This checklist provides a useful tool when investigating and evaluating Residential Care for the Elderly or Assisted Living Facilities. The checklist is divided into two sections: Quality Dimensions and Practical Dimensions.
Although the quality dimensions are crucial, they need to be balanced by practical considerations. If the “best” home in an objective analysis is not affordable or is too far away to visit frequently, it will probably not work for the resident or the family members. Depending on the person’s needs and preferences, some questions will be more important than others. Also refer to the Dementia Care Checklist.
In using the checklist, keep in mind the following general tips:
- Start the process early before there is a crisis.
- Involve the prospective resident as much as possible in the process.
- Use the checklist to get an overall feel for the facility and its practices.
- Pay special attention to how residents are being treated by staff and the quality and responsiveness of the services. Don’t be sold only on the attractiveness of the facility.
- Narrow the options down to two or three facilities.
- Visit each facility several times.
- In making visits, walk through the whole facility and visit at different times of the day.
- Drop by unannounced and visit at night and/or on the weekend.
- Make sure that you visit during a mealtime.
- Obtain a copy of the admission agreement. Read it carefully. Understand the services, costs and conditions for transfer.
Before you make a final decision, check the latest survey report and any other citations issued by the state licensing agency. Facilities should make these reports available to you upon request. Or you can view the reports at the Community Care Licensing Office, California Department of Social Services, or at some Ombudsman Offices.
Quality of Care and Service
- Do residents appear well cared for?
- Are residents up, clean, and dressed by 10 AM?
- Are the residents well groomed, e.g., (shaved, clean clothes, nails trimmed and hair done)?
- Is there a written plan of care for each resident? How often is the care plan reviewed and changed? By whom?
- Does the facility offer programs and/or services which meet your particular care needs, e.g., dementia unit, etc.?
- What is the system for distributionof medicaton? Who does it? What is their level of training?
- Does the facility have access to doctors, hospitals, home health agencies and adult day health care services?
- Does facility provide transportation to medical services? Charges?
- Are there clear procedures for responding to medical emergencies?
Quality of Food
- Does the food appear and smell appealing? Are fresh ingredients used?
- Do residents seem to be enjoying the food?
- Are residents receiving the assistance needed in eating?
- Are meals served at appropriate temperatures?
- Do menus offer choice? How often are menus changed? (Ask to see a copy of the week’s menu.)
- Can the facility meet special dietary needs? Ethnic preferences?
- Are nutritious snacks available?
- Is fresh drinking water available?
- Can residents prepare meals in apartments?
- Does the facility make provisions to serve residents in rooms? Costs?
Quality of Social Interaction
- Are residents interacting with staff and/or each other?
- Are residents occupied in meaningful activities?
- Does the facility have a planned activities program? Are activity calendars posted? On weekends?
- Is there a designated staff who coordinates activities? Are activities individualized or only done in large groups?
- Do volunteers and outside groups regularly visit the facility?
- Are there planned trips outside the facility?
- Is transportation provided for shopping and personal errands? Charges?
- Are pets allowed? Does the facility have pets?
- Are religious services offered at the facility?
Quality of Participation
- Are residents and family members involved in assessment and care planning?
- Are residents and family members involved in roommate selection?
- Do residents have an opportunity to provide input into menu and activity planning?
- Are there procedures for responding to requests for information and complaints?
- Is the Ombudsman Program’s poster and telephone number posted?
- Does the facility have a residents’ council? Does the facility have a family council or support group?
Quality of Staff
- How long have the current owner/s been operating the facility?
- How long has the key staff been working at the facility, i.e., administrator and assistant administrator, activities coordinator, cook, and nurse consultant?
- Has there been a recent turnover in key staff?
- How many direct care staff are there for each shift?
- What is the staff to resident ratio? What is the ratio on the night shift? Weekends?
- What is the turnover rate among direct care staff?
- Does direct care staff understand and speak English?
- What special training do staff receive in working with persons with dementia?
- Do the administration and staff know the residents by name?
- Does staff take time to talk with residents?
- Do administration and staff interact with residents in a respectful way?
- How long does it take for staff to respond to a resident’s request for help or to a call bell?
- Does staff respect residents’ privacy by knocking on doors or announcing themselves before entering rooms?
- Does the staff wear name badges?
Quality of Environment
- Is the overall décor pleasant and homelike?
- Is the environment clean and odor free?
- Is the facility quiet or noisy?
- Is the temperature comfortable?
- Does the building seem safe and free from dangerous hazards? Cluttered?
- Are the residents’ rooms, hallways, and common areas well lighted?
- Are floors of non-skid material and are carpets firm to ease walking and to prevent falls?
- Is the dining room pleasant and inviting?
- Are common areas, bedrooms and bathrooms accessible to wheelchairs and walkers?
- Are bathrooms conveniently located?
- How many residents share a bathroom?
- Do all bathrooms, showers and bathtubs have handgrips or rails?
- Are call bells accessible to residents? By bed? In bathrooms?
- Is there privacy in residents’ rooms, especially in shared rooms?
- Is there any place to have a private conversation?
- Are residents encouraged to bring in some of their own furnishings?
- Is there a bedside table, reading light, chest of drawers and at least one comfortable chair for each resident?
- Is there a locked drawer to store valuables? If not, does facility make provisions to store valuables?
- Is there adequate space for clothing and personal belongings in each room?
- Does the facility have extra storage space for residents’ belongings?
- Are there outside sitting and walking areas for residents? Are any covered to protect from sun or rain?
- Is there a fenced yard? Locked?
- Are there enough fire and carbon monoxide detectors?
- Is there a designated smoking area? Inside? Outside?
- Is there a disaster plan posted? How often does the facility hold drills?
- Is the facility close to family and friends who will be visiting most frequently?
- Is the facility near public transportation?
- Is there adequate parking for residents that drive, and residents’ family and friends?
- Is the facility in an area where it would be safe to visit at night?
- Is the facility convenient to the resident’s doctor? Home health agency?
- Is the facility close to a hospital?
- Are family and friends welcome at any time or are there strict visiting hours?
- Does the facility have a good reputation in the community?
- Will they give you a list of references?
- Are residents and/or family members willing to talk with you about the facility?
- How did the administrator and staff treat you when showing you around?
- Did they answer all your questions to your satisfaction?
- Did they show you around the entire facility? Were any areas or sections not shown to you? Why?
- Do you feel that the administrator and staff are people you can work with and communicate with honestly?
- How would you or your loved one fit in? Is this facility compatible with your lifestyle?
- Can you imagine yourself or your loved one living here?
- How did you feel when visiting the facility?
- Are Supplemental Security Income (SSI) residents accepted?
- Do the estimated monthly costs (including extra charges) compare favorably with other facilities?
- Are there any upfront fees, e.g., assessment, community fees?
- What services are included in the basic rate?
- What is the cost for extra services? Levels of care? How is the need for extra services or higher levels of care determined?
- What are the costs for specialized services, e.g., dementia unit?
- Will the facility continue to charge a resident who is transferred to a nursing home or hospital and does not return to the facility?
- Are the costs and payment schedule clearly described in the admission agreement?
- Ask the facility for a copy of the most recent rate increase disclosure statement to find out the average monthly rate increases (actual amount and percentage) for each of the previous three years.
- Are the total monthly charges affordable over time?
- Will the facility give you a copy of the admission agreement to take home and study before making a final decision?