Assisted Living Questions and Answers

All the information here is general information and does not refer to a particular resident or particular assisted living facility. And I am sure it is not complete; but it may be used as a guide.

But I would like to emphasize that assisted living facilities have no medical care comparing to nursing homes, which that have medical care. If a medical treatment is needed in an assisted living facility a home HEALTH agency must come in and provide the care. Please see also “Information for Future Residents of Nursing Homes.”

Are there licensed nurses, (RN or LVN), on dayshift/nightshifts?

There is no requirement by law to have RN/LVN on staff. But very often, as I have seen it, larger facilities employ an RN and/or LVN.


Is the same caregiver responsible for the same resident every day? Except her/his days off.

It should be. If a resident has the same caregiver each shift, the caregiver knows the resident well. It benefits the resident and the consistency of the care may improve the quality of life of the resident, as well, for early recognition of the resident’s health changes.


Does this facility use staff from a temporary employment agency?

Temporary workers do not know the individual residents and their special needs, except if they work a longer time in the facility. Over reliance on temporary staff can cause problems. Occasional backup from an agency may be necessary, however, something is wrong if an assisted living facility routinely relies on temporary workers for regular staffing.


What is the resident / caregiver ratio?

A ratio means: the number of residents each caregiver has to take care of.

There is no law to follow but a national resident advocacy organization recommends direct caregiver ratios of average 1:5 to 1:7 on days, 1:10 on evenings, and 1:15 on nights, sometimes up to 1:25. One caregiver for 5, 7, 10, 15, 25 residents, respectively.

But be aware that this ratio cannot be used for all care of residents. If an assisted living facility has more residents with respiratory problems, urine catheter care, or other treatments in using a high amount of time and staff, staffing will vary on the kind of care residents need, recruitment, staffing policies at the facility, etc.

For more information about staffing, click Ratios and Staffing.

In time of special care needs for your loved one, talk with the facility and you may bring your own caregiver from an outside home care business. Some facilities work together with a home care agency.


Is there a registered dietitian available?

In general, there is no dietitian on staff. But very often the chef “cook” has the education to help you in this case. If not ask for recommendation for a dietitian/nutritionist. Make sure you talk about the special diet you need before you move in.


Are physical therapists, speech therapists, and occupational therapists available?

No, in general no therapists are employed by assisted living facilities. But if you like to have someone come into the facility and provide treatment for your loved one, ask your loved one’s physician for a prescription for this kind of therapy. The next step is to ask the facility if they work together with some therapists. If not, a therapist from a home health care agency may come and give the treatment. The physician may send the prescription to the home care agency. It may be covered by your insurance with a doctor’s prescription.


How does the staff help new residents adjust to the facility?

Staff members should be able to explain how they help adjust. They may use a welcome banner, social service visitation, activity staff visits, and other efforts to involve new residents in the facility. Also new residents may be a welcomed by a committee or be greeted with welcome crafts or small gifts. Another resident may be an “escort” for the new resident for a while to assist with the daily life at the facility.


What are typical problems that new residents have when they come to this facility? How does the staff help them handle these problems?

Typical problems may include not knowing anyone in the facility, not being able to find the dining room, not understanding the daily routine, etc. The staff should be able to explain common problems that concern new residents and how they can help. Sometimes another resident is an “escort” for some time to assist the new resident.


One-bed or two-bed room? How are residents matched as roommates?

In general, rooms in assisted living facilities have one bed in a room, besides having larger living spaces, as of studios, 1- or 2- bedroom apartments, etc. An exception may be at smaller facilities, which may place two residents in one room, called shared room. If you share the room with a mate, the staff should try to match interests, healthcare needs, ability to get along, and other characteristics.


What happens if roommates do not get along?

Residents should have some recourse if they cannot get along with their roommate. The staff may suggest another roommate or move you to another room, or they might arrange a meeting between the roommates and a staff person to try to resolve the conflict. Do not face the situation alone. See also ombudsman/advocacy.


Are there other residents here who might be interested in socializing?

Very often after a time the staff becomes aware of other residents who may be a good social match for you or your loved one, especially if the residents share some games or other interests.


Is there a family advisory or support group?

There should be. Family groups can help residents and their families adjust to facility life.


Is there a resident council?

Facilities, especially larger one, have a resident council, most under the umbrella of the activity department, where residents routinely meet with the staff to discuss care and the “home life”. It is a state requirement to offer a resident council.


Is there a family council?

Many facilities have family councils so families can routinely communicate with staff about care and quality of life issues inside the facility to improve services and make some changes, if possible.


Do families and residents meet routinely with the staff to discuss care concerns and share ideas to make the life even better?

You should be able to meet regularly with the staff to discuss care concerns and share ideas to make assisted living life even better. (Not every suggestion is applicable and not every suggestion is possible to make implement). Be reasonable: cooking just the food your loved one likes is not possible. Your concern is your loved one, the concern of the facility if for all the residents.


What do residents usually say about the food?

The staff should know if residents like the food in general or not.


What happens if a resident does not want to eat a particular meal?

Residents should be given alternative choices. Ask what substitute foods are available to residents for this particular day.


Are residents able to request special food items?

Residents should be able to make special requests but sometimes it is not available. Families may be able to bring special food to the resident, after consultation with the nurse.

In larger facilities more than one meal at each mealtime is available.

In smaller facilities the staff may suggest something else and prepare it for you.


Can I taste the food and observe a meal?

The staff should let you taste a meal prepared for residents. Watch meals being served. It should look and smell appetizing. Often when you visit assisted living facilities you are invited to share a meal there.


Is there a program to help residents regain or keep their physical abilities?

There should be an organized program; sometimes it is part of the daily activities, f.e. exercise classes.


Are residents assisted to the bathroom when they ask?

Oh, yes, the caregivers should assist residents to the bathrooms. And if needed: there should be set up a routine schedule to go “automatically” every few hours to the bathroom with incontinent residents or at least remind the resident.


Are there grab bars and other safety devices in resident bathrooms?

There should be, and state law requires it.


How does the staff help residents maintain privacy and dignity when they assist with bathing and other kind of care?

Staff members should tell you how important it is for residents to maintain privacy and dignity. They should have an orientation program to teach new staff how to preserve a residents dignity when providing care.


How long do residents usually wait until their emergency call is answered?

Although staff members cannot always respond immediately, residents should not have to wait long for help. Make a point of watching when you tour the facility to see if there are lots of lights on, or you hear the call button sounding how quickly the staff is responding to them. In general, in assisted living facilities the residents are more or less able to walk and request less calling.


What activities are available?

There should be a variety of activities to interest a variety of people. Many facilities offer craft classes, music groups, exercise groups, small discussion groups, games like bingo and bunko; and field trips to fairs, festivals, and other community events. In addition, individual activities, such as reading or playing cards, should be encouraged. But there should be a consideration that activities are also set up for people with different cognitive abilities.


How frequently are activities offered?

Activities should be offered frequently so residents can socialize, explore new interests, and occupy their time. Occasional evening and weekend activities should supplement traditional mid-morning and mid-afternoon events.


Are religious services conducted for the residents? How often?

Religious services should address the needs of residents with different denominations. They should be offered frequently enough to meet residents’ interests and needs. Ask about services that meet the requirement of your loved one. Some residents attend a place of worship outside the facility on a regular basis. There should be transportation available.


Can residents leave the facility for an outing or other leisure activities?

There should be opportunities for an occasional outing. Families should be encouraged to take their loved one out to a favorite restaurant, a wedding, or family celebrations, going to church, synagogue, or other places of worship. And the facility should provide transportation if the resident likes to go to places but please sign out when you leave and sign in when you return.


Do residents have the freedom to say no when they don’t want something or would prefer not to do something?

Sometimes residents do not want certain medical treatments, or they prefer not to participate in some activities. They have the right to say no. Treatment decisions should be discussed first with the resident, then with the resident’s doctor, family, and probably staff (nurse), so everyone understands what the resident wants, and I repeat: what the resident wants.

In my experience: residents often do not have all necessary information to make a contentious decision.


How does the staff help residents who are depressed?

Staff members should be able to describe a number of techniques, such as talking frequently with the resident, trying to involve them in activities, spending extra time just with this resident, reporting to the supervisor, information to the physician, probably getting a psychological evaluation, etc. But be aware all medications for depression have quite severe side effects: Just to name one side effect: drowsiness, which may lead to fall risk.


Where is the Ombudsman, Advocacy for the facility? Does the Ombudsman, Advocacy visit regularly?

Assisted livings facilities have an ombudsman, advocate who is part of the official state ombudsman, advocacy program. Ombudsman, advocacy, investigates and attempts to resolve concerns rose by assisted living residents, their families, or their friends. The staff should be able to tell you who the ombudsman, advocacy is and when he or she usually comes to the assisted living. Family members may also call the ombudsman, advocacy office any time with any concern, and the phone number should be available and visible, hanging on some wall inside the facility.


Additional information:

  • Assisted living facilities are regulated by the Social Department of the State.
  • Each State has its own regulations/requirements.
  • At assisted living facilities, often before the resident moves in, family members provide information about the care of this resident. Then a kind of “outline” of a care plan is written. And after the information from the physician is received at the facility (you may not move in before) a definitive care plan is provided and given to all the departments.
  • From my experience care plans are adjusted as the need arises.
  • Make sure you understand what is included in your monthly payment and what is not.
  • If you like to have additional therapy, like massage, or other treatments you are used to, talk with the assisted living facility and I am sure you can bring in the people who provide this kind of treatment to you, or you may go outside for this treatment and the facility should provide a transportation for you. Ask if this transportation is included in the monthly fee.
  • Larger assisted living facilities have beauticians, and / or hairdressers who come on assigned days to the facility.
  • A dry cleaning business may come once a week and pick you your stuff and bring it back.
  • But your -non dry cleaning- clothes should be washed. There is no regular ironing of your clothes, and it should be included in the monthly fee.
  • Only in very high-end assisted living facilities the clothes of residents will be ironed.
  • Make sure that you know what is included in the monthly payments to the facility and what is not, for example, dry cleaning of your clothes is not included, as also the hairdresser. But the washing of your clothes should be included.