Section II. State Consumer Guides to Assisted Living (continued)

Residential Care and Assisted Living: State Oversight Practices and St

Table 14. New Jersey Consumer Guide

Resident agreementIs there a contract/resident agreement available for review?
Is a contract/resident agreement available to include accommodations, personal care, health care and support services?
When may a contract/resident agreement be terminated and what are the refund policies?
(This area includes questions that are listed in other parts of the guide)
AtmosphereAs you arrive at the residence, do you like its location and outward appearance?
As you enter the lobby and tour the residence, is the décor attractive and homelike?
Did you receive a warm greeting from staff welcoming you to the residence?
Does the administrator/staff call residents by name and interact warmly with them as you tour the residence?
Do residents socialize with each other and appear happy and comfortable?
Are you able to talk with residents about how they like the residence and staff?
Would residents be appropriate neighbors for you or your loved one?
Are staff personable and friendly?
Are visitors welcome at any time?
Physical environmentIs the community well designed for residents' needs?
Is it easy to find your way around?
Are doorways, hallways, and rooms accommodating to wheelchairs and walkers?
Are elevators available for those unable to use stairways?
Are handrails available to aid in walking?
Are cupboards and shelves easy to reach?
Are floors of a nonskid material and carpets firm to ease walking?
Does the residence have good natural and artificial lighting?
Is the residence clean, free of odors, and comfortably heated/cooled?
Is there a secure environment for wanderers?
Is an outdoor recreation area available?
Unit featuresAre different sizes and types of units available?
Are units for single and double occupancy available?
Do units have lockable doors?
Is a 24-hour-a-day emergency response system available in the unit?
Are there private bathrooms with access for walkers and wheelchairs?
Is furniture provided? Are residents able to bring their own furnishings? Is other storage space available?
Do all units have a telephone and cable TV, and how is billing handled?
Is a kitchen area provided with a refrigerator, sink, and cooking appliances?
Are residents allowed to smoke in their units? Is there a designated smoking area?
Cost/financingAre there any government, private, or corporate programs available to help cover the cost of services to the resident?
Are additional services available if the residents' needs change?
What is the procedure to pay for additional services like nursing care when the services are needed on a temporary basis?
Are there different costs for various levels or categories of service?
How are they determined?
Do billing, payment, and credit policies seem fair and reasonable?
May residents handle their own finances with staff assistance if able, or should a family member or outside party be designated to do so?
Are residents required to purchase renters' insurance for personal property in their units?
ServicesAsk the residence to provide a list of services available.
Are staff available to provide 24-hour-a-day assistance with activities of daily living (ADLs) if needed? ADLs include dressing; eating; mobility; hygiene and grooming; bathing; toileting and incontinence; using the telephone; shopping; and laundry.
Does the residence provide housekeeping services in residents' units?
Does the residence provide transportation to doctors' offices, hairdressers, shopping, and other activities desired by residents?
Can residents arrange for transportation on fairly short notice?
Are pharmacy, barber/beautician, and/or physical therapy services offered on site?
Are there special programs for those with memory loss?
Services: Care planIs there a process to identify and address residents' needs?
Does this process include residents, their families, and residence staff along with the residents' physician?
Medication and health careWhat are the policies regarding storage of medication, assistance with medication, training, and supervision of staff?
Is self-administration of medications allowed? Can medication be kept in the resident's room? How is it monitored?
How do you coordinate visits from the physician, nurse, hospice, physical therapist, occupational therapist, and others?
Are trained staff available to assist residents who experience memory, orientation, or judgment losses? How are they trained?
What is the procedure for responding to a resident's medical emergency?
Meals/diningAre three meals a day offered?
Do dining room menus vary from day to day and meal to meal? Ask for a menu.
Are snacks and beverages available?
May a resident request special foods?
Are special diets accommodated?
Are private dining areas available?
Are guest meals available?
May residents eat meals in their units? Is there an additional charge?
Can meals be provided at a time a resident would like, or are there set times for meals?
Can residents have alcoholic beverages?
ActivitiesDo you see activity programs in progress? Ask for a copy of the schedule.
Can residents participate in activities outside the residence?
Is there a volunteer program?
Are pets allowed in the building? Who is responsible for their care?

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Table 15. Oregon Consumer Guide

Physical environmentIs the facility clean, odor free, well lit, and free from clutter?
Are the common areas attractive, comfortable, and inviting?
Do the size and design appeal to you?
Atmosphere/surroundingsDo residents socialize with each other and appear happy and comfortable?
Ask residents how they like living in the facility.
Cost/financingWhat is included in the basic rate?
How does the facility charge for services?
Are there charges for things such as not using the facility's pharmacy, arranging for medical appointments, or transportation?
Do billing, payment, and credit policies seem fair and reasonable?
What is the refund policy?
Does the facility cap the percentage by which the monthly rate can increase?
ServicesDoes the facility accommodate two-person transfers?
Are services available, if needed, to assist residents with eating?
Does the facility provide transportation to doctors' offices, shopping, and other activities? Does the facility have its own vehicle?
Are barber/beautician services offered on site?
Can your current needs be accommodated and as those needs intensify or increase, is the facility able to continue to provide necessary care?
How often are the service plans updated?
Does the facility accommodate terminally ill residents and their families?
StaffingHow long has the administrator been at this facility?
Does the administrator appear to be knowledgeable and sincere?
Chat with staff about their job responsibilities.
Talk with the administrator about his/her experience working in an assisted living or residential care environment.
Are employees of the facility easy to identify by name badge or attire?
Do personal care workers seem satisfied and involved?
Do they show interest in, affection, and respect for residents?
Are workers respectful and friendly to other staff members?
Are residents' requests handled in a timely manner?
How much time is spent in staff training, and what topics are covered?
What qualifications do the trainers possess?
Meals/diningAsk current residents how they like the food.
What are the meal times?
Is the menu available in advance?
Is a dietitian involved in planning menus?
Are residents involved in meal planning?
Are extra helpings or substitutions available?
ActivitiesAre the activities appealing? If not, will they accommodate your preferences?
Are residents engaged in activities as you walk through the facility?
Does the facility provide activity equipment and supplies?
Is there evidence of an organized activity program, such as a posted daily schedule, events in progress, reading materials, etc.?
Does the facility take residents on outings?
Are there on-site religious/cultural activities?

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Table 16. Pennsylvania Consumer Guide

What is a Personal Care Home?Personal care homes (PCHs) provide lodging, food and some support services for people who are elderly or who have mental or physical disabilities; who are unable to care for themselves but who do not require 24 hour nursing services in a licensed nursing care facility. Typically, residents of PCHs need help with dressing, feeding, taking medications, mobility issues, and finances.
Where to find a Personal Care Home?Information regarding personal care homes can be found in newspapers, telephone directories, through social service agencies, from the State licensing authority, and even from the Internet. Like most businesses, the consumer can check with the local Better Business Bureau for information about area facilities. Hospital social services departments generally keep a list of local facilities with which they are acquainted.
Occasionally, personal care homes are inadvertently listed in telephone directories under "Nursing Homes," so it is important to clarify the type of facility it is when you phone.
Go to the PCH directory listed alphabetically, by county and region.
How do you go about Choosing a Personal Care Home?Location: Personal care homes are located in the inner cities, in the suburbs, and in rural areas. Which is the most desirable spot? Certainly if a particular community is "home" because a person's life had been spent and enjoyed there, then the selection of that area would be wise.
If living near relatives provides a sense of security, then that is an important consideration. In addition, a home close by would give loved ones a better opportunity to visit. A PCH where a friend lives and has "paved the way" presents an incentive for making a choice. Sometimes the decision is based on the needs of the spouse. If one's spouse is already living in a PCH, then many times their mate chooses to move in as well.
Urban facilities offer many advantages, like access to mass transportation, large medical facilities, and malls. There are advantages of having a store, a church, a library, access to a senior center, and mental health county services nearby that should not be overlooked. Many residents choose rural homes because of the affordability factor, but rural homes also offer their own brand of charm. Perhaps looking out on rolling hills or mountains is of importance.
The most significant factor, when considering "where to live," is that it should coincide with the individual needs of the resident who has to live there. Personal care homes can almost always meet that need, as they are found everywhere.
Provider agreementAsk to see the standard contract between the facility and the resident. Read it, and be sure you understand the content. Many contracts have specific restrictions regarding refunds and resident discharge conditions. Every contract must include, but is not limited to: a list of the services provided, the monthly charges for room/board and services, any additional charges, home rules, resident rights, and arrangements for health and emergency services. Be aware that the monthly fee may not include all listed services, and additional charges may be specified in the contract. Often, extra charges apply for such things as shampoos, hair setting and other specialized hair care, nail care, transportation, incontinence care, special diets, assistance with specialized food intake, catheter care, durable medical equipment, pharmacy services, and specialized individual care services beyond the usual contractual commitment for care. Residents who are recipients of SSI receive special contractual protections under State regulations. An SSI personal care resident may not be charged more in their resident contract for rent and other services then their actual current monthly income reduced by the personal needs allowance. The personal needs allowance is a minimum amount of a resident's own funds that must be set aside for his/her personal expenditures. Also, SSI recipient residents may not be asked to agree to give more than one-half of the annual Senior Citizens Rebate to the facility. Personal care homes must also provide the following items, at no additional charge, to an SSI recipient resident: necessary personal hygiene items, such as a comb, toothbrush, toothpaste, soap and shampoo. Personal laundry services and personal care services are also provided free of charge to SSI recipient residents.
Administration/policiesTry to get a feel for the personalities of the people who manage the home and care for the residents. Decide if they are warm and caring people; if they acknowledge the residents by their names; if they welcome visitors and try to make you feel at home. Does the home have a resident committee? How do they handle complaints?
(Things to look at during the visit)
The residents in the home. Some homes admit a mixed age population. Some cater to older residents. There are facilities that serve persons with behavioral health issues, dementia, and a variety of other disabilities. Do the residents appear comfortable? Are they appropriately dressed? Does their personal hygiene seem acceptable? Are the residents socializing together? Are they provided an opportunity to meet and greet visitors?
The housekeeping. Look at the overall appearance of the outside of the PCH. Are the grounds cared for? Are there cleaning and laundry facilities in the home or do they use contract services. Ask to see the bathroom and the kitchen to determine their condition. Are there strong or overpowering unpleasant odors in the home?
Ask to share a meal with the residents. Preferably arrange to visit at a meal time and observe the food preparation and serving. If a special diet is needed does the home offer that service?
Activities are a very important part of the stay in a personal care home. Are there a radio, television, table games, magazines and newspapers? There should be reading materials available in the living area. Is there sufficient lighting for reading? Ask about the opportunities for socialization at the home and in the community. Ask about the location of the nearest senior citizen center, Area Agency on Aging, Mental Health/Mental Retardation Service Unit, stores, malls, church, and available transportation.
Physical environmentThe size of personal care homes ranges from single family dwellings, to large mansion-type homes, to converted motels, to multi-service level facilities that resemble hotels or retirement communities. Some offer limited service packages, some offer the full range of assistance and health care packages. Larger facilities, usually those with 50 or more beds, tend to be more "institutional" in their operations, while smaller "family" style homes can allow for more individual flexibility. A small home may have a homey atmosphere where residents get to know everyone who lives there and become a type of surrogate family. In larger homes, residents may have more living area for moving around and socialization activities.
In converted motels, bedrooms and baths are usually shared with only one other person at most. Privacy, then, is a distinct feature.
The "institutional" type home will have a more diverse population of residents, allowing for a greater choice of friends and activities. That type of home will probably have specialty staff, like a social director, on staff.
All personal care homes have advantages. A person's life-style prior to the move to a home should be considered in order to determine the size of the home that best suits the resident.
UnitNote the available closet space and drawer space. Bear in mind that this room may be shared with at least one other resident. Look at the bed linens, furnishings, and the proximity of the beds. Note the windows and daylight provided through the window coverings. Note the temperature of the rooms and ask how the rooms are heated in cold weather. If summer heat is a concern, inquire if the home is air conditioned. Some homes are not air conditioned and provide fans only. Ask which of the resident bedrooms will be yours. If it is located above or below grade level, remember that steps must be able to be negotiated. A handrail should be present in stairwells and hallways for support.
Costs/financingWhat can be afforded: a small amount, a moderate amount, or is cost of no concern? The average amount is somewhere between $700 and $3,000 per month. The more that is charged, the more that can be expected in the way of furnishings, variety of menus, activities, and individual service packages. A number of homes will accept persons who receive Supplemental Security Income (SSI) for the amount of their room/board and service fee. For SSI recipient residents in licensed personal care homes, there is a Personal Care Supplement amount that can be applied for by the resident, with help from the operator of the home. This Personal Care Supplement is not automatic, and persons interested in learning more about the application and assessment process should contact their local county Area Agency on Aging.
Others will ask that the resident's SSI income be supplemented somewhat from another source as from relatives. This is called a "Third Party Agreement" and is specifically for a service package. This agreement must be held separate from the resident's usual written room and board contract with the home.
Still others accept only private pay from residents. The resident who signs a private pay contract should remember that if their resources become exhausted during their stay, they will probably be required to move. Keeping this in mind, there is a personal care home to fit every budget. After applying your standards and narrowing the options, determine if the homes you are considering are licensed personal care homes. You may ask the PCH if they have been inspected by the Department of Public Welfare, Division of Personal Care Homes; or to find out if they have the appropriate licensure, you can phone or write your regional office.
When personal care homes are inspected, a set of State regulations are applied. The homes must comply with these regulations before a license is recommended. A copy of these regulations can be obtained by phoning the regional offices. Questions and complaints about personal care homes in Pennsylvania may be directed to the regional licensing offices by phone or by mail.
Medication and health servicesMedical followup is also very important. Does the home encourage the residents to keep with their own physician or do they have a house doctor that follows the medical needs of the residents? What home health care agencies are available? Pharmacy services are rarely part of the facility, so do they use a local pharmacy or mail order service? There are also questions about durable medical equipment providers, rehabilitative services, and emergency medical services that should be asked before admission. If there is a local medical transportation/ambulance service, is there a membership fee?
Visiting the Personal Care HomeAn important step in choosing a personal care home is the home visit. If possible, the resident and family members or close friend should try to visit the home before moving day.

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Table 17. South Dakota Consumer Guide

TopicQuestions (selected)
Resident agreementIs there a clear, itemized list of services that are included in the basic daily rate?
Is there a clear, itemized list of extra services and charges?
Does the facility require the signature of the resident or their legal guardian?
Does the admissions agreement state they are willing to accept Medicaid-eligible residents and those who convert to Medicaid any time after admission?
Does the facility require a down payment?
Does the agreement provide a reasonable timeframe (i.e., 30 days) to be notified of any increase in the facility's fees or charges?
Does the agreement include an understandable statement of residents rights, or is it stated in a separate document?
Does the residents' rights document outline the procedures for filing a complaint about the care or services provided within the home? The name of the local ombudsman should be made available upon request.
Does the agreement seek a consent for medical treatment or pharmacy services?
Do any agreement provisions waive or limit the facility's liability for lost or damaged personal possessions or injury to the resident?
Does the agreement provide reasons the resident can be discharged for other than (1) medical reasons, (2) the resident's welfare or that of other residents, (3) nonpayment except as prohibited by Medicaid?
Does the contract provide for a minimum number of days advance notice to any discharge or transfer initiated by the facility?
Does the agreement explain how many days a resident's bed can be held should the resident be absent during a hospitalization, family event, etc.?
AtmosphereDo the residents appear to be well tended?
Is the assisted living center clean and odor free?
Does there appear to be adequate staff for the number of residents?
Can a resident bring their personal furniture and belongings?
Does the resident have privacy during family visits?
Do staff appear to know the residents and treat them with respect?
Would the center consider a short term stay for a trial period?
ServicesCan I hire a nurse privately to provide me services?
Can I ask for more assistance from staff on certain days?
Medication and healthIs this facility approved to provide medication administration or have other specialty licenses?
StaffIs the staff trained; do they appear to know what their job requires?
How many staff are employed by the center?
Will the residents have the same person helping them each day?
If a staff person calls in sick, are replacement staff available?
Have there been any staff resignations lately? Why?
Is there a call system from each resident's room in case of emergency? If not, how do they plan to accommodate this need?
Meals/diningCan I have an occasional meal in my own room?
During meal time, did the food look and smell appetizing?
ActivitiesAre there activities, individual or group, offered at the center?
Can I go to my church in the community?
Can I attend activities in the community?

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Table 18. Washington Consumer Guide

AdministrationHow long has the current administration been in place?
Costs/financesWhat are the basic rates (it's a good idea to get this information in writing)?
What services are covered by these rates?
Are there charges additional to these rates?
What are the payment policies?
What is the refund policy if someone leaves before the end of a month?
What is the policy for rate increases?
AtmosphereAs you arrive, do you like the location and outward appearance?
Do residents socialize with each other and appear happy and comfortable?
Are you able to talk with residents about how they like the residence and staff?
Do the residents look like people you will want to live with?
Is the facility close to friends and relatives?
Is the facility on a noisy street?
Are there shops, a library, a park, or other amenities within walking distance?
Is the facility close to activities you enjoy?
Is the facility on a bus line?
Is there an outside area to sit, walk, or garden?
Physical environmentIs the floor plan easy to follow?
Are doorways, hallways, and rooms accommodating to wheelchairs and walkers?
Are there hand rails to help with walking and in the bathrooms?
Are cupboards and shelves easy to reach?
Are there nonskid floors and firm carpets to assist walking?
Does the facility have good natural and artificial lighting?
Is the facility clean, free of odors, and well heated and cooled?
Does the facility meet your standards of cleanliness?
Is the facility free from obvious hazards?
Are the facility's rooms clean, safe, and adequate for your needs?
Will you have free use of the kitchen, activity rooms, toilet facilities, dining room, and grounds?
Can residents smoke in their rooms or in public spaces?
What pieces of furniture are provided?
Is there a chair, a reading lamp, and an overhead light?
Is there a sit-down shower?
Can you bring along some of your own furniture or other personal items?
ServicesAre doctors, nurses, and emergency assistance available if needed?
Are emergency procedures clearly posted throughout the facility?
What is the facility's policy regarding the level of care they will provide?
Who will take you to doctors' appointments?
Can residents arrange for transportation on fairly short notice?
How will needed specialized services, such as physical therapy, occupational therapy, or recreational therapy, be arranged?
StaffAre staff suitably dressed, personable, and outgoing?
Do the staff members treat residents with respect and dignity?
Do staff members treat each other in a professional manner?
Who will provide the needed personal care?
Who will provide any nursing care?
Is staff available to meet scheduled and unscheduled needs?
What language does most of the staff speak?
Is there frequent turnover of staff?
Will staff plan for your activities, such as a hair appointment or regular poker games?
How flexible will the staff be in working out a plan of care with you to meet your needs?
ActivitiesWhat recreational activities are available?
Will you be able to attend religious services of your choice?
Does each resident get a copy of house policies and resident rights?
What are the policies regarding visitors and pets?
Must everyone get up and eat at the same time or is the facility flexible?
Are there regularly planned activities that you will enjoy?
Meals/diningIs the food pleasing, nutritious, adequate, and attractively served?
Are snacks available?
Are there specific meal times, or can you snack throughout the day or evening?
Will the facility meet your dietary or cultural food preferences? Can residents request special foods?
MedicaidWhat is the policy for accepting Medicaid or transferring to Medicaid at a later date?

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Table 19. Wisconsin Check Section of Consumer Guide

Licensing statusDoes the home have a current State license/certification/registration?
Resident agreementDoes the admission agreement clearly specify:
Services provided in the monthly rate?
Daily or monthly rate?
Additional charges for services not covered in the rate?
Thirty-day notice for a change in the rate or service?
When payment is to be made?
Physical environmentDoes the home or apartment appear to be safe and secure?
Are telephones available?
Can or do residents/tenants have telephones in their rooms/apartments?
Are halls free of obstacles (furniture, equipment)?
Are exits unobstructed and easy to reach?
Are fire extinguishers visible?
Is there an evacuation plan posted?
Are drills held at least quarterly?
Are floors clean and non-slippery?
Are there any obvious odors?
Are doorways/hallways, rooms big enough to accommodate wheelchairs?
Is the temperature in the facility comfortable?
Can residents regulate the temperature of their own room/apartment?
Is heat/electric/cable included?
Are other living areas sufficient in size for the number of people in the facility?
Is there sufficient space for visitors, conversation, watching TV?
Does the facility have amenities such as a beauty shop, store, or fitness area?
UnitsWill the room/apartment shown appear to meet his/her needs?
Are rooms/apartments attractive, clean, well-lit, and ventilated?
Can residents/tenants use their own furnishings in their room?
Is there a bedside stand, reading light, and chest of drawers for each resident?
Is closet space/storage space sufficient?
Are provisions made for privacy?
Is there space for private visits in the home?
Are there private bedrooms?
Are there private bathrooms?
Are cupboards easy to reach and electrical outlets conveniently located?
Are bathrooms conveniently located?
Are bathrooms clean, well-maintained, and odor-free?
Are handgrips or rails near toilet and bathing areas if needed by the residents?
Do bathrooms have showers or tubs?
Are bathrooms equipped with locks for privacy?
Are there emergency pull cords?
How many people share a bathroom?
ServicesDoes the facility provide help with bathing, getting in and out of bed, care for hair and teeth, dressing, exercise, and other personal care needs if residents require it?
Does the facility teach personal care activities to improve independent functioning such as feeding, grooming, and dressing if needed?
Do the program and services appear to be appropriate to meet the needs of the prospective resident?
Medication and healthIf desired, will the facility control residents'/tenants' medications?
Can residents/tenants retain their personal physician?
Does the facility assume responsibility for making medical appointments if residents are unable to?
Does the facility provide transportation for medical appointments? Is there a charge?
Does the facility have a plan to respond to medical emergencies and dental needs?
Are staff trained in the provision of emergency first aid?
What happens if health changes? Will the facility provide additional services or arrange for home health care?
Will the facility provide or arrange for specialized therapies if needed?
StaffDo staff know the residents/tenants?
Do staff show interest in individual residents/tenants?
Do residents/tenants talk freely with staff?
Are residents/tenants treated with respect and dignity?
Is privacy respected (knocking before entering rooms)?
Are calls for assistance responded to quickly?
Is the appearance of staff neat and clean?
Does there appear to be enough staff to meet residents'/tenants' needs?
Who is the owner of the facility? Is the facility locally owned?
Who is the operator? What is the professional and educational experience of the administrator?
Is there a nurse on staff? Is it an RN?
How often is the nurse in the building?
Meals/diningIs a menu available? Did the home serve what was on the menu?
Does the facility monitor nutritional needs and provide modified diets when
Are hot foods served hot and cold foods served cold?
Are dishes and silverware used (instead of disposable plates and utensils)?
Does the food appear appetizing?
Do meals appear to be nutritionally balanced?
Are fresh fruits and vegetables served in season?
Do residents/tenants appear to enjoy their meals?
Is food served family style or do staff determine portion sizes?
Are residents/tenants able to have snack foods and/or soft drinks in their bedrooms?
Are provisions made for residents/tenants who are ill and unable to eat in the dining room?
Do residents/tenants have input into meal planning?
Who plans the meals?
ActivitiesAre activity calendars posted?
Do activities include a variety of interests?
Are planned activities appropriate to the age and abilities of the residents/tenants?
How often are there planned outings?
Do residents/tenants participate in planning the activities?
Are residents/tenants encouraged to participate in community activities?
Does the facility provide transportation to community activities?
Are arrangements made for residents/tenants to attend religious services and to practice their beliefs?
Are escorts to programs and meals available, if needed?
OtherWhat is the refund policy?
Does the facility have a resident's bill of rights and complaint procedure?
Did the facility have any complaints in the past year?
If so, were they resolved?
Does the facility have Wisconsin Administrative Codes governing the applicable facility available for review?
Page last reviewed September 2006
Internet Citation: Section II. State Consumer Guides to Assisted Living (continued): Residential Care and Assisted Living: State Oversight Practices and St. September 2006. Agency for Healthcare Research and Quality, Rockville, MD.