naturally you want a clean, attractive setting. But fresh flowers in the reception area don't guarantee that Mom will get her prescription drugs on time, or that your spouse will receive care from staff members trained in working with people suffering from memory loss.


  Susan Olshan, a New York City-based brand consultant, found out the hard way. Six years ago, her 73-year-old mother needed assisted living after breaking her hip and developing a seizure condition. Before moving her mother into the facility, "We thought we asked all the questions we needed to ask," Olshan recalls.

But over the next several years, Olshan discovered a number of disturbing shortcomings, including low-quality food and untrained personnel who neglected to give her mother her medication. This prompted Olshan to do an extensive search and ultimately switch to a different, better-quality facility.

As the average life span of Americans has increased, the assisted-living concept has gained popularity. It provides an option for those who don't need constant nursing care but still have limitations preventing them from carrying out certain daily activities such as dressing and bathing.

A March, 2005, a draft report by Robert Mollica of the National Academy for State Health Policy and consultant Heather Johnson-Lamarche indicated that the U.S. has about 938,000 assisted-living residents. But the figure is not conclusive because no standard definition of assisted living exists. Some states include facilities such as adult group homes -- smaller residences where adults may share bedrooms or bathrooms, for example -- as well as the tonier complexes with manicured lawns and chandeliers.


  Before starting your search for the right facility, accept that you're facing a long-term project, says Karen Love, founder of a nonprofit advocacy group, the Consumer Consortium on Assisted Living (CCAL). "People typically think they're going to put a couple of hours" into it, she says. "But it's more like a child selecting a college. You need to do your homework." Love suggests visiting as many as five prospective locations.

A number of factors make it a challenge to accurately assess the candidates. Financial arrangements and costs vary tremendously, so you need to take the time to make a final tally. And facilities generally need not undergo standard inspections or disclose all the information you may need to judge the quality of care. Why? Unlike nursing homes, assisted-living facilities are paid for almost entirely by private funds (including long-term-care insurance), so they generally need not meet federal and state regulations for Medicare or Medicaid.

A 2004 report by the Government Accountability Office, an arm of Congress, concluded that consumers "often do not have key information they need" to identify the best assisted-living facility.

The report suggested that the most important information includes "staffing levels and qualifications, costs and potential cost increases, and the circumstances that could lead to involuntary discharge from the facility." (Discharge policy is an issue because some facilities require residents whose health status declines to move out.)


  Fortunately, consumers can find help online. The CCAL offers FAQs and publications on assisted living. The Assisted Living Federation of America (ALFA) posts several useful consumer articles, including one on key financial issues, and a consumer information statement that can serve as a guide for your search.

ALFA and other consumer sources suggest you ask yourself the following questions when visiting a facility: Do the residents seem happy and comfortable? How do the workers relate to residents? Is the staff professional? You'll also want to look into what type of training the employees have had, the quality of the meals served, and which services the facility makes available on a 24-hour basis.

Bill Kays of Bristow, Va., carried out a successful search for the right home for his wife, who suffered from Alzheimer's. The retired head of labor relations for Bell-Atlantic started by seeking advice from members of an Alzheimer's support group and the staff at an adult day-care program his wife had attended. He used a checklist from a Consumer Reports article on choosing a nursing home or assisted-living facility and visited five prospects.

Kays's homework paid off, when he found the perfect home, in Front Royal, Va. His wife, who has since passed away, "really liked it there. She never once said she wanted to go home."


  While the well-being of your family member ranks as the No. 1 concern in your quest, you should also consider that the average minimum cost of room, board, and some basic assisted-living services totals $30,000 per year, according to an October, 2004, survey by the Metlife Mature Market Institute. Extra medical services such as blood tests, rehabilitation therapy, or administering oxygen can add thousands of dollars to the annual tab. That kind of financial commitment makes it crucial to do your homework.

In a world where surface glamour serves as a marketing point for almost everything, the facility with the prettiest landscaping or the most opulently furnished public rooms might look tempting. Just remember that to find what's truly important -- kind, conscientious, well-trained staff members who deliver excellent care to residents -- you must invest your time in delving beneath the surface.

In addition to writing Your Retirement for BusinessWeek Online, Hoffman is the author of The Retirement Catch-Up Guide and Bankroll Your Future Retirement with Help from Uncle Sam. You can contact her through her Web site, www.retirementcatchup.com

Edited by Patricia O'Connell

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