Touring Assisted Living Like an Insider

If you are not familiar with senior living communities but are suddenly faced with having to start a search (because most inquiries occur out of an acute/sudden medical need), here are a few things I would recommend for you. First, a quick list of the terminology.

• Senior Living - a general term to encompass a wide range of living and care needs; this term is not a designation of care level but rather a general name for various housing and care options for seniors.
• Independent Living (IL) - seniors generally seek convenience, socialization, and basic availability of non-care services like meals, housekeeping, maintenance, and transportation. Typically, seniors who have a few hands-on care needs (called ADL's or assistance of daily living) hire outside private caregivers to bring care to them.
• Assisted Living (AL) - seniors generally need regular ADL support. These communities typically have caregivers and nurses on staff but not a physician. You have all the same services as IL plus the coordination and delivery of daily care such as medication management, dressing and shower assistance, and even some basic support for memory impairment.
• Memory Care (MC) - a specific type of AL catered to meet the unique and wide range of needs for someone living with dementia or any other form of memory impairment. Generally the community is "secured" meaning that exit doors have an added level of security to minimize risks associated with wandering behaviors. All the same services as AL but with specialized dementia-care.
• Skilled Nursing Facility (SNF) - either a short-term rehab stay following a hospitalization, injury or other acute medical event (typically covered in part or fully by insurance depending on length of stay) or a long-term living and care offering for people who need daily, 24-hour care due to medical needs (typically private pay). SNFs have a medical director and nurses around the clock (typically).

Touring an Assisted Living community (mostly applicable to other levels of senior living.) A few tips in no particular order:

1. Talk to the Executive Director - if this isn't offered, insist that you meet them personally (on this visit or the next). The culture of the team is set by the E.D., and the MOST critical factor of success in whether your parent will feel at home is how well the team works together. If possible, try to observe the E.D.'s interaction with residents and with staff. Is there a genuine and familiar rapport between them? Do residents engage with him/her beyond a simple greeting? An E.D. who is actively a part of daily life at the community and appears to have good rapport with staff is far more valuable to your loved one's experiences than any amenity you'll see on the tour.
2. Try the food yourself in the dining room (not the private dining room) - order off the menu. Some communities make special meals for guests whenever tours are scheduled ahead of time. Try half portions of multiple options. If it doesn't taste good or fresh to you, it won't to your parents either. Keep in mind, this is the equivalent of eating at the same restaurant 3 meals a day x 365 days a year. So on any given meal the food should be better than okay. Observe interactions between residents - are they friends or just table mates? Are any managers present? Are beverages pre-poured and already set at an empty seat? (A sign that habit trumps choice.)
3. Observe an activity that residents are doing - are residents out and about on their own and socializing with one another? (Sign of comfort and a sense of community.) Ask for multiple months worth of the activity calendar. If the majority of activities seem redundant from one month to the next, it's usually a sign that only a portion of the community is engaged in social programs. Ask residents what they've done this month that they've found interesting.
4. Trust your senses and your gut - the "feel" of a community is everything. Don't worry as much about what's shiny, new, or pretty. The best communities - regardless of age - smell clean, sound active, food tastes good, and looks inviting. Visit more than once at different times/days of the week and tour with a different employee each time. You can mask bad, but you can't fake good.
5. If the community has a Memory Care portion, tour it even if your parent doesn't have memory impairment. Unfortunately, many communities put all their tour preparation and "wow" factors into IL, then AL, and finally MC. To see, firsthand, how the team does at the highest level of care is to see the depth and quality of their teamwork. The best teams I've seen in senior living do their best work at the greatest levels of care need.
6. Look for non-age-appropriate decor - if you see any decoration, a bulletin board, or display that could also be in an elementary school, consider what that conveys. Improper regard for seniors (i.e. that they can't do for themselves, that they need to be kept on schedules, etc.) is not overt. It's shown in many small doses, and I have found that childish decorations tend to correlate strongly with that mindset.
7. Be friendly and answer questions honestly - some people treat the tour as a hard-nosed interview/test. It should feel more like a first date. While the above tips can feel test-like, it's more for internal notation rather than fodder for confrontation. If you are at ease and are friendly, it sets the entire team at ease. This means you're more likely to see the team at their natural best. Be self-aware that you're likely walking into the tour with some emotional baggage and it can come across as cold. Let the sales person know how you're feeling and commit yourself to being in a positive mindset (even if you have to fake it for now).
8. Ask to speak to an employee who recently started with the company - getting a sense of how new employees are treated will help you to understand how seriously the leadership take orienting team members. If, say, an employee is 60 days into their job and they say something like, "I haven't had a chance to meet the E.D. yet, but I hear she's nice" that's not good. If an employee is in their first week and they tell you, "I'm excited to be working here. I've heard good things about this place" - that's worth A LOT.

Of course, all these tips are to be taken with a grain of salt. They aren't meant as a definitive list of tests but rather guides to re-frame the purpose of your visit from touring real estate to exploring relationships. Your loved one won't care about crown molding or amenities they won't use. They'll care if the people around them (residents, staff, and family members) take pride in their home and have built a sense of community.

And one final, bonus tip for anyone serious about finding the best senior living arrangement for their loved one: the vast majority of sales people in our industry do this because they genuinely want to help. Your best ally in this daunting task is the person you may be avoiding and mistreating (i.e. ignoring calls, not responding to e-mails/texts, giving shallow answers to). Instead of thinking of them as a sales person talking you into something you don't want to do, think of them as mountain guides for a challenging and unknown journey. You are traveling a road that you have never gone down, and you are responsible for getting a loved one to safety. The senior living sales person is the guide - the sherpa - who has been up and down the mountain side and wants to see you safely through. If you can, just start with one or two guides rather than blindly blasting out information requests from 10 communities.

For the tens of thousands of professionals dedicated to serving seniors and their families, it's important to us too that you choose your community (partners) well. We are waiting for the honor to be invited to be a part of your family. I hope these tips are helpful to you or someone you know. God bless.

*For my colleagues in senior living, please feel free to share this article along with your own personal tips.*