Questions to Ask When Evaluating Assisted Living Communities

A foreword on the Coronavirus and assisted living.

As I am sure many of you are aware, the Life Care Center of Kirkland, in Kirkland, WA, has been at the center of the COVID19 outbreak in the USA.

It was, unfortunately, the perfect storm. A new, relatively unknown virus, which seems to disproportionately affect the elderly and those with compromised immune systems, landed in a community that was home to the most vulnerable people. That, coupled with a lack of tests, led to the high death rate we have seen in this community to date.

As a result, many other assisted living communities have taken additional steps to protect their residents. Last Tuesday, Washington State Governor Jay Inslee announced the following changes which are now in effect:

• Visitors must be adults and the visit must take place in the resident’s room. This does not apply to end-of-life situations.
• All visitors must follow COVID-19 screening and follow reasonable precautionary measures. Precautionary measures include, but are not limited to, wearing personal protective equipment, social distancing, or visiting in designated locations.
• All visitors must sign into a visitors’ log. Owners and operators must retain that log for 30 days.
• Employees and volunteers must be screened for COVID-19 symptoms at the start of each shift.
• People who live in nursing homes or assisted living facilities and who test positive for COVID-19 must be isolated from other people.
• Owners, operators, staff, and volunteers are prohibited from disclosing protected and confidential health information, except as otherwise provided by law or with the resident’s consent.

Some facilities are not allowing any visitors at present. While it is understandably distressing to consider looking at assisted living communities right now, they still provide excellent care for their residents. Remember to ask questions, especially about the safety measures they have in place.

What Should You Ask When Evaluating Assisted Living Communities

This is a very complicated and emotional time for most families. Here are some important considerations that can give you peace of mind with your ultimate decision:

• What is the staff-to-resident ratio?
• Are there specialized caregivers for people with dementia?
• What type of training is the staff required to have? Are background checks required?
• How many staff members per shift – is there someone on-site 24/7?
• Can staff administer medication? What are staff member’s credentials? RN’s, LPN’s, VS, CAN’s.
• What kind of monitoring and call systems do they have in place?
• Do they have a fall prevention program?
• Can staff assist with the six activities of daily living (ADLs): eating, bathing, dressing, using the toilet, moving, and continence?
• Is there an in-house medical facility or physician on staff?
• Is the interaction between staff and residents warm and respectful?
• Is transportation provided to doctor’s offices and other appointments?
• What types of security and safety measures are in place? What will they do in the event of fire, power outage, or disaster?
• Are potential new residents assessed before they move in?
• What type of apartments are available? Do the units have full kitchens?
• What are the monthly charges and what do the standard monthly fees include?
• What other “al la carte” options are there and how much do they cost?
• If the senior is still driving, is there parking available and does it cost extra?
• How often can an increase in price be expected?
• What happens if a resident runs out of private funds?
• If a resident purchases a life estate*, what repurchase agreements are available?
• Does the community offer linen services and housekeeping?
• Can the “a la carte” option be switched as needed? For example, a parent may need help bathing after a fall, but will not need assistance once they recover.
• Will the catering staff modify diets as needed? Many dementia patients have a difficult time choosing what to eat, or they may choose bacon and eggs for daily breakfast, even when they are meant to be on a healthy eating regime!
• Are pets allowed? If so, can the staff support taking care of the pet? Is there any extra cost for pets?
• Will staff help with move-in and set up? Do they have a move-in coordinator?
• Is there a family orientation program? This option is helpful with residents with dementia so families know who they should be communicating with.
• Can furniture be rented? This is very useful if a parent is moving from the existing family home.
• What is the billing policy? Do they bill the long-term care company and are there fees associated?
• What kinds of outings and activities are provided for residents? Are additional fees charged?
• Is “end of life” hospice care provided?
• What is the waitlist policy? Do existing residents get preferential treatment if they want to move to a larger or smaller apartment?
• Does the facility have experience with Dementia/Parkinson’s/Diabetes or the specific issue you are dealing with?
• Does the facility help residents make new friends and ensure they are participating in daily life around them?
• Can residents have meals delivered to their rooms? If so, are there restrictions on how many days in a row they can select this option? What is the cost to have meals delivered?
• Are there social mixers?
• Is alcohol or tobacco permitted?
• Ask for the facility’s “Disclosure of Service’ statement.
• What would be a scenario where a resident would be asked to leave?

*A life estate is the ownership of a property for the duration of a person’s (or couple’s) life. Once they die, the ownership of the property reverts to the original owner. There are assisted living communities in which you buy a home under a life estate. You live in the home until the last spouse dies. There are also various agreements that stipulate how much of the value of the property passes to the estate. These options allow people to potentially purchase a home at a lower price with less going to their estate when they pass away. This may be used for a family home for estate planning purposes – i.e. the kids own the home, but mom and dad have the right to live in it rent-free until the last spouse dies.

We Can Help

As I wrote in part one of this series, it can take an extended time to transition a loved one from their home to an appropriate long-term care home. It’s one of the most important decisions that you and your family will make.

In the last post of this series, I will discuss the pros and cons of in-home care. If you would like additional information, please do not hesitate to reach out.

This report is intended to be used for educational purposes only and does not constitute a solicitation to purchase any security or advisory services. Past performance is no guarantee of future results. An investment in any security involves significant risks and any investment may lose value. Refer to all risk disclosures related to each security product carefully before investing. Soundmark Wealth Management, LLC, its advisors and its affiliates do not provide tax or accounting services. This material has been prepared for informational purposes only and is not intended to provide, and should not be relied on for, tax or accounting advice. Please consult with your tax advisor prior to engaging in any transaction.