Section II. State Consumer Guides to Assisted Living

Residential Care and Assisted Living

This section presents information and questions for consumers in guides and checklists available on State agency Web sites. Individual State guides may not use the same terms for each topic area listed or present information in the order in which topic areas are listed here. The terms used and the order of the topic areas were modified to facilitate comparison across States. Some questions may overlap two topic areas. For example, a question in the provider agreement may include a question about costs or discharge criteria.

The information in the following tables may be included in a stand-alone consumer guide or checklist or be included in a document that has additional information about assisted living and how to choose a facility. For complete information, go to the Internet links in Table 2.

Table 6. Arizona Consumer Guide

TopicQuestions
Licensing statusIs there a posted current license, with the facility's correct address, from ADHS?
AdmissionWhat are the admission requirements?
Ask for a "typical profile" of a resident in their facility.
Are residents alert or confused?
FinancingWhat are the added expenses? (service plan, transportation, personal items, beautician)
What is facility policy on holding a bed if a resident leaves the home for hospitalization or vacation?
Physical environmentAre the grounds and the building(s) neat and clean?
How close is the location of the home to family and friends?
Are resident permitted to access to the outdoors, get beverages, use the telephone, rest, etc. on their own?
Can residents go to bed at night and get up in the morning when they choose?
Are resident rooms decorated with personal belongings?
Do they allow pets?
Are residents permitted to have visitors at any time?
StaffingWhat are resident to staff ratios?
Is there a certified manager on duty?
Are caregivers available 24 hours a day?
Are residents clean and comfortable?
Are residents wearing appropriate seasonal clothing?
Medication and health servicesWho arranges doctor appointments and manages resident medication?
Can residents continue to see their own doctor?
Meals/diningIs the menu balanced and appealing?
How much time do residents have to eat their meals?
Do they have substitutes if a resident does not like the meal?
ActivitiesWhat activities are available?
CommunicationAre relationships between staff and residents warm and friendly?
Are there communication barriers between staff and residents?
Do staff know residents by name?

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Table 7. Colorado Consumer Guide

TopicQuestions
Licensing statusIs the facility licensed by the State and in good standing?
Is the facility Medicaid certified?
Resident agreementDo the admission criteria match my needs?
Have I reviewed the terms of the financial/provider agreement?
Is the unused portion of the rent refunded upon transfer/discharge?
Do I have a choice in the selection of medical/health care providers if additional services are needed?
Are the specific services offered clearly identified in the agreement?
Have I reviewed the house rules?
Have I reviewed all of the reasons for which I may be transferred of discharged?
Physical environmentIs the bedroom private or shared?
Is the bathroom private or shared?
Are the shared areas clean?
Is there space for personal belongings?
Does the floor plan allow for easy mobility for me?
Are there private areas other than the bedroom for visits?
Is bathroom safety equipment installed or available if needed? (grab bars, raised toilet seat)
Is there a call system?
Are walkers/wheelchairs permitted?
Are hallways and doorways wide enough for wheelchairs?
Physical environment observationsHave I toured the entire facility?
Have I observed the kitchen and pantry?
Have I observed a meal?
Does the atmosphere seem pleasant?
Does there seem to be enough staff available?
Are pets allowed?
Do residents seem happy and engaged?
Do residents appear to be clean, groomed and odor-free?
Have I observed for staff/resident interaction?
Have I observed for cleanliness and odors?
ServicesDoes the facility provide:
Assistance with dressing?
Assistance with bathing?
How many times per weeks is bathing provided?
Assistance with toileting?
Assistance with incontinency? Does this include assistance with bowel and bladder?
Assistance with transfers from wheelchair to bed, etc.
Assistance with medications?
Care planAm I involved in the care planning process?
Is my family/responsible party involved?
Is my physician or other health provider involved?
Are the care plans updated to reflect changes in care needs?
StaffWhat is the operator/administrator's training?
Do staff receive training to work with special needs or behaviors, such as dementia?
Is there high staff turn-over?
What is the ratio of staff to resident?
Are staff awake at night?
Meals/diningAre specialized diets available?
Are cultural or ethnic preferences considered?
Are residents involved in menu planning?
Can residents help with meal preparation and have access to the kitchen?
Are snacks/beverages readily available between meals?
Are extra helpings and substitutions available?
ActivitiesAre activities available within the facility?
Does the facility take residents on outings?
Is somebody designated to conduct activities?
Would my interests match the level/type of activities provided?
Are there residents I can socialize with?
Is there a written schedule of activities?
CommunicationDoes facility inform family/physician when an unusual event occurs?
Do you feel comfortable talking with the: administrator/operator, manager/billing, staff/caregivers?
Is the grievance procedure easily understood?
Is telephone use accessible and conducive to privacy?
TransportationDoes the facility provide transportation?

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Table 8. Florida Consumer Guide

TopicQuestions/information
Licensing statusIs the facility licensed by the State of Florida? Is the ALF licensed for the specific services you need?
Florida issues a standard ALF license, a license to provide Extended Congregate Care (ECC) allows the ALF to maintain residents who become frailer than would normally be permitted, in order for the resident to age at the facility; a license to provide Limited Nursing Services may include such nursing services as the application and care of routine dressings, care of casts, braces, and splints, catheterization, and other services; and a Limited Mental Health license must be obtained if an ALF serves three or more mental health residents.
Resident agreementCan I see a copy of a sample contract?
Each resident will sign a contract with the ALF. Read the contract carefully. If there is anything you do not understand, ask the ALF staff person to explain it to you. You may want to consult with your family, friends, or an attorney before signing a contract.
Admission criteriaA resident cannot be bedridden, cannot require 24-hour nursing supervision, cannot have stage 3 or 4 pressure sores, and other criteria as described in Florida law.
Physical environmentAm I able to choose the room/unit that I will live in or is it assigned to me? Are there different sizes and types available? Are there lockable doors? Can I have a telephone and cable TV? What furniture and accessories are provided?
Do all of the rooms/units have private, full bathrooms? If the bathroom facilities must be shared, where is the bathroom located, and with how many residents would it be shared?
Will I have a kitchenette? If so, are there a refrigerator, sink and stove? If the room/unit does not have a private kitchenette, where are the cooking facilities located?
What will be the size of my room/unit? Is it large enough for me to feel comfortable if I spend a great deal of time there? Is there enough closet space to meet my needs? Is there additional storage space available and at what cost?
What are the common areas like? Are there areas where I would feel comfortable spending time? Do the residents use the common areas or are they more for appearance?
Is the ALF easy to get around in? Are there too many stairs or long hallways? Is the ALF well lit? Does the facility have outdoor grounds suitable for walking in nice weather? Is the facility (including the bathrooms) accommodating to wheelchairs, canes, and walkers?
What type of security is available at the residence? Is there someone at the front desk 24-hours a day? Are the main doors locked at night? If the doors are locked, are keys made available for residents who come in late at night?
Does the residence have a special care wing or any special procedures and equipment when caring for individuals with Alzheimer's or other memory impairments? You can request literature about the programs the ALF offers for residents with Alzheimer's and other memory disorders.
Am I able to furnish the room/unit as I wish with my own furniture and wall hangings?
Can I control the temperature in my room/unit?
Is there an emergency call system in each room/unit and each bathroom?
Are pets allowed in the rooms/units and common areas?
Is smoking allowed in the facility and, if so, where?
Is parking available for residents and visitors?
Does the facility have fire drills, smoke detectors, and a sprinkler system?
Cost/financingDoes the ALF require an initial entrance fee, application fee or deposit up front?
Is there a cap on the percentage by which the monthly rate can be increased?
What services are included in the monthly rate? Some rates include the basic service of room, meals, and at least one personal service. Additional services may include an increase in costs.
Ask the ALF staff person to clearly explain the costs and services and to provide you with the facility's admission package.
When considering these prices, think about services that might be needed in the future, not just the current needs.
ServicesWill I receive a written plan of care? If so, will it be addressed periodically as my needs may change?
An assisted living facility provides housing, meals, and one or more personal services for residents who are not related to the facility's owners. Personal services include assistance with or supervision of the activities of daily living like eating, walking and toileting. A person can become a resident of an ALF only if certain functional criteria are met, such as being able to perform the activities of daily living (with supervision or assistance).
Services offered by an ALF include:
Basic housing; meals and snacks; 24-hour staff availability; assistance with activities of daily living (ADLs), if needed, such as bathing, dressing, toileting, hygiene and grooming, eating, and walking;
administration, or assistance with self-administration, of medications,
housekeeping; maintenance; laundry; social and recreational activities; transportation to activities, appointments, shopping, etc
StaffWhen you visit the ALF, speak to as many different staff and residents as possible. Get a sense of how the residents and workers feel about the ALF, if they enjoy living or working there. Is the staff friendly and respectful? Are workers able to take time to speak with residents or are they too busy rushing around?
What is the ratio of staff to residents? How many staff persons are available to provide personal care services? How many workers are available during the day, in the evening, overnight, and on weekends? Florida regulations require a certain minimum amount of staffing, depending on the number of residents. Is the staff trained to handle the special needs of these patients? What medical care options are available? Is there a doctor or pharmacy on-site? If the ALF provides nursing, what services can the nurse provide? If I need to receive services from a home health agency, like nursing, physical therapy, home health aide services, etc., will the ALF assist me in arranging for these services?
What is the procedure for signaling staff of an emergency? How are medical emergencies handled? What if there is an emergency in the facility that requires evacuation?
Meals/diningHow many meals and snacks are provided each day? If I prefer to have a light breakfast in my own room, is there a package that allows me to pay only for lunch and dinner?
Are meals in the dining room provided at convenient times? Is there much choice in when I can have breakfast, lunch or dinner, or are these meals served at the same time every day? If I like to sleep late, are things like coffee, juice and muffins available later? If I am away from the ALF and arrive after mealtime will I be served my meal?
What is the ALF's policy about having meals delivered to my room? Is this allowed? Is there an extra charge or limit on the number of times that I may eat in my room?
What is the menu like? Are special meals or diets available, if needed? Are there enough interesting choices? Are choices always available, or does the kitchen often run out of one choice, leaving few options? Is the food tasty and nutritious? If I have special dietary needs how will they be handled?
Are there special seating arrangements or can residents sit where they want in the dining room? Do the residents eat at the same time or in shifts? Do the residents eat in one large dining room, or are there several dining rooms that serve different groups in the ALF?
Are there any arrangements for late night snacks? If I want a snack other than at a designated mealtime, are snacks available? Is there an extra charge for this service?
ActivitiesMost ALFs advertise that they have many activities available for residents. Ask to see a schedule of activities, and consider whether you or your family member would want to participate in these activities. Do the activities appear appropriate for the resident?
Are there a variety of activities to choose from? Are residents active in planning activities and events? Are the activities provided at convenient times? How frequently are they provided?
TransportationIs transportation available to access community activities? This information is one way to determine how much the ALF encourages the participation of its residents in community activities. Is transportation only available at certain times, or can it be accessed whenever it is needed? What if I have a doctor's appointment or want to go to a church service in the community? Is there an extra cost for transportation?
MedicaidWhat happens if I run out of money? Does the facility participate in the Medicaid program?

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Table 9. Kentucky Check List

TopicArea
Licensing status (Certification)The Assisted Living Community has received or applied for Certification by the Office of Aging Services and information is available for my review.
Resident agreementClient information must include:
An assessment of client's ability to perform activities of daily living and instrumental activities of daily living.
Emergency contact person's name.
Name of responsible party or legal guardian.
Attending physician's name.
Information on personal and social preferences.
Advance directive if client desires.
Other information that would help meet the client's needs.
Policy regarding termination of the lease agreement.
Terms of occupancy.
General services and fee structure.
Information about specific services provided, description of the living unit, and fees.
Provisions for modifying client services and fees.
Minimum thirty (30) day notice for a change in the fees.
Minimum thirty (30) day move-out notice for nonpayment.
Assistance for client to find appropriate living arrangements prior to actual move-out date.
Refund and cancellation policies.
Description of any special programming, staffing, or training.
Other community rights, policies, practices, and procedures.
Written policies about contracting or arranging to receive additional services from an outside agency or individual.
Grievance policies related to complaints.
AtmosphereThis is a convenient location.
The grounds and décor are attractive.
The employees treat visitors, clients, and other employees in a friendly manner.
Clients socialize with each other and appear happy.
Visitors are welcome in the assisted living community.
Physical environmentIndividual living units (i.e., apartments) are at least 200 square feet.
Each living unit has a private bathroom (exception allowed).
Each living unit has a lockable door.
There is a window to the outdoors in each living unit.
A telephone jack is available in each living unit.
There are provisions for emergency response in each living unit.
Each living unit has thermostat control (exception allowed).
Access to a laundry facility is provided.
Central dining is available.
There is a common living room area.
Doorways, hallways, and living units accommodate wheelchairs and walkers.
Elevators are available if the assisted living community has more than one story.
There is a kitchenette with a refrigerator, sink, and microwave oven in each living unit.
Clients can access shared kitchen space for individual snacks (to the extent allowed by health department requirements).
There is good natural and artificial lighting.
It is easy to find one's way around the community.
Clients can bring furniture and furnishings.
It is possible to share a room with a spouse or another individual under mutual agreement.
ServicesAssistance with activities of daily living including bathing, dressing, grooming, transferring, toileting, and eating.
Assistance with instrumental activities of daily living which includes, but is not limited to, housekeeping, shopping, laundry, chores, transportation, and clerical assistance.
Three meals and snacks made available each day.
Scheduled daily social activities that address the general preferences of clients.
Assistance with self-administration of medication.
StaffThe assisted living community has a designated manager with management or administrative ability.
There are sufficient staff to meet the 24-hour needs of clients.
Criminal records checks are conducted on employees.
Employee orientation and in-service education are completed within 90 days of employment.
No employee who has an active communicable disease is permitted to work.
The assisted living community ensures that no employees are listed on Kentucky's nurse aide abuse registry.
Meals/diningThree nutritionally balanced meals and snacks are made available 7 days a week.
Special foods may be requested.
The meal schedule and menus are posted.
Clients are permitted to dine in their living units.
ActivitiesThere is an activities program that addresses the general preferences of clients.
Activities are posted in advance.
Volunteers and families are encouraged to participate in activities.
Clients have access to religious activities at their churches or within the assisted living community.

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Table 10. Maryland Consumer Guide (Chapter 2)a

TopicQuestions
Licensing statusWhat level of care are you licensed to provide?
When was the provider last inspected by State licensing authorities?
What, if any, violations have been cited by the authorities in the past two years?
Did the provider submit a plan of correction?
May I have a copy of the inspection results and any plans of correction?
Resident agreementRequest a copy of the resident agreement.
Request a copy of the disclosure Statement.
Is the print readable?
What is the grievance procedure?
What are the rights of residents?
(Other provisions are listed elsewhere below)
Admission criteriaWhat behaviors, conditions or circumstances can result in termination of services?
Physical environmentWhat is the size of the facility?
What types of living units are available?
Do you have a waiting list?
What type of unit will I have?
Are bedrooms, hallways, doorways, bathrooms, and common areas fully accessible to people with walkers or wheelchairs?
Cost/financingWhat is your monthly fee?
What services are included in the fee?
What services are extra?
Do you require a deposit?
Refund policy?
What fees stop if I am away from the facility? Is there a charge for bed holds and when does it begin?
When, how often, and why can fees be changed? Who is informed and how when fees change? How much notice is provided?
What is the cost difference between special care and regular units?
ServicesWhat services do you provide?
How often will my level of care be reassessed?
How will the provider meet my current care needs (e.g., incontinence, insulin shots, etc.)?
What happens if my needs change—I need more help, become incontinent, become confused?
How does the provider tailor schedules for preferences of residents (like bathing and waking times)?
How does the provider help residents maintain their abilities to toilet, dress, and eat?
Is there a schedule for staff to check on each resident's whereabouts and well being?
What resources does the provider have to address difficult behavior?
If rooms are shared, what does the provider do if there are problems between roommates?
Services: LaundryHow often will my room be cleaned?
How often will my linens be changed?
Will the provider do my personal laundry?
Are washing machines available for me to use at the facility?
If so, is there any cost to use them?
What extra charges, if any, are there for additional housekeeping or laundry services?
Services: Care planWhat professionals/staff will be involved in the development of my written service plan?
How often is the plan revised?
How will my family and I be involved?
What involvement does a confused resident have?
What happens if I do not agree with the service plan?
Medication and healthWhat kinds of health monitoring checks are available (e.g. weight change, glucose levels, etc.)?
If a nurse is not on staff, are there regularly scheduled visits by a nurse or other health provider?
If so, what medical services do they provide?
How will the provider facilitate my access to health care and social services?
Will the provider schedule routine medical appointments for me?
Will the provider schedule transportation to and from medical appointments?
What health services are available on site: e.g. nursing care, lab work, physical therapy, wound care, hospice, social work, podiatrist, etc.?
What health services does the provider furnish, and what does it arrange for outside agencies to provide?
Under what circumstances and when will the provider call my family?
Under what circumstances and when will the provider call my doctor?
What safeguards are in place to ensure that I get the appropriate medications on time and in the correct dosage?
Who is responsible for having prescriptions filled?
Must I use the provider's pharmacy, even if it costs more than my pharmacy?
Who gives out medications?
If not a nurse, how are staff trained and supervised about medications?
If I am able, will I be allowed to take care of my medications on my own?
StaffHow many staff are there for each shift?
What are their responsibilities?
What is the training/certification of the people who care for residents?
What other duties do direct care staff have?
Which direct care staff on each shift are fluent in my native language?
Is there special training for staff about dementia and Alzheimer's disease?
How is staff trained to deal with aggressive individuals?
How is staff trained to deal with wanderers?
What if I do not like the staff person assigned to me?
What is the staff turnover rate?
MealsWhat times are meals served?
What happens if I am late, miss a meal, or refuse a meal?
How will any special dietary needs I have be met?
When can I have a tray delivered to my room?
Is there an additional charge for tray service?
If I do not like a meal, what are the alternatives?
When are snacks available?
May I see the printed menu for the past month?
How do you make sure each resident is taking in adequate nutrition?
ActivitiesHow often are activities in the community scheduled?
Will staff attend with me?
Are there protected or enclosed walking areas for residents?
How are resident's religious or spiritual needs met?
Who develops and supervises recreational activities?
How do residents have input into the activities offered?
What is the provider's policy on pets?
What is the policy on visitors?
TransportationIs any transportation provided?
If so, how often (daily, weekly, evenings, weekends)?
To where is transportation provided (grocery stores, shopping malls, medical appointments)?
Will the provider call and arrange for transportation it does not provide?
Is transportation available if I want to go to an event by myself or with a friend?
Are there fees for using the provider's transportation or transportation arranged by the provider?
Is transportation wheelchair accessible?
MedicaidWhat happens if my funds run out?
Do you participate in the Medicaid waiver program?

Other
Special care units

(Note: Additional sections deal with safety, emergencies, and choice.)

Is there a separate area specifically for people with dementia?
How do services in the special care unit differ from services in the rest of the facility?
What is the difference in staff training?
What is the staff-to-resident ratio?
Is there a special outdoor area for residents with dementia to use?
What techniques do you use to ensure that the resident is getting proper nutrition?
Do you offer decaffeinated drinks throughout the day?
Does the calendar of activities look appropriate for the resident?
What is the provider's policy on restraints, both chemical and physical?
How much space is there to walk around on the unit?
Are the rooms private or semiprivate?

a  Consumer Consortium on Assisted Living. The Consumer Consortium on Assisted Living (CCAL) originally developed this questionnaire with assistance from the Arlington Area Agency on Aging and the Northern Virginia Long Term Care Ombudsman Provider. Other professionals and potential consumers reviewed it as well. It has been significantly modified for use in Maryland.


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Table 11. Montana Consumer Guide

TopicAsk about
LicensingIs the home licensed by the State of Montana?a
AtmosphereWhat do the residents think of the home?
Physical environmentFloors and furniture clean?
Are there noticeable odors?
Does the home appear safe?
Are there noticeable dangers for trips and falls by residents and staff?
Are there stairs that make it difficult or unsafe in the event of fire?
Is the home neat, clean, safe, and in good repair? When
taking a tour of the home, look for these:
Are there fire exits, extinguishers, smoke detectors and exits identified?
Is the home as neat and clean as you are accustomed to?
How large of a building is the home?
What are the sleeping rooms like in the home?
Will there be room for my furniture?
Do I share a room with someone?
StaffIs there enough qualified staff to provide care to the residents?
ActivitiesWhat are the physical and social activities offered by the home?
MealsWhat do the meals look like being served while you are visiting the facility?
Is the menu posted for the residents to see?
Do the meals look appetizing?
Do the residents have assistance with eating?
Are there snacks available during the day?
Will they prepare special meals?
Can you have guests or family stay for meals?
Is there an alternate meal provided?
CommunicationAre the residents treated with dignity and respect?
OtherDo the home rules suit my lifestyle?
Do they allow pets?
Smoking or alcohol?
Visitors?

a  All Personal Care Homes should have a current license posted and available to the consumer. The license will specify how many "A" and "B" residents.


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Table 12. Michigan Consumer Guide

TopicAsk about
Cost/financingPrices for each service
Rate increase process and history
Conditions for terminating services
Assessment and ongoing care planning
Additional services available and the charge
Provisions for meeting scheduled and unscheduled needs
Availability of 24-hour ADL assistance
Physical environmentCondition of the building, fixtures, and furnishings
Emergency fire sprinkling system
Back up generators
Evacuation procedures and drills
StaffRequirements for direct care staff
Supervision of direct care staff; ratio of supervisors to staff
Activities staff
Regular visits by doctor, nurse, podiatrist, and other professionals
Registered dietician and sample menu
Criminal background checks for staff
Staff on-site 24-hours a day
Talk to residents about their impressions of facility, staff, activities, meals, attention to complaints
ActivitiesActivities available at various levels of functioning

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Table 13. Nebraska: Selected Examples of Questions for Staff

TopicQuestions
AtmosphereOutward appearance and location
Décor, homelike, clean, comfortable?
Warm greeting from staff?
Are residents socializing with one another?
Common areas available to socialize?
Staff appropriately dressed, friendly, respectful?
How long have staff worked there?
Policy concerning pets?
Admission and dischargeWhat criteria are used to determine whether a person is admitted to this particular facility? (Although State law requires certain overall admission and discharge standards, facilities differ on their specific criteria.)
What criteria are used to determine when the facility can no longer meet a resident's needs?
Who decides that a resident be discharged to another level of care?
What is the process for transfer or discharge?
Is there a process to discuss/appeal a transfer or discharge?
Physical environmentFloor plan easy to follow?
Clean, free of odors, and suitably heated/cooled?
Stairs and halls well lit; handrails, exits marked?
Non-skid material on floors?
Space for wheelchairs and walkers?
Sprinkler system?
Are visitors monitored or asked to sign in?
Beauty/barber shop available?
Living unitsWhat sizes and types of rooms are available?
Are units for single or double occupancy different?
Are toilet/bathing rooms private and handicapped-accessible? If they are not private, how many residents share these areas?
Emergency call system available?
How is resident privacy maintained?
Do residents have lockable doors to their apartments/rooms?
Are residents able to bring furnishings?
Do all of the units have a telephone and cable TV hookup?
May residents keep food in the units?
Is smoking allowed in residents' rooms? Is there an inside and/or outside designated smoking area?
ServicesWhat exactly are the housekeeping services? Is there dusting? Vacuuming of upholstered furniture and floors? Cleaning of sinks, toilets, and floors? Trash collection? Window cleaning?
How often are apartments/rooms cleaned? Is there planned, more intensive cleaning on a regular basis?
Does the staff make beds and change bed linens? If so, how often?
Are there additional costs for housekeeping services?
Laundry servicesAre laundry services provided? If so, what is included in the service?
If bed linens are laundered by the facility, does the service include taking the sheets off and remaking the bed?
Does the facility provide the sheets and towels?
For facility laundry, does the clothing need to be marked? If so, who is responsible for the marking?
Do the residents have options regarding how and when their laundry is done?
Is there a laundry area with clothes washers and dryers for resident use?
Are there additional charges for laundry services?
Medication and health servicesAre there Registered Nurses and Licensed Practical Nurses on staff? If so, are they scheduled routinely to be on-site at the facility? When and for how long a period of time? Are nurses available only on an on-call or consultant basis? How often are they available? (Licensing does not require that nurses be on-site at the facility.)
Will you want help taking medications? Ask if the facility assists with medication provision.
Do you have special medication needs (such as insulin shots)? Or need special health services (such as checking blood sugars)? Be certain to discuss any special needs during your visit.
Who provides the residents with medications?
Is there a choice of pharmacies from which to purchase medications?
Does a pharmacist review medications for the facility? How often?
How does the facility assist residents who wish to take their own medication?
What is the facility's procedure for responding to residents' medical emergencies?
How are advance directives followed?
Is help available for setting up medical appointments and for transportation to/from these appointments?
Do outside health care providers come to the facility? Is a staff person available to coordinate or oversee visits from health care professionals?
Are hospice services available?
Are there additional costs for medication assistance and health services?
Activities of Daily Living (ADLs) and Personal Care Help:
Who determines what assistance the resident needs?
How is the resident or the resident's designee involved or consulted about the determinations of what the resident's needs are and how those needs will be met? Which staff members provide the actual assistance to the resident? What are their qualifications?
How many direct care staff are available to help residents during the day? In the evenings? At night? On the weekends?
If a resident's condition changes (improves or declines), who is involved regarding any changes made in personal care? What happens if the resident or resident's designee disagrees with these changes?
How often is a resident's physical and mental status and level of functioning evaluated? Who does this evaluation?
Is assistance with showers/bathing or whirlpool bath available? How often? Which staff assists with bathing?
Are there additional costs for personal care assistance?
Meals/diningWhat exactly does food service include?
What is the appearance of the food? How does it taste?
Ask to see menus that have been planned.
Does the facility provide three nutritionally balanced meals per day, seven days per week?
Does a dietician or nutritionist review the menus?
What provision is made for residents with special diets and special food preferences (religious and otherwise)?
What times are meals served? Are meals available outside scheduled times?
Are the menus posted? Are there alternate choices comparable to the entree?
What size portions are served? Are second helpings available?
Does the facility provide snacks between meal times? How often?
Are fresh fruits and fresh vegetables served? How often?
Are coffee, tea, and other beverages available anytime?
Are guests for meals allowed? How much notice is required? What is the charge?
Can residents have meals delivered to their rooms?
Does the facility provide reminding or assistance with meals? What kind of assistance is provided? Is there an extra charge?
Are there additional costs for meal service?
ActivitiesIs there an organized program of activities that is planned in advance? Ask to see a copy of the activity calendar.
Who organizes and supervises the activities program?
What types of activities are offered? When? How do the residents know about the activities? Is there an information board with the activities for the day listed? Are residents given reminders to attend, if they need this assistance?
Are religious services/activities offered at the facility?
Is an exercise program (or equipment) available at the facility?
Is there help for individual activities (such as help with reading/writing for a resident who is visually impaired)?
Is there a Residents' Council at the facility? How are residents able to present any suggestions to the facility management?
Are there any additional costs for participation in social and recreational activities?
TransportationIs transportation provided? Where to? When is it available to residents?
How do residents schedule transportation? How far in advance?
Can vehicle accommodate residents with varying levels of physical mobility?
Is there space for residents to park personal vehicles at the facility?
Are there additional costs for facility transportation or a personal parking space?
MedicaidIs the facility a Medicaid Waiver provider? Are the same services and living units available to you if you qualify for the Waiver?
Other—Special needsAre residents with special needs, such as Alzheimer's disease and dementia, housed with other residents or do they have special units within the facility?
Are there separate staff, dining areas, and/or activities for residents with special needs?
How is the staff specifically trained to care for residents with special needs?
Are there special programs for memory-impaired residents and residents who have dementia?
Are there special accommodations for memory-impaired residents to be outside?
At what point would the facility no longer be able to meet the needs of a resident with Alzheimer's disease or dementia and seek to transfer the person to a higher level of care (such as a nursing home)?
Are there any additional costs for a resident with special needs?

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Current as of September 2006
Internet Citation: Section II. State Consumer Guides to Assisted Living: Residential Care and Assisted Living. September 2006. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/residentcare/rescare4.html