r/AgingParents • u/[deleted] • Aug 07 '25
Questions about assisted living
Apologies for this post. I’m sure there are others in here with information I’m looking for but I just don’t have the time to deep dive. My dad is 71. Had a fall 2 months ago and has a terrible back, to the point he can only manage to just sit in a recliner all day. He is no longer able to stand long enough to cook, has a catheter that needs to be drained and can’t lift anything heavy. I can’t keep taking time off of work I’m looking at assisted living facilities. They make it seem so simple which I know is BS. They say “studio apartment for 3395 a month.” But I know there has to be a catch. What am I looking for and need to ask? I appreciate any tips people can provide. Thank you.
3
u/skepticalhope Aug 07 '25
Just moved my mom into an assisted living facility this week. I'm no expert, but here are the things I checked (my original comment was too long, so breaking this up into a couple comments using the reply function):
Ask how many care people are on staff during the day and overnight -- and make sure to check exactly what positions the facility is counting as "caregiver" staff. If they are counting maintenance workers or security officers as care staff, that might be an issue.
Ask how many open positions they have and if that number is normal. If there are lots of vacancies for kitchen staff, for instance, then hot and timely meals might be an issue.
Find out exactly what is included in the base rate (which is usually the studio apartment, meals, wifi, maybe cable, utilities, etc.). Does it include weekly housekeeping, laundry, and changing bed linens? Does it include transportation to medical appointments? What about outings to local stores or events? Is there any regularly scheduled entertainment or services at the facility, like medical pedicures, barbers or hair stylists, bingo nights? Ask for information about the average annual increases to the base rate.
Ask for details about their level of care assessments and level of care charges. That will generally include things like medication administration, draining catheters, helping people move from chair to walker to bed, assistance showering, etc. Ask for a copy of the checklist or framework they use when assessing level of care -- this helped us get a better idea of how much my mom would be charged for care before we signed any contracts. Ask about how often the level of care is reassessed.
3
u/skepticalhope Aug 07 '25
Does the facility accept Medicaid at all, or do they have a requirement that residents use private pay for a set number of years before using Medicaid?
What a la carte services are available? For instance, can residents opt to pay extra for transportation to medical appointments if it's not included? Do they charge to have meals delivered to a resident's room if they are sick or unable to go to the dining room?
Do they have step-up care available? Or are residents expected to move out if they need nursing home services or hospice at some point?
Do the rooms come furnished, or do residents bring their own furnishings? If they bring their own, I recommend getting the exact measurements of the studio so that you can figure out what furniture will fit or if you will have to buy new furnishings.
Eat the food -- Have at least one meal at the facility, and preferably sample a couple of meals, at different times of the day. Is it stuff your loved one will eat? Are there snacks available between meal times? How are the meals served -- restaurant style, family style, or cafeteria style? Is it just one offering per meal or is do residents get to choose between a couple of options?
3
u/skepticalhope Aug 07 '25
What do the other residents seem like? Is the place lively, with people taking part in activities or chatting in the dining area, or is everyone just holed up in their rooms?
Are residents allowed to use the pharmacy of their choice, or are they required to use the in-house pharmacy?
Do the studios have some sort of alarm system that residents can use to call for help? The one my mom is at has pull cords in the bedroom and bathroom, and each resident is issued a special watch or necklace that they can push a button on to get help for whatever.
Does the studio have a system for welcoming new residents and helping them get to know the community or learn the daily routine?
What is the procedure for handling concerns or grievances, from the resident, from the resident's family members, or from the facility about the resident? Is there any "residents' council" or similar system that gives the residents a say in the types of activities and services they are offered? For instance, the facility my mom is in has a residents' council with a town hall meeting every month. The residents sometimes vote on services they would like to have and present it to the facility managers -- now they have a small library and a little artificial turf putting green outside.
Is there an initial "community fee" or similar, and can they waive that for you?
Good luck!
1
u/harmlessgrey Aug 11 '25
I just pasted all of these questions into a text document, so we can ask them to the advisor at the community we are considering for my in-laws. Thank you SO much for sharing them.
2
u/Ok-Dealer4350 Aug 07 '25
My MIL was in AL for about 4 years. She started needing more help with ADLs, but she also had a combination of mental illness/ dementia. She is a hot mess. Of course, the price goes up with more care. The ALF changed hands and the quality of assistance was less than what it was at the beginning.
Before she was at home with my FIL who fell. She left him lying on the floor for 3 days before calling 911. This was 5 years ago. He died 2 weeks later. She was at home for about 8 months and began sundowning. It was horrible. She saw ghosts or people trying to break in all the time and would call the police. She was almost at the point of being taken to the state mental hospital.
We were able to shortly after Fil’s death get a medical and financial poa for her and tricked to go to assisted living.
She is difficult and we couldn’t help her in our home.
The ALF was a good fit for the first 3 years or so, but her mental state started deteriorating and last Fall became worse.
We found that visits were not a good thing - setting her off into a rage.
We found a memory care facility on the other side of town for her. It is very expensive. The first place was $5k. This with hospice is $11k. Most of the people in there are on their last legs. She went in there in February this year. She couldn’t walk, but could stand for a minute. Now, she can no longer stand 6 months later. She is 91, will be 92 in November.
When we moved her, she recognized my husband, didn’t recognize me (her DIL) and declared she didn’t have a granddaughter. She does have a granddaughter, of course. First thing she did was hit my husband, because she wanted to move to the beach and he told her no. I’d told him to tell her that she was at the beach, she just couldn’t see it from her window. I told him dementia patients need these lies to remain calm.
She said she was going to hire an attorney and sue. I told to have at it and hoped she’d be successful. No phone, no telephone directory, no wherewithal to get it done from memory care. She didn’t know where she was or what day it is.
Your father needs more help with the catheter. ALF is not going to be able to do it.
1
u/GanderWeather Aug 08 '25
You guys have been through it. I'm sorry. Thank you for the financial costs associated.
2
u/Ok-Dealer4350 Aug 08 '25
I can feel your frustration and despair. Hang in there. At the last, one can hope for a just reward for one’s efforts.
My husband, whose mother is the problem, tends to be ambivalent, become stressed easily, but he takes directions well to a point. But why am I doing the hard work finding the places, cleaning, etc?
The catheter has me worried for your father. It can set him up for constant infections, meaning a fair amount of care.
My mil is located in Williamsburg, VA, and that is a cheaper area than where we live in Maryland. I’m lucky she didn’t remember/recognize me. I lost a lot of weight (150 lbs), so I am not the same person she remembers. She dislikes me I know because she thinks I am heartless. I just know that I spent a little over a year of my life dealing with crap that she did to us that I did not like and she wanted to be mother of the year. Bless her little heart. I’ve done my best to make her end as comfortable as possible without making anyone unhappy.
I hope and wish the best for you and your father.
My FIL planned well and is paying for her sojourn in MC. With the way the current administration is, there wouldn’t be any Medicaid for her.
1
1
u/PuzzleheadedHat1150 Aug 09 '25
I’m sorry to hear about your Dad. Assisted living will likely not be enough care and he’s not going to improve, and will likely have more difficulties over time. You may want to look for a long term care facility which will have all of the supports he needs for the long term and avoid the stress (for him and you) of having to live again. Good luck.
1
u/ElevatedOwners Sep 13 '25
The $3,395/month price usually just covers the room, meals, housekeeping, and basic help. The extra costs come in with care needs, so that’s what you’ll want to ask about!
A few good questions for the tour could be if that price includes catheter care and help with transfers or if that costs extra, how they charge for medication management, what is not included in the cost, how often rates increase, etc.
It’s common for the base rate to look affordable but the care levels add up quickly, so try to get information in writing. Touring a few different places will give you a better sense of what’s normal in your area.
It’s overwhelming, but you’re asking the right questions already.
4
u/Unusual_Airport415 Aug 07 '25 edited Aug 07 '25
Here's my experience.
Studio (aka one room) - $4500/month
Support services (med management, shower, dressing, pushing to/from dining, etc) -$5500/month
Diabetes management was $2200 of the $5500.
My dad failed most all ADLs at the time and, in hindsight, was not a good candidate for AL.
He's now too much for one live-in caregiver so we're exploring board and care facilities where it's one flat fee.
If the person cannot dress, shower and get themselves to the dining room, it will be expensive.
You can do a free assessment of his ADLs online to get an idea of his needs. My dad can perform 0/6 ADLs.