Assisted Living or Continuing Care Community for Mom?

by After 50 Finances Reader Contributors

Assisted Living or Continuing Care Community photo

When deciding between assisted living and a Continuing Care Community for an elderly parent, get informed. The wrong choice could be costly both emotionally and financially.

Dear Gary,
We’re looking for a retirement community for my mother. She’s not able to stay in her home alone and doesn’t want to move in with us. I know that there are all kinds of retirement facilities. It’s hard to tell the difference between independent and assisted living. Seems like every place has their own definitions of what’s included. I know that some facilities are independently owned and others are part of big corporations. Some require a big upfront fee and others do not. Mom will depend on me to make the decision and I don’t want to make a really big mistake. Can anyone tell me what I should consider before making a decision regarding which retirement community Mom should move into?
Marcia F.

Is Nursing Part of Assisted Living?

One important thing to consider is whether there is nursing staff on site 24/7. An assisted living facility in my area has a nurse on site Monday through Friday, 8 am to 5 pm. Any falls or medical emergencies that happen at night or on the weekend have to be dealt with by calling the on-call nurse at her home. Anything non-emergency waits until the next time the nurse is in the office, which could be 2 days away. To me, this is unacceptable.

Continuing Care Includes Both Independent and Assisted Living

Look for a “continuing care community.” I’ve worked at one for 12 years and my parents both were there while they were still living. They will help you choose the right level of independence/care, and as more care is needed, your mother can move into it without changing facilities. That is so helpful.
Karen R.

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Each Independent or Assisted Offers Different Services

Your question tells that you already know most of the questions to ask regarding buying insurance, etc.

First you need to calculate all available cash, retirement accounts, sale of home, etc. Will you and the other siblings be willing and able to help if the money runs out?

Secondly, consider what kinds of activities your mother enjoys. Does your church have a community? In my area there are Catholic, Baptist and Jewish retirement communities among others. Where she could continue her religious activity conveniently is a big plus.

Many communities offer various levels of care, from independent, to assisted living, to long term care. While the individual units are in different areas, she would still be near her new friends as her needs change.

What kinds of activities do they provide? Do they provide reliable transportation for shopping and doctor appointments? How about field trips? Craft groups? Book clubs?

After you have decided what services are important to you, visit several communities. You will have a tour. Usually they will provide a lunch or dinner for you and your mom. After seeing them up close it will help you to make your decision.
Sharon M.

A View of Assisted Living from Germany

Perhaps Marcia F. could read Can’t We Talk about Something More Pleasant?: A Memoir by Roz Chast. It’s a graphic novel about what her parents faced with the same situation as her mother is in right now. I know, I know it’s unusual, but Ms. Chast describes all the mistakes that were made so that others don’t have to make them.

Here in Germany almost the same things apply. Plus you as a child have to pay “parent support” if your parents cannot pay for themselves (and you are solvent, that is).

The gist: Do not go rushing in head over heels if you can avoid it. People (like retirement communities, too) only want your best: your money.
Best regards from Germany,
Heidi A.

An Organized Approach to Assisted Living

I worked in long term care for many years and am happy to share some ideas of things for you to consider when looking for a community for your mom. I have a rule of three that I like to follow:

    1. Visit your favorite three communities each at least three times. The first visit is with an appointment with the admissions/marketing representative. Ask that person questions to get a feel for the things that they highlight as “features” that set that community apart from others.
    2. During the second visit, consider just popping in after the hours that the regular marketing person isn’t there. You want to see how the early evening staff functions after the 9-5 management team is off duty.
    3. The last visit is also without an appointment. It’s to observe how the community operates during the weekend shifts. Some of the things to look for are cleanliness, meals, activities, staffing (adequate number of employees?, are they friendly?, are they complaining?, etc.) and hearing what other residents are saying about living there.

Also consider pulling their state inspection results and look for the positives and deficits in their inspection grades.

As far as costs go, yes it can vary widely so you’ve really got to figure out what your mom’s long term financial plan looks like. Is this a community that only offers basic private pay care or do they also have a step process so that if your mom needs skilled nursing care or “spending down” her assets in a few years, they can accommodate that transition or will she need to move again?

My biggest suggestion is to go with your instincts. Be friendly and approachable but very aware at the same time. There are so many wonderful communities out there, but there are also some quite awful situations. You’ll need to be your mom’s best advocate at all times. After you all have chosen the community where she will live and she’s moved in, I’d really suggest that you visit at random days/times so that you are getting familiar with all of the staff and being a good set of eyes and ears for your mom. An open line of communication with the management team is essential, so if they don’t seem like a team you can trust to hear your concerns, then you might want to keep on exploring other communities. Best wishes to you guys.

Our Assisted Living Experience

You will fill out application paperwork and take a tour, no doubt. That will give you basic financial information and will help you determine if your mom can even afford the place. Some places allow for Medicare beds once your funds run out, some do not, and she’s back on the street. Is it a continuing care community, (does it go to nursing care from independent living)?

You may be fed a meal during your tour. That is not necessarily what the residents eat. That may have to do with dietary restrictions or just cost saving or quantity cooking measures in place.

Look at the activity lists. Look at how clean the place is and smells. See if you can talk to residents as well. And not just the ones primed for the job. They will be able to tell you what they like and don’t like.

One place we visited was family run, but one of the residents there kept catching my eye during the spiel and shook his head to warn me off. I had already gotten an uncomfortable feeling even though the tour guide was chipper, as the whole place was on lock down, (not just the dementia residents), and seemed poorly lit in the hallways. Not good for elderly people with poor eyesight wanting to leave their rooms.

What is the staff to resident ratio? Is there an activity director? What is the turnover in help? Are they salaried or from a temp agency? (There tends to be more pilfering at places staffed by temp people as they’re not as invested in the residents). Is there a doctor/nurse on site?

As a side issue, you will want to get your mom’s POA (Power of Attorney) paperwork, (medical and financial), as well as her will and living will in place. Even in the best run places you may need to advocate for your mom’s care and have her wishes honored. Hope this helps.

Our Assisted Living Questions

Here are some of the questions we asked:

  1. Basic costs
  2. Additional costs and what they are for
  3. Observe the layout and tone of the community
  4. Visit during an activity and ask about regularly scheduled activities as well as special events
  5. Pay attention to staff friendliness
  6. Eat a meal at the property and ask residents about the food
  7. Ask security and safety questions
  8. Ask questions about personal care
  9. Visit the outdoor areas
  10. Ask about move-out criteria

Susan H. M.

How Much Care Can They Provide?

Having been through this situation with my grandmother, one thing I’d suggest is that, if possible, move her into a facility that has a ‘higher needs’ section. My grandmother was in a lovely assisted living facility for years, but when she began to exhibit early signs of dementia and needing more care in day-to-day routines, they couldn’t get rid of her fast enough. Which meant our family had to begin the search all over again and then uproot her from familiar surroundings.

Ask About Special Benefits

We just went through this process with my 94 year old grandmother. It is really important to not only call, but visit each place you are considering.

Find out what activities, transportation and services are included in the monthly fee. Some places also charge a one time community fee upon move in, which can be around $1000 or more. If your mom is a veteran or a spouse of a veteran, she may qualify to live in an Armed Forces community or for special financial support through her late spouse’s benefits.

In the case of my grandmother, her husband was killed in action in WWII, which was a qualifying situation. Also, find out if meals are included in the monthly fees. What about housekeeping and laundry services or a shopping assistant? Some communities offer independent, assisted living, rehabilitative care, and even hospice care, while others do not, and would require a move if your parent’s health takes a downward turn. Hope this information helps!
Tara P., Crestview, FL

Reviewed August 2022

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