Assisted living for seniors: How to find the right community for you

Table of Contents

• Overview
• Who resides in assisted living
• Who may not be a good fit
• Why choose assisted living
• Housing
• Home care services for IADLs
• Personal care services for ADLs
• Cost
• Paying
• Choosing a community
• Application process
• Alternatives

Overview

Assisted living is a senior living option that provides housing, services, and care in a maintenance-free community setting for older adults who need ongoing help with some Activities of Daily Living (ADLs).  In the United States, these facilities are regulated at the state level to ensure residents’ health and safety.

Who resides in assisted living

In assisted living for seniors in the United States, over half the residents are 85 and up, and women outnumber men 2:1.  The ADLs they most often need help with are bathing, walking, and dressing. Many residents use mobility devices such as canes, walkers, rollators, and wheelchairs and are not bedridden.

Who may not be a good fit

People who need help with the following may not be a good fit for assisted living for seniors:

• Skilled nursing or medical care:  Assisted living communities are not licensed to manage feeding tubes, insulin injections, open wounds, and usually medication administration.  Residents who need this type of assistance may be able to remain in assisted living if they bring in home health providers to help on a scheduled basis or if they can self-manage (e.g. PEG feeding tubes, insulin injections).
• Advanced dementia or Alzheimer’s care:  ALFs can care for residents who are in the early stages of cognitive decline, but those who need greater supervision and are at risk of wandering would be safer at a memory care community.  Anyone who poses a danger to themselves or other residents or staff members would be asked to find a different type of facility as well.

Why choose assisted living

The primary reasons people move into assisted living facilities are to get:

• Personal care for ADLs:  By living in a licensed assisted living facility, seniors get access to:
  • Trained caregivers and on-call nursing staff who are familiar with the challenges that seniors face and well-versed in ways to help them that are effective and safe for both parties
  • 24×7 supervision and on-demand assistance for unscheduled needs, such as toileting and transferring, and emergencies such as falls
  • Greater caregiving resources when they need increasingly more help with ADLs
• Caregiver relief and peace of mind:  Having staff available around the clock enables existing caregivers to lighten their workloads, stave off potential burnout, take care of their own needs, and feel reassured that their loved ones are being well taken care of.

Additional benefits include the below, which also are available in independent living, but are provided in assisted living on an expanded scale to accommodate the lower levels of mobility:

• Maintenance-free lifestyle:  Assisted living communities take care of all home maintenance and repairs, housekeeping, laundry, and meal preparation.  This prevents residents from falling or injuring themselves while doing chores and frees up time for more enriching activities.
• Social opportunities:  Residents live with peers who are at a similar stage in life in an all-inclusive community.  This provides built-in social opportunities where they can connect with others and build new friendships, and therefore stay healthier – physically, emotionally, and cognitively.
• Accessibility:  These communities incorporate home modifications so they are more accessible by people using mobility aids.  These can include sinks without cabinets underneath, lowered countertops, roll-in showers, pocket doors, abundant grab bars, ramps, and more.
• Safety and security:  These communities have staff onsite 24×7, who not only help to keep the community secure, but also can help residents in case of emergency, such as severe weather or power outages.
• Convenience:  Communities may have amenities ranging from a hair salon to a movie theater to a general convenience store – and activities ranging from game nights to group exercise classes to educational talks.  This makes it easier for residents to take care of their needs and stay engaged, even though they may be less mobile than before.

Housing

Assisted living communities often are apartment-style buildings made up of one-bedroom units, studios, and sometimes even shared rooms or shared showers in the hall.  Occasionally, the community may have some two-bedroom units or may even create converted two-bedroom units by installing a connecting door in the wall between adjacent studios and/or one-bedroom units.  These communities are less likely to have multiple floors, separate buildings, or sprawling campuses in order to accommodate residents’ more limited mobility.

Home features

Features you can expect in your own unit include:

• Accessibility:  Units are more likely to be ADA-compliant, wheelchair-accessible, compact, and streamlined to align with lower mobility levels.
• Safety:  In addition to standard safety devices such as smoke alarms and fire sprinklers, emergency pull cords will also typically be available in the unit.  These are most commonly in the bathroom, where accidents are most likely to occur, and may also be in the bedroom.
• Bathroom: 
  • Grab bars: To prevent falls in a slippery environment, the bathroom will have plenty of grab bars. 
  • Shower: For easier access, the shower will be at a minimum a walk-in shower with a low curb – or occasionally, a true roll-in shower where a wheelchair can pass easily over a compressible rubber strip that helps to keep water from flowing outside the shower.  Inside the shower will often be an adjustable, handheld shower head along with a shower seat that can flip down when in use and flip up against the wall for storage. 
  • Door: The bathroom door may be a sliding pocket door so that it doesn’t get in the way when it swings open.  The community also may offer to remove the bathroom door entirely if you find that safer. 
  • Vanity: For wheelchair accessibility, the sink typically will not have a cabinet underneath. 
• Kitchen:  Because residents are not expected to cook, units rarely have full-size kitchens, which may be found in high-end communities – or older communities that have not been updated.  Most places offer kitchenettes with a sink, mini-fridge, and perhaps a microwave.  They typically will not have a stovetop or oven for safety purposes, but residents may be allowed to bring in their own small appliances.  For wheelchair accessibility, the sink will usually not have a cabinet underneath.  Occasionally, the kitchen counter will be lowered as well.
• Laundry:  In assisted living for seniors, it’s not as common to have self-serve laundry facilities, whether shared or inside the unit, since residents are usually offered full laundry services.
• Parking:  Communities typically will have parking, but residents often may no longer be driving.
• Storage:  Closets tend to be less spacious in assisted living for seniors.  Onsite storage units also are less common, as these can be challenging for residents to access and use effectively.  People may need to downsize significantly before moving in.
• Furnishings:  Housing may be provided with or without furniture.  The benefit of the latter is that residents can bring their own belongings to make the place feel more like home.

Common areas

The shared areas of an assisted living community often provide the following: 

• Accessibility:  Like the individual housing units, the common areas also will be set up to be more accessible by residents who use mobility aids.  They may be more compact, provide elevators, have wider hallways lined with handrails for support and benches for resting, and provide ramps for wheeled mobility devices.
• Safety:  To better protect their residents, some communities may be gated.  Others may have emergency power generators that kick in during power outages.  For evacuations, some communities have stair evacuation chairs or inflatable slides for residents who live on the second floor but are not able to walk down a flight of stairs.  Many communities also are shelter-in-place facilities, where the fire department comes to evacuate residents who have mobility challenges while they wait safely behind 90-minute fire doors.
• Dining room:  The central common area is the dining room, where residents gather for communal meals up to three times a day.  Some communities also have a separate small dining room that residents can reserve for private events with their family and friends.  A few also have communal kitchens that residents may use to prepare meals that require more appliances, equipment, or space than is available in their own kitchenettes.
• Activity rooms:  Most places will have a general activity room or clubhouse where larger events are hosted, along with a few smaller rooms or lounge areas for informal resident gatherings.  They also may have more specialized activity rooms, such as a library, computer room, movie theater, arts and crafts room, or chapel.
• Fitness room:  To help seniors stay healthy, just about all communities have an exercise room.  Equipment will be geared toward people with mobility challenges, choosing recumbent bikes over treadmills and ellipticals.  For further safety, some communities may keep the exercise room open only during business hours when staff is actively supervising all usage of the equipment.
• Outdoor spaces:  Getting fresh air and outdoor exercise also boosts health, so many communities have outdoor gardens, patios, courtyards, and walking paths.
• Onsite rehabilitation:  Many communities partner with a company that provides outpatient physical, occupational and speech rehab therapy services, and set them up inside the community with their own office or section of the exercise room.  This makes it easier for residents to regain their health from the convenience of home, without having to opt for more costly inpatient rehab.

Onsite amenities:  For greater convenience, some communities dedicate rooms for amenities that typically require making a special trip offsite, such as a beauty salon or a general convenience store.

Home care services for IADLs

Home care services provided by assisted living for seniors vary from community to community, but they usually help with Instrumental Activities of Daily Living, including full dining, housekeeping, laundry, 24×7 staffing, home maintenance and repair, and utilities, which is valuable for those with mobility challenges – as well as some level of transportation and activities.

Dining services

At assisted living for seniors, the dining room typically serves three meals a day restaurant-style, so that residents can remain seated comfortably at their tables throughout the meal.  They generally have fixed mealtimes, which tend toward earlier senior-friendly hours. A few communities also supplement the fixed mealtimes with all-day table service for select menu items for residents’ convenience. At communities with ample dining room staff or where the dining staff reside onsite, it’s easier to provide meals at residents’ preferred times; at other communities, the three meals of the day may get compressed into a shorter total time period in order to fit with staff availability.

Restaurant menus vary each day, usually with a couple options to choose from.  Some communities also have a supplementary everyday menu that offers popular standards if you aren’t keen on that day’s menu choices.  Most communities are mindful of the need for seniors to eat healthfully, and offer low-salt or sugar-free choices.  What sets apart assisted living facilities is that they also can accommodate doctor-prescribed, specially-prepared meals as part of a resident’s care plan, such as mechanical soft or pureed diets.

While residents benefit from dining with others, they also are welcome to bring their meals back to their rooms in takeout containers.  Most communities are happy to pack up your meal if you call in your takeout request in advance; some let you pick up the takeout meal at the start of the mealtime, while others only make them ready after mealtime is over.  Most communities also provide complimentary room service delivery when residents occasionally feel under the weather, or full-time room service as part of their care plan.

Housekeeping

Full housekeeping for your unit is included, usually on a weekly basis, but sometimes on a daily basis.  Trash may be removed as often as twice a day, especially if the resident has incontinence issues.

Laundry service

Assisted living for seniors usually provides full laundry services – washing bed linens and personal laundry, changing bed linens, and sometimes even providing their own linens that residents can use.  Keep in mind that some communities may wash each resident’s laundry separately, while others may have a policy of combining multiple residents’ laundry together.

Transportation 

A wheelchair-accessible van or shuttle typically will be available to take residents to other locations on a complimentary basis, often limited to weekdays during daytime hours.  Destinations may be limited to a 10 to 15 mile radius from the community, but some communities will drive beyond that for an extra surcharge.

Certain days of the week may be reserved for regularly scheduled group trips to grocery stores or for group social activities.  Other days of the week are dedicated to taking residents to their personal medical appointments.  A few communities also will drive residents to and from personal errands, such as to the bank or post office.  Few communities will take residents for social outings, such as to visit a friend.  Personal trips often need to be booked a couple days in advance and are subject to vehicle availability.

Keep in mind that you can always supplement the in-house service with outside transportation services for seniors.

Activities 

Communities organize a variety of social, recreational, educational, and fitness activities that are appropriate for their residents and help them stay as engaged and active as possible.  These include movie nights, games, group movement classes, arts and crafts activities, holiday-themed celebrations, and cultural events – all held conveniently onsite.  Many community activity directors welcome suggestions from residents on the types of activities they would enjoy, which can help make the activities even more relevant to you.

Staffing

To help residents with non-medical needs, someone on the staff will be available onsite around the clock.  Some communities also provide a concierge during regular business hours, while others may have live-in managers who get to know each resident personally.  In the event of severe weather or power outages, residents can be assured that there will be staff around the clock to guide them safely.

Home maintenance and repairs

All maintenance and repairs are included – for each resident’s unit, the common areas, and the external spaces.  If you want additional grab bars installed in your own unit, assisted living communities typically will purchase and install those for you for free.  If you enjoy doing some home improvements such as gardening, note that some communities have resident-led gardening clubs that greatly improve the property.

Utilities 

All home utilities are included, so residents don’t need to spend time and effort requesting, managing, and paying for these separate services.  These generally include water, electricity, gas, trash, and sewage.

Cable and internet access may be included for each home, or may be provided in common areas only.  If the community provides each resident with internet access, it could be a dedicated network for each person, or a shared network across multiple residents, in which case you should use a virtual private network (VPN) for security.  Personal phone service is not included.

Personal care services for ADLs

What sets apart assisted living from independent living is the availability of in-house personal care services to help residents around the clock with Activities of Daily Living (ADLs): bathing, dressing, grooming, toileting, incontinence, transfers, walking, feeding, and medication reminders, storage, and management.  This becomes especially helpful for needs that are difficult to schedule, such as toileting, incontinence, and transfers.

Note that only some assisted living communities are able to accept residents who require more intense assistance, such as:

• Bed transfers
• Personal assistance for emergency evacuations
• Two-person transfers
• Transfers without being weight-bearing
• Hoyer lift transfers

Each resident is assessed by a nurse to determine their functional abilities and to prepare a personal care plan that describes what type of help and how much help they need.  This plan is drawn up when they move in, and updated regularly afterwards to accommodate any improvements or declines in their health.

Caregiving is provided around the clock by a staff that works in three shifts, with a staff-to-resident ratio that may be around 1:15 during the day and lower at night.  Typically there will be at least a licensed vocational nurse (LVN) onsite during weekday business hours, and on call during evenings and weekends.  Some communities may choose to increase their support by having nurses onsite during the evening shift as well or by bringing on a registered nurse (RN).  Medical technicians may also be on staff to provide medication management services.

Communities typically provide each resident with a personal pendant that lets them alert the staff if they need help, whether for an emergency or for on-demand help with an ADL.  Response time varies across communities, and may range from a few minutes during the day to over 15 minutes at night.  Some of these call systems have a central dashboard that automatically measures response times, so you could ask the community if they can provide you with this data.

For falls and other potential medical situations, the nurse on staff typically will assess the resident along with the relevant medical history.  Staff will be allowed to lift the resident up off the floor if the nurse deems it fully safe to do so, but if not, they will call emergency medical services (EMS).

For additional safety, some communities also implement daily check-ins, where each resident is expected to press a check-in button inside their unit by a certain time in the morning.  Those who miss the check-in will get a visit from the staff to make sure they are OK.

This article, Assisted Living For Seniors: A Comprehensive Guide, has been written and published by Senior Wing.

Cost

Assisted living communities operate on a rental basis.  Your own cost will depend on a combination of the following factors:

• Community:  Location, amenities, services, overall condition and age, the extent to which it has been enhanced to be more accessible
• Housing unit:
  • Square footage
  • Number of bedrooms and bathrooms
  • Other features (e.g. patio, balcony, washer/dryer, etc.)
  • How recently the unit was remodeled
  • The location within the community (e.g. ground floor, shorter walks to the dining room, and nicer views command higher prices)

Typically, you will pay:

• A base monthly fee that includes home care services
• Plus a monthly fee for personal care services
• Plus a monthly fee if you want certain expanded lifestyle services and amenities
• Plus one-time upfront fees as a new resident

Genworth’s Cost of Care Survey indicates that the median monthly cost of assisted living in the United States was $4,500 in 2021.

Base monthly costs

Costs vary significantly across communities and will be higher than what you see in independent living, even before you add the personal care services.  The reason is that assisted living for seniors requires heavier staffing and supervision around the clock, and provides more extensive housekeeping, laundry, and other home care services as well.

Extra monthly costs

Here are the services that incur extra monthly costs at assisted living for seniors:

• Personal care: The largest additional monthly cost will be for personal care services.
  • Many communities define anywhere from 3 to 6 “levels of care,” each with progressively more intensive care and a higher fee.  Then they assign each resident to a level based on the nurse assessment.  Other communities prepare a personal care plan and then price that out based on estimated hours required. Some charge based on the specific types of services provided.
  • Nearly all communities charge for continence and medication management separately from the other care services.  Diapers may be included, charged separately, or not included (bring-your-own) for those paying for continence assistance.
  • A few communities charge a flat all-inclusive fee for personal care services, regardless of how much help that resident may need.
• Room service:  Most communities charge for room service if the resident is not sick.  Pricing may be a flat fee for the month or based on the number of meals delivered.
• Transportation:  Pretty much all communities place limits on their complimentary transportation services.  Some will drive you beyond their stated radius for a per-mile or flat surcharge for the trip.
• Second person:  If two residents share one unit, the community typically charges a flat monthly second person fee in order to cover utilities and additional services.  Sometimes this second person fee automatically includes meals, but sometimes there may be an additional meal fee on top of that, so be sure to ask.  The second person fee almost always does not include any personal care services, which would be charged separately. 
• Pets:  Communities that allow pets also charge a monthly fee for this.
• Beauty salon:  All services will incur extra charges.
• Special activities and outings:  Select activities will require additional out-of-pocket fees, such as restaurant outings and local attraction admission tickets.
• Guests:  When family and friends visit you, they will incur additional fees for any meals.  Guest meal prices will be either comparable to or slightly higher than resident meal prices.  Of course, these fees will be charged to your guests and not to you.

Any additional costs you incur at the onsite rehab clinic, beauty salon, or convenience store are charged to you directly, and not handled by the assisted living community.  Subscriptions for personal phone service (and Internet access, if applicable) also are your responsibility and not charged to you by the community.

One-time upfront fees

Assisted living communities also may charge the following upfront fees when a resident moves in:

• Community fee:  This is a one-time non-refundable fee charged for each unit (not for each person who lives in the unit).  It may range from a few hundred dollars to the base costs for one month.  The community may use these funds for cleaning and updating the unit before you move in, making general improvements to the community, and for assessing your health condition and needs upon move-in.  
• Background check fee:  You may incur this charge per person once you commit to moving in.
• Transfer fee:  If you move to a different unit within the same community, some places will charge you a transfer fee per unit.

Discounts

Some communities are willing to offer discounts, especially if they have extra vacancies and are trying to meet end-of-month quotas.  They may waive the community fee or provide the first month’s rent fee if you commit by the end of the calendar month.  Also ask if they provide a veteran’s discount or large employer discount (for people who previously worked at certain companies), if relevant for you.

Contract structure

For assisted living rentals, the lease agreement is typically month-to-month from the very start, as residents need flexibility in case their needs change.  At the same time, this means that prices can change unexpectedly. Ask how often and when rent increases typically occur.

If you want to terminate the agreement, communities usually ask you to give them 30 days advance notice.  Many will waive the advance notice requirement entirely if the reason is that the resident wants to get a higher level of care, typically at a skilled nursing facility. Assisted living communities also can ask a resident to leave if they’ve determined that they can no longer provide sufficient care. They will typically give 30 days advance notice here as well.

Paying

Most people pay for senior assisted living from their own savings, investments, home equity, or retirement and home rental income.

Some people pay using the methods below:

• Medicaid:  Medicaid coverage varies from state to state, but some states will cover the cost of assisted living personal care services through Home and Community Based Services (HCBS) Medicaid Waivers.  Check on your state’s specific Medicaid policies.
• Veterans:  Veterans may be able to pay for assisted living costs with the help of these programs:
  • VA Aid and Attendance or Housebound benefits
  • Veteran-Directed Care program, which is comparable to the Home and Community Based Services (HCBS) Medicaid Waivers mentioned further above
• Long-term care insurance:  Individual policies vary, but many will cover assisted living costs as long as you meet their criteria of not being able to perform at least two ADLs based on their own nurse assessment.  Many policies have a waiting period of up to 90 days before benefits kick in, so initiate the approval process as soon as you no longer can perform two ADLs, rather than waiting until after you move into assisted living.
• Life insurance:  Some policies can be used to pay for assisted living.  Check with your insurance provider.

Assisted living costs are not covered by health insurance or Medicare Part A or Part B.

Choosing a community

If you’ve decided that assisted living is right for you, follow these steps to find the specific communities that are best for you.

Start early

If you want to move into assisted living for seniors, start looking at your options well in advance, if possible, for the following reasons: 

• There may be waitlists to get into some communities, or to get into the more in-demand types of units.
• It takes some time for a prospective new resident to obtain a nurse assessment and approval to live there.  A few communities may be able to accelerate the process and take in a new resident the next day in an emergency, while others will ask for a few weeks to complete all their processing.
• If someone is currently in a skilled nursing facility (SNFs) and plans to move into assisted living upon discharge, note that some SNFs may release patients unexpectedly early with no notice.  You don’t want to be scrambling to choose a senior assisted living facility at that point.
• Another reason to look at assisted living well before you need it is that it becomes difficult to conduct in-person tours and to move to a new home when you are having mobility challenges.

If you are just starting your search but need to find a place ASAP, then stay flexible.  Be willing to move into a community or a unit that may not be among your most preferred, and know that you may move again later once other options open up.

Identify your priorities

The most important criteria will be your specific care needs.  While just about all assisted living communities handle basic personal care, some say they do not handle the following:

• Bed transfers
• Personal assistance for emergency evacuations
• Two-person transfers
• Transfers of non-weight bearing residents
• Hoyer lift transfers

If you need any of these, make sure to list them explicitly in your requirements.

Additionally, if you need medical care (e.g. feeding tube, insulin injections, open wound care) and intend to bring in home health care providers to handle those services, make sure the assisted living facility will accept this arrangement.

Of course, also review the different housing features, amenities, and home care services described above in this article, and decide which aspects are most important to you.

Understand state regulations and licensing requirements for your needs

Take some time to review your state’s assisted living regulations. While these may seem dry and boring, understanding them can prevent you from wasting time in looking at assisted living communities that won’t meet your needs.

As a concrete example, the Texas regulations explain that they classify assisted living facilities as Type A or Type B.  People who live in Type A assisted living facilities must be able to self-evacuate in an emergency (within 13 minutes), including if the emergency happens during typical sleeping hours at night.  If someone needs assistance to evacuate from their bed at night and exit the building, then they are limited to Type B assisted living facilities.  Knowing about this regulation can save someone time from assessing Type A facilities needlessly.

Search for communities

Put together a list of communities that are in your target location.  Possible ways to accomplish this:

• Area Agency on Aging:  Find your local agency using the Eldercare Locator.  It will be able to help you get a list of assisted living communities for seniors in the area.  If you plan to use Medicaid, also ask the agency for help in identifying these.
• Google web search:  Doing a regular Google search for “assisted living [city]” will turn up some of the most well-known communities.  
• Google Maps search:  To get a more complete list of communities in a specific area, search on Google Maps.  This can help you find some gems that have more available units because they haven’t put as much effort as other communities into promoting themselves online.  Search for businesses labeled “assisted living” or “retirement community” since Google Maps seems to classify assisted living communities using a mix of those two terms.

Research the communities

For each community on your list, gather the high-level information that is available online so you can quickly rule out those that do not meet your needs:

• Community web site:  From the community’s web site, you can see high-level information such as the types of senior living the community offers, their minimum age limit, and sometimes even floor plans with current pricing.
• Inspection reports:  Assisted living communities are regulated by each state. Some states require the ALFs to undergo inspections on a regular basis and to post the results online.  Look up each facility’s inspections, if available in your state.

Call the communities

Next, call the communities that still remain on your list.  Talking to their agents, you’ll find out answers to most of your questions and get a good idea of whether the community meets your top needs.  Remember to find out the limits of the facility and what would disqualify someone from being able to live there.

Hold off on asking about pricing until the latter part of your call, as asking too early in the call tends to elicit a response of, “Let’s discuss pricing when you come in for a tour.”  That also tends to happen more with expensive communities, which will give you some directional information on pricing.

Plan visits

Based on what you’ve learned from your calls, narrow down your list of communities.  Then call back and set up in-person tours.  For scheduling purposes, estimate that each visit could take anywhere from about 45 to 90 minutes, depending on how interested you are and how many questions you ask.

If you are no longer driving, some communities are willing to come pick you up from home and drop you back off, if you live within a reasonable distance of them.  Otherwise, check out other local transportation options for seniors.

If doing in-person tours is difficult because of mobility challenges, get virtual tours instead.  Connect to the video calls on as large of a screen as possible so you can get a clear view of the property.

If you will be visiting in person, you also can try dropping by each community during their regular business hours, which involves less coordination work and gives you flexibility as you go from community to community.  There are also benefits to doing unscheduled visits, which may provide a more genuine view of the community.  The caveats are that you may be asked to wait a while or even come back later if no one is available to take you around, or if your desired units require advance notice in order to be shown, or if the community is having a COVID outbreak and not allowing visitors.  Speaking from experience!

Initial tours

When you see each community:

• Housing:  Of course, you’ll want to see the type of unit you’re considering to determine how well it meets your top needs.  When you tour the common areas, note if there are residents actually using them, though this varies by time of day. One consideration for the pandemic: Since assisted living communities are regulated by the state, you may be required to wear a mask when touring. If so, then you may not be able to detect smells well through your mask. Make sure to take off your mask briefly at some point to check if the building has any bad odors!
• Photos:  After visiting a lot of communities, memories can become a blur.  Take photos to help you remember what each place looked like, as long as you make sure not to include any residents in the photos for privacy reasons.
• Talk to residents:  …but don’t just look at the facilities.  Make sure you talk to residents and ask open-ended questions, even if you feel shy and introverted.  You can gain a lot of unexpected information this way.  See how they feel about living there.  Reflect on how well you may fit in with them.  Keep in mind that the residents you see may not be representative of everyone in the community, as some people may be out and about, while others may be in their rooms.
• Observe staff:  See how the staff interacts with residents (and observe how the residents respond).  Also pay attention to how the staff seems to feel about doing their jobs.

In-depth visits

After the initial tours, you’ll likely rule out more communities.  For those remaining on your short list, do a deeper dive visit.  Don’t just look – make sure you experience what it would be like to actually live there.

If your tours have been conducted virtually on video calls and you cannot visit, ask a friend to visit on your behalf.  There are some important aspects of a community that aren’t apparent on video, like if it smells like mold!

• Meal:  Time your next visit to overlap with lunch.  Eat a meal there, not just to taste the food, but to experience the dining process from beginning to end.  Talk to more residents.
• Activities:  Review the activity calendar before scheduling the deep dive visit so you can participate in (or at the very least, watch) a group activity of interest to you.  Note how the residents interact with each other, how active they are, and how happy they seem in general.
• Trial stay:  Some assisted living communities offer short-term respite stays.  For communities on your short list, consider doing a respite stay.  Once you see what the community experience is like at each meal, in between meals, and in the evening, and at a wide range of activities, and after you interact with more residents, you will understand far better what it’s like to live there.  You may be surprised at what you learn!

Join waitlists

Once you’ve decided on your preferred assisted living community and type of unit, the question will be whether any such units are available.  If not, ask the community if they manage waitlists.  Many do, and will call you when an appropriate unit opens up.  These waitlists often require that you provide a check as a deposit, but it will not be cashed until you agree to take a specific unit.  The check also can be returned to you if you decide you no longer want to be on the waitlist.  Some communities do not manage waitlists, and ask that you call them each month to find out the latest availability.

Also find out how long you may remain on the waitlist, as a reality check.  Some communities have at least a year-long waitlist, while others may be able to reach out to you with good news within a month.  For communities that are unsure when you will get off the waitlist because their availability changes unpredictably, you can ballpark the wait time by asking:

For the type of unit you’re interested in:

• How many of these units exist in their community?
• How many people are on the waitlist now?  (Keep in mind that current internal residents typically get priority over new residents for any units that open up, so more internal residents could potentially jump ahead of you in line while you are waiting.)
• How many times has this type of unit become available over the past 12 months?

They may not know the answer to the last question, but at least now you’ll know if you’re number 42 in line for one of two such units that exist on their property (don’t hold your breath) – or if you’re at the top of the waitlist for one of thirty such units that exist on their property (sounds promising).

Another strategy to get your desired unit in a community is to take any available unit, while getting on the waitlist for your desired unit.  As an existing resident, you will have higher priority once your desired unit opens up.  Keep in mind that you may incur a transfer fee when you move units.

Application process

Applying to an assisted living community is more involved than applying to senior living communities that don’t provide personal care.  You typically will need to provide medical history and undergo a physical and cognitive assessment by their nurse.  This enables the community to:

• Determine if you qualify to live there or if your needs exceed their capabilities
• Prepare a personal care plan that will indicate how much assistance you need with ADLs, any doctor-prescribed diets you may require, and how much this will cost
• Decide how often they will reassess you and update your personal care plan

Alternatives

If you’ve concluded that assisted living for seniors does not quite meet your needs, then consider the following adjacent senior living options:

• Independent living plus home care:  If you value the services in assisted living, yet want the more expansive lifestyle amenities found in independent living or want to keep costs down, then you may be able to reside in independent living and bring in home care providers.  This solution could be appropriate if you only need limited personal care services and they can be managed on a scheduled basis, which tends to exclude those who want assistance with toileting or transfers.
• Residential care homes:  If you want senior assisted living, but don’t like large community or institutional settings, then consider residential care homes.  These are converted private homes where residents can get individualized care and attention in an intimate setting.  Note that private homes will not be set up to provide the scale of lifestyle amenities found in a larger community.
• Respite care:  If the offerings in assisted living seem like a great fit, but you feel you only need it on a short-term basis because you are recovering from surgery or an illness, then consider respite care for a few weeks.  Some assisted living communities make some of their rooms available for this purpose.
• Memory care (MC):  If you need a place that can manage advanced dementia or Alzheimer’s, then a senior assisted living facility will not be safe enough.  A memory care facility will have secured facilities, higher staffing levels, and activities that are specially designed to help these residents.  Accordingly, they also offer fewer lifestyle amenities and services, since they would not be utilized as much.
• Assisted living plus home health care:  If you want to be in assisted living, yet need medical care or rehab therapy services, then a solution may be to bring in home health care on a scheduled basis.  Confirm that your desired assisted living facility will accept this arrangement for residents with your specific medical needs.
• Skilled nursing facilities (SNFs):  If you need round-the-clock or on-demand medical care to help with things like feeding tubes, medication injections, or open wounds, then skilled nursing will be a better fit.  Assisted living for seniors supplemented with third-party home health care services will be more suitable for limited, scheduled medical care.  Keep in mind that skilled nursing facilities focus heavily on medical care, and scale back significantly on the residential amenities and services found in assisted living.
• Continuing care retirement communities (CCRCs):  If you value senior assisted living, but are concerned about possible future health declines, then a CCRC may be the solution.  You can move into the assisted living section, but know that skilled nursing is easily accessible if ever needed.  You will have transfer priority over external residents.  There also are a few communities that are not full CCRCs but combine assisted living and skilled nursing in a single place.