Pitfalls to Avoid When Choosing an Assisted Living Facility

Copyright © 2014 AARP. All rights reserved.

When deciding whether assisted living is the right care place for you or your loved one, there are some common problems to watch out for. After you make the commitment to locate to an assisted-living facility, make note of the pitfalls in the following sections and have a plan ready.

Unnecessary trips to the ER

Assisted-living facilities are understandably concerned about responding appropriately to medical emergencies. But that doesn't mean that every fall or fever requires an ambulance trip to the emergency room, with a long wait and then a likely ambulance ride back to the facility. These episodes are stressful and frustrating. Often the problem could be monitored or treated in the facility with a doctor visit the next day.

Everyone at the facility should have a clear understanding of your preferences about going to the ER, whom to contact should you be unable to communicate, and under what circumstances you would want cardiopulmonary resuscitation (CPR) to be administered if your heart stops.

You should ask your doctor about the risks and benefits of CPR for someone with your or your parent's health conditions. Your wishes should be documented. All staff should be aware of your preferences. Most states allow an out-of-hospital do not resuscitate (DNR) order, if that's what you want. Without this document in place, an ambulance attendant is required to perform CPR.

Additional costs or discharge from the facility

Sometimes a hospital stay is necessary, and sometimes a resident's condition changes. Often when older people are discharged from a hospital, they need additional time and help to recover. The hospital stay itself can lead to a temporary loss of function and cognitive problems, especially if you have been on pain medication or had anesthesia.

Some assisted-living facilities insist that the resident hire a private aide to help, or even suggest that the resident can no longer stay in the apartment and must move to a nursing home. The circumstances under which this can take place should be spelled out in the contract and should allow for an independent medical assessment. This process may also be part of the state's bill of rights for residents.

According to the federal Fair Housing Act Amendments Act of 1988, which prohibits discrimination against people with disabilities, facilities should make a “reasonable accommodation” to the new needs. However, some may refuse, citing state regulatory requirements, and courts may agree.

You can seek legal help from a consumer advocacy group or a private attorney. A court may require the facility to continue to provide services while the case is being decided.

Exclusion from social activities by other residents

One of the most difficult situations in any group-living arrangement occurs when one group of residents bands together to exclude another, perhaps because he or she is showing signs of dementia, has poor table manners because of a neurological disorder, is unable to participate fully in some activity, or for no clear reason at all.

Staff have to be sensitive to these situations and try to negotiate an acceptable balance. This might never happen to you or your parent, but it would be helpful to know how staff handle these situations.

Failing to read the contract

Read the contract. Really read it, fine print and all. Ask your attorney, financial advisor, or a trusted friend or family member — or all three — to read it. This is your chance to ask any final questions and to make any final changes. Probably the most common mistake people make when signing up for assisted living is to fail to read the contract very carefully. Don't be one of them.

Consider adding your state's bill of rights for assisted-living residents to the contract. And certainly read both to make sure that nothing in the contract contradicts what is in the bill of rights.

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