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Questions to ask before choosing assisted living

When an older family member needs supportive housing, there's often a rush to find a place with the "best quality." But what is quality? Do family or friends value the same things as the future assisted-living resident?

Assisted-living settings are extremely diverse. To find a good fit, it is essential to look beyond the factors highlighted in marketing tours: cost, room size, staff ratio and appearance. Opinions on which factors are truly essential to quality vary, but one voice should receive the most attention as you decide on housing: the voice of the person who is to live there. Ask yourselves these questions before visiting facilities:

•What are this person's priorities? While there is usually a focus on health care needs, many other elements may matter more once the person is settled. A socially active person might prefer a place with more people and outings; a very private person might be more comfortable staying in his or her room, pursuing hobbies or phoning friends. Does decor or room size matter? Is it important to be near their old neighborhood, where friends can visit, or to move near family members? What about continuing lifelong behaviors, like having a drink before dinner, attending religious services or spending time outdoors?

•What types and amount of care does this person need? One of the most important and difficult discussions to have involves the person's preferences in light of what health and safety issues require: intense medical attention, oversight of multiple medications or for cognitive challenges, or simply help with dressing and mobility. Some assisted living settings specialize in medical or dementia-related care, while others offer more limited health services.

•How important is flexibility in the person's daily routine? Should a setting with a highly structured routine of breakfast by 8 a.m. be immediately ruled out for a person who has always slept late and skipped breakfast? Choosing when to wake, eat, bathe, dress and sleep are extremely important to many individuals. Constraints in daily routines, including drinking alcohol, smoking or ordering pizza for delivery, are essentials not usually covered in a marketing tour. Attending to important routines of daily life can help to reduce the difficulty of adjusting.

•Who would your family member feel comfortable with in a shared living environment? Collective settings means sharing tables at meals and socializing at events featuring regular interaction with residents and staff. For some, finding others who share their interests (like playing bridge, music or knitting) is essential to an enjoyable social life. Others might desire a community with a shared religious faith or a group rich in diversity. Being surrounded by individuals with dementia may feel isolating to someone whose health problems are physical.

•Whose priorities matter most? Assisted living is a consumer-driven sector with two kinds of consumers: residents and their family members. While families often support their relative's choices, in some cases kin use this move to achieve their own goals. Examples would be children who insist on nightly room checks or seek to control smoking or eating habits, despite their parent's opposition. When assisted-living staff receive conflicting messages, quality of life for the assisted-living resident may be compromised.

•What happens if the money runs out? Assisted living is primarily paid for by individuals through savings, pensions or proceeds from a home sale. Occasionally, long-term care insurance or state-based programs provide support. All family members should frankly discuss the cost of care to evaluate how long known resources will last. Paying more does not guarantee the best quality. Considering finances at the start may prompt selection of a less costly care setting to stretch resources, but one that meets other, important needs to ensure quality.

Leslie Morgan is a professor of sociology at the University of Maryland, Baltimore County and co-director of the UMB/UMBC gerontology PhD program. Her most recent book, coauthored with colleagues from UMBC's Center for Aging Studies, is "Quality Assisted Living: Informing Practice through Research." Her email is

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