Assisted Living: Secrets and Tips From an Administrator

· stress

Caregiving in General

Yesterday, an old friend contacted me, asking about placing his mother-in-law in an assisted living. However, after answering him in two different emails, I realized that you might be interested in the same information. Here’s the interesting thing I discovered about myself – my tone with him was different than if I were going to write for my blog or for an Ezine article.

In many ways, it was much better because of my mind set. I was focused on giving my friend advice rather than writing a “well written” article.

So except for a few deleted lines that would identify my friend, here is some good advice about picking an assisted living:

Hi Donahue,

How’s everything? We need to catch up soon.

Need your input – soon –

We are looking at places for Mary’s mom – she has continuing health issues primarily heart and respiratory.

Would you look at the attachments and let me know your thoughts on these two places?

Thanks so much


Hey John,

I will look at the attachments closer later, but let me first highlight some important stuff to consider:

First of all, if there is a non-refundable “community fee” of any kind, it is negotiable.

What is going to be more important than the room layout and the view and the transportation and all the other B.S., is how much care is going to cost. Howdo they charge for extra care? By levels of care? or by minutes? And when you find out – figure out what your maximum budget is, and what the most she will have to pay if she gets ALL their services.

Next, ask the facility about what would cause her to HAVE to move out? Ask them if they have a hospice waiver. (they are in California, so their rules are exactly like mine and I can tell you, if they do not have a hospice waiver, then when she gets towards the end, they will kick her out to a nursing home).

Ask them about house doctors (do they have a doctor that comes to the facility to see clients), and are home health care agencies allowed in the building? and if so, do they require that you use theirs or if you can pick your own.

Ask about wheelchairs. Are they allowed? What about motorized ones? Does mom have a dog or cat? Many place will let you bring it…for a fee.

Think about this stuff and get back to me.


Thank you so much for your help. I am lucky to have you for support.

Mary and her sisters are going to San Jose tomorrow to meet with her hospital exit manager. Of course their mom wants to go home but it is time – a painful situation I’m sure you have lived over and over… They are struggling (as you would expect) with this and any information helps to make a better situation.

Thanks again for this….

PS – Mary’s is asking about your next CD.


ha, I forgot that she had one my CDs. (Referring to my stress management CD). God bless her for being one of the few that actually bothered to open it and listen to it. But false modesty aside, ; just bought 50 more to sell on their website. So somebody has been listening after all.

You know what I really need bad are testimonials. The FTC is cracking down, and if you have a testimonial on your website, you have to have your source handy. So if she can write me a good one, I will make sure that she is on the list for the nest recording I do.

You and/or she can market my website to your friends: ; or at the very least sign up for my free newsletter at

OK, Back to mom. Both those places you asked me to look at seem fine. When Mary and her sisters tour, I find that instinct is your best guide. Good ole gut feelings often gets borne out as accurate over time. It’s a feeling. Do staff seem happy? Do they run away from a tour, or do they stand their ground and say hi to people touring? That is often a great indicator of what is going on in the facility.

The stuff I mentioned in my last email too. Also important is the facility’s proximity to whichever sister is going to be visiting the most. They have to get honest with themselves about this…no wishful thinking.

You can ask the facility if they had any licensing complaints in the past year. And then ask to see them! Yes. They are supposed to be posted, and available to anyone that asks. Every complaint has the evaluators conclusions on it. So if a complaint is “unfounded” then it was more than likely a disgruntled employee or resident, if it was “inconclusive” either the facility covered their tracks well, or again it’s due to a former employee or unhappy resident, but if it was “founded” then read the “plan of correction” and then ask the facility representative about their version of events…watch for evasiveness.

Next, look on the wall for the Ombudsman poster and write the phone number down. Call them and ask them what they think of the facility. You will usually get a volunteer (they rely on them a lot), and the even though they are not supposed to express an opinion – they often leap for the chance to talk about what they know about a place. Many Ombudsmen are a pain the facilities rear end. Because no one really knows the rules that govern them, and they are often showing up at a facility unannounced and start asking the residents if they are having any problems. What neglected old busybody is going to pass up a chance to throw the place ‘under the bus’. (when I say neglected I mean by family not staff).

Take a look or ask about the emergency response system. Older building will sometimes have a voice intercom in the room, new buildings will have a pendant (like a life alert). Each has its own advantages. The voice intercom is great for immediate responses, but can get misused with people using it for non emergency issues. The pendant has it’s problems because the resident has to wait for someone to respond, and late at night that can be a long time.

Ask if they offer escorts to the dining room. Resident’s often need someone to walk them down to meals, or if in a wheelchair, for someone to push them there and back again. Ask if they charge for this? Some places will not charge for the service, and this can be something that can get used a lot. Ask about periodic checks. What if your mother-in-law is under the weather, and needs someone to look in on her a couple of times during the night. Some places will charge for that, and others will not. This is another often overlooked service.

Oh, when talking about showers and bathing…2 or 3 times a week is plenty. Just because you and I take one or two showers a day, most people over 80 don’t need or want to shower that often. Is she a big woman? Will she need two caregivers to be with her for things like showers? Ask about extra charges if this applies.

Room/meal trays – how much? This little thing can add up, there are on average 90 meals per month. What if she needs them for every meal? Do they have a discounted plan for that? Laundry? Do they charge by the load? Some places will have a laundry day, and they will not count the loads (because they use a big commercial washer and dryer), other charge for every single load.

Be ready for incontinence care. Nobody likes to think about, but it happens, it is almost inevitable, and it is very expensive. She may be OK now, but have the flexibility in your budget to accommodate it. If she needs it…it will not be optional, and you will not be able to postpone it.

Finally, when you pick a place and move her in, be very conscientious to bring a lot of her stuff to make her feel at home…but do not bring anything that has a sentimental value or is irreplaceable (beautiful jewelry, stuff that has been in the family for generations, etc.) Things get broken and thing disappear…even in the fanciest places. Also, if she needs cash for a hairdresser or shopping, never give her more then $50 a month, better still try to arrange to have hairdressers and other service providers bill you.

Whew, thats a lot. If I tell you anymore, your eyes will glaze over.

Forward this to your wife and they can ask what they need or want to know.

And to you, if you found this helpful please use the information, if you have a particular question, do not hesitate to ask. (You would be surprised how rarely people write question).

Good Luck, Donahue

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