An assisted living facility under construction. (ALYSSA POINTER/ALYSSA.POINTER@AJC.COM)
Photo: Alyssa Pointer
Photo: Alyssa Pointer

Opinion: Steps to help ensure quality assisted living care

The new investigative series in the AJC, “Unprotected,” highlights all-too-common problems experienced by those needing long-term care and services. How can individuals and families know that the place they select will be a good fit for their needs? How can they be sure that the community will provide high quality, compassionate care; enhance their quality of life; and ensure resident safety? Can they trust the slick marketing brochures and carefully guided tours with beautiful lobbies, fancy dining rooms, and promises they want to hear? It is not unreasonable for a consumer to expect that the high cost of long-term care, often as high as $10,000 per month, would mean high quality care. Sadly this is not always true. Consumers can, however, educate themselves about long-term services and support options before they are needed.

Know your setting

Assisted living and large personal care homes, the subject of the AJC series, are residential settings for individuals not needing around-the-clock nursing care or supervision. They provide assistance with activities of daily living, such as dressing and bathing, and medication management. These providers increasingly advertise that they provide “memory care” services or caregiving for people with dementia. Assisted living and personal care homes should be licensed by the state and must follow state rules. Know the type of provider you are looking at to ensure they provide the care to meet your needs. Ask friends and neighbors for recommendations. Our online resource, Piecing Together Quality Long-Term Care, can help.

Visit prior to moving in. Take the formal tour, but look beyond the chandeliers and decorations. Pay attention to smells and sounds. Are the residents engaged, clean, appropriately dressed for the time of day? How do the staff interact with the residents? Do they treat them with kindness and dignity? Do staff seem rushed and scattered? Talk to residents and families about their experience. Eat a meal in the dining room.

If possible, visit more than once, including during an evening or weekend. Pay attention to differences between visits, especially how many staff are on duty and caring for residents.

Ask Questions

  • What care and services are included in the daily rate? How much are other services? If a provider offers specialized care, such as “memory care,” ask what makes this care special and different from other care provided.
  • Who decides if you need more care – you or the provider? What happens if you need more care than can be provided by the facility?
  • What is the staff-to-resident ratio? How many nurses, aides, and other staff are available on each shift to provide care?
  • Ask about staff training and experience. If the provider offers specialized care, what additional training do staff receive to assist residents needing this type of care?
  • Are national or state background checks done for all employees, contractors, and volunteers?
  • What happens if your money runs out? Does the provider participate in the Medicaid program?

Be an Active Participant in Your Care

Regardless of the care setting in which one lives, being an active participant in your care increases the likelihood of getting your needs met. Educate yourself, to the greatest extent possible, about your medical condition and symptoms of that condition. Participate in the development of any care plan and monitor its implementation. Include family, friends, or other trusted people for support and who can help advocate for necessary care and services. For signs of quality care, warning signs, and advocacy tips, see the resource, Put a Stop to Poor Care.

Know Where to Get Help

Keep notes about your care and any incidents that arise. Raise issues or concerns with staff or a responsible person in the facility. Resources also exist outside the facility to provide assistance or receive complaints. The Long-Term Care Ombudsman Program advocates for residents in long-term care facilities including assisted living and personal care homes. Complaints can also be filed with the state agency that licenses assisted living or care homes, or with Protection and Advocacy organizations or Adult Protective Services. If there are concerns about criminal activity, law enforcement should be contacted immediately.

Most long-term care providers want to provide quality care for residents. Adequate oversight of these care providers, strong standards, and accountability for failure to provide the necessary care and services is necessary to promote quality care and protect residents.

For more information about getting quality care, residents’ rights, and finding help, go to

Lori Smetanka is executive director of The National Consumer Voice For Quality Long-Term Care.

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