How to Choose an Assisted Living Community: Critical Questions to Ask

By Jeannie Finnegan, CDP, Elder Care & Dementia Care Specialist at Stanton Aging Solutions

Perhaps you’ve seen that your loved one can no longer live alone safely, or maybe you care for your loved one in your home and have realized that their care needs exceed what you can provide. You’ve decided it’s time to find an assisted living community in Maryland that will provide the best care and quality of life possible, while within your budget and at a comfortable driving distance.

Researching, touring, assessing, and selecting an assisted living community can be overwhelming. You may live in an area with few assisted living options or many, so what should you look for and what should you ask when visiting an assisted living community?

Start by asking these important questions as you research each community, and feel free to reach out to us for guidance at any point in your search.

What is the staff-to-resident ratio?

Ideally, the staff-to-resident ratio for personal care/direct care would be one direct caregiver for every four to five residents, but the number of residents per caregiver will likely double during the nighttime shift and, in reality, there are no state regulations for what the ratio should be.

However, the qualifications of staff on hand is actually the most important factor in resident health and quality of life, according to several studies. An assisted living community with a full-time Registered Nurse (RN) who provides care to residents reduces a resident’s likelihood of going to a nursing home or some other care setting by approximately 50 percent. Research has repeatedly demonstrated that assisted living communities with full-time RNs and in-house nursing staff have a direct and positive impact on resident outcomes.

What are the qualifications of the direct-care staff?

Most direct-care staff at an assisted living community should be either a GNA (Geriatric Nursing Assistant) or a CNA (Certified Nursing Assistant). Both GNAs and CNAs have completed an approved nursing assistant program, although a GNA must also pass a state exam. Both are certified by a board of nursing and are trained to assist seniors with the activities of daily living, including bathing, dressing, grooming, toileting, mobility, and eating. A CNA is also trained to take vital signs and, depending on additional training, may also draw blood or provide other more advanced medical care. GNAs and CNAs both work under the supervision of a registered nurse.

Do the staff receive ongoing professional training?

It is important that the community you are considering provides ongoing staff training, especially in dementia care. Many assisted living residents have some level of memory impairment or dementia, even if they do not require placement in a memory care unit. Staff who receive ongoing specialized dementia care training are more equipped to effectively and compassionately care for residents with dementia. It is also important to ask how often staff receive training, whether it is in person or online, and who does the training.

What is the rate of staff turnover?

Frequent staff turnover may indicate that the community is not well-managed, or perhaps it does not offer competitive compensation, benefits, flexible scheduling, or opportunities for professional growth. When a community has employees that have been there for several years or more, it can indicate a solid management approach and dedicated employees who love what they do and where they work.

Does the community have a dedicated memory care unit?

For someone with Alzheimer’s or a related dementia, memory care will eventually be needed. Many senior care communities have an assisted living wing as well as a dedicated memory care unit. Memory care units are typically staffed with professionals who have additional specialized dementia care training. They are generally secure, locked units to ensure that residents are safe and cannot leave the building. Memory care rooms are typically smaller than in assisted living, but the goal is for residents to spend more time out of their rooms, engaging in meaningful activities.

What is the size of the community?

As you are researching assisted living communities in Maryland, remember that these communities can vary widely in the number of residents/beds, units, size of the building, number of activity and gathering spaces, size of activity/life enrichment team, etc. Large commercial assisted living communities — especially those that are new or newly renovated — may have movie theaters, large and small activity and gathering rooms, libraries, fitness and physical therapy rooms, outdoor spaces, and more. The average number of residents in these communities is 33, although many commercial communities are much larger, with 60, 80, or over 100 residents. 

Small, community-based assisted living facilities are typically renovated residential homes with several bedrooms and no more than five residents, and are typically about half the cost of large commercial communities.

What kinds of activities will my loved one be able to participate in?

Most large communities will advertise a wide variety of engaging activities and outings available to residents, including games, movies, musical entertainment, guest speakers, crafts, and more. Each community should have an “Activities’’ director and staff, sometimes also called “Life Enrichment” or “Vibrant Living.”

It’s a good idea to ask for daily, weekly, and monthly calendars of activities that are offered, but it is even better to visit a community under consideration to observe some activities with your loved one. This will give you an opportunity see how many residents participate, what their level of ability is (i.e., do only the most independent residents participate in activities or are there activities for every ability level?) and how engaging the activities and the staff are. If your loved one is a man, ask if there are activities specifically geared toward men. Many communities have lots of activities around crafts, jewelry making and art; however, the most creative communities will also have activities that appeal to men, such as “poker night,” men’s club, or sporting event trips and viewing.

What are the costs and what do they include?

Most large corporate communities, such as those that are part of a chain, range from $4,000 to almost $10,000 per month, depending on location, quality, amenities, staffing, dining, and level of care. Your loved one will be assessed by the nursing staff. For each additional level of care required, the monthly fee will increase.  Since assisted living residents need varying levels of medical and personal attention, communities typically provide a range of services that cater to their residents’ physical, emotional, and psychological needs. These include:

• ADL assistance (activities of daily living, such as bathing, toileting, transferring, dressing, and continence)
• Administration and management of medication
• Three meals each day
• Recreational, social, and therapeutic programs
• Exercise and wellness programs
• Housekeeping and laundry
• Transportation to local physician appointments, outings, etc.
• Supervised care
• In-house security
• Personal emergency alarm systems in resident apartments/rooms

Assisted living communities are not designed to support residents with critical medical conditions. Instead, they are designed to prioritize comfort, safety, and care within a home-like environment. Residents are encouraged to bring personal and decorative furnishings to help them feel more comfortable and at home.

In addition, a well-run community will develop individualized resident care plans upon admission using special software, enabling caregivers to work as a team to meet individual needs while giving residents the freedom to live as independently as possible in a safe and controlled environment. The more information the resident and their loved ones can provide to the community about their needs, goals, and desires, the better the community is able to create a care plan that provides the best care and quality of life for its residents.

Some communities have an “all-inclusive” fee structure, and rates will not change based on the level of care needed. This can be a plus when a family is planning for years of care for their loved one. There are also assisted living communities that are part of a “Continuing Care Retirement Community” (CCRC). In this scenario, the community offers a “continuum of care” on the same campus, including independent living, assisted living, and skilled nursing home care for “critical” or “skilled” medical conditions. As your loved one ages, or as their illness or condition progresses, your loved one would move to another level of care to accommodate their changing needs. The downside to a CCRC is that they typically require a substantial deposit known as a ‘buy-in’ up front, usually well over $100,000. The buy-in fee ensures if a resident outlives their finances, the community will cover all necessary expenses. However, residents also are required to pay a monthly fee based on the size of the unit, the amount of their initial deposit, their level of care, and other factors. A CCRC is obviously not for everyone, but something to consider and a decision we can walk through with you.

Who should I talk to if I later have a concern about the care my loved one is receiving?

It is important for staff to communicate regularly with family members, and make sure their concerns and goals are part of the care plan or service plan for their loved one. A care plan meeting should be held every six months in an assisted living community, or any time there is a significant change in a resident’s status. Since assisted living communities are not required to have a social worker on staff, it is key for families to know the point of contact and the grievance procedure. Make sure to ask the following:

• Who is the point of contact should I have questions or concerns about my loved one’s care?
• How often will I receive updates as to my loved one’s progress or status? Will I receive regular emails, texts or newsletters?

Your Next Steps in Selecting an Assisted Living Community in Maryland

Our clients often ask us if they need to take a tour of every community they are considering. Talk to us first and we can point you in the right direction based on what you’re looking for, but touring multiple communities is truly the only way to discover what a community is really like.

Every community has its own culture, its own level of vibrancy, its own “feel.” This can be related to the newness of the building and the décor, how active and involved the residents are, the enthusiasm of the activities staff, and much more. When touring a community, it’s always a great idea to not only walk around with your guide, but also to have a meal in the resident dining room as part of your tour and to observe an activity or two. You might even be able to chat with a resident or some family members. This will provide you with detailed information you won’t receive in a brochure or with just a walk through the community.

As your partner in care, Stanton Aging Solutions can assist you in finding the right assisted living community in Maryland for your loved one. We are very familiar with most senior care communities in Howard County, the Greater Baltimore region and throughout Central Maryland. We understand that no two people are alike, nor are any two communities. If you’d like us to help you narrow your search or go on tours with you, please reach out to us. We work for our clients — not for senior communities — and often, we continue to visit our clients in their assisted living communities, for check-in visits or our Concierge Connection Care service.  We’re happy to help as you navigate finding the best assisted living community in Maryland for your loved one. Please call us at (443) 812-1028 for a 15-minute phone consultation at no charge, or use our contact form here.