You are probably reading this late at night, after everyone else has gone to bed. You have four or five tabs open and every one of them says the same things. Compassionate. Person centered. Like family.
None of it tells you anything.
The difficulty is that a tour is designed to impress you. The house will be tidy, someone will be friendly, and you will leave with a folder. What you actually need is a way to get underneath that in the hour you are given.
Here are five questions that do it. Ask them everywhere you visit, including here. A home that answers them easily is a home worth thinking about. A home that gets vague is telling you something.
1. What level are you licensed for, and what happens if we need more care than that?
Maryland licenses assisted living homes at three levels. Level 1 is for residents who need a little help. Level 3 is for residents who need a great deal.
This matters more than almost anything else you will be told on the day, because it decides whether your loved one can stay.
A home licensed at Level 1 or Level 2 has a ceiling. When your father needs more help than that license allows, the home has to ask you to move him. That conversation usually arrives with very little warning, and by then he is frailer, more confused by change, and you are making the decision under pressure with a hospital or a doctor waiting on an answer.
Ask for the license number and the level. It is a matter of public record and any home should give it to you without hesitating.
2. Can you keep a resident who goes onto hospice, or would we have to move?
Families rarely think to ask this at the beginning, because at the beginning it feels a long way off.
It is the question that saves the most pain later. Not every home is able to keep a resident once hospice care begins, and the ones that cannot will not always volunteer it while you are standing in their living room in month one.
If the answer is anything other than a clear yes, ask what happens instead, and ask who decides.
3. Is someone awake in the house overnight, or asleep on call?
This one surprises people, because most families assume the answer is obvious. It is not.
In many small homes the overnight staff member sleeps on the premises and is woken if something happens. In others, someone is awake through the night.
The difference shows up at three in the morning. Falls, confusion, breathing trouble and wandering do not keep office hours. Someone already awake responds in seconds. Someone asleep responds in minutes, and only if they hear it.
Ask it plainly. Awake, or on call.
4. How many residents live here, and how many staff are on at one time?
You are not looking for a particular number. You are looking for whether the answer is given comfortably.
A larger community can be excellent and a small home can be poor. What you want to understand is the ratio, and what happens during the difficult parts of the day. Mornings, when everyone needs help washing and dressing at once. Evenings, when confusion tends to rise. Shift changes, when information gets dropped.
A good follow up question is simply this. Who is here right now, and what are they responsible for?
5. Who holds the license, and are they here day to day?
In Maryland every assisted living home has a named Assisted Living Manager who is accountable for it.
Sometimes that person is in the building every day. Sometimes they are an owner who visits, or a company in another state. Neither is automatically wrong, but you should know which one you are dealing with, because it tells you who you will actually reach when something goes wrong on a Sunday.
Ask who answers the phone at seven in the evening, and whether that is the same person who will be responsible if you have a complaint.
What to look at while nobody is talking
The answers matter. So does the hour you spend in the building.
Notice the smell. A home that smells of cleaning products at eleven in the morning is a home that cleaned for you. A home that smells of nothing much, or of lunch, is a home that lives like that.
Notice whether residents are dressed. At two in the afternoon, people should be up, dressed and out of their rooms unless they are unwell. A living room full of residents in nightclothes in the middle of the day tells you about staffing.
Notice how staff speak to residents. Are they using names, or terms like sweetie and darling for everyone? Do they crouch down to talk to someone seated, or speak over their head to you?
Notice the bathrooms. Grab bars, walk in access, and whether they have been thought about or just installed.
Notice whether anyone interrupts the tour. In a real home, someone usually needs something. If an hour passes with no interruption at all, ask yourself where everybody is.
The money questions worth asking
Rates vary widely and most homes will discuss them with you directly rather than publish them, which is normal in this industry.
The question that matters more than the figure is this one. Does the monthly rate change as care needs increase?
Some homes charge a base rent and then add a fee for each level of care on top, so the amount you agreed at move in is not the amount you will be paying in two years. Others hold the rate steady. Both are legitimate, but you want to know which you are signing up for.
Then ask what is not included. Incontinence supplies and transportation to medical appointments are the two that most often sit outside the monthly rate.
One last thing
Visit more than once, and try to visit at a time nobody suggested to you. A weekday evening tells you more than a Tuesday morning that was arranged three days in advance.
And trust the feeling you get in the first five minutes. You have known your loved one their whole life. You will recognize a place where they would be comfortable faster than any checklist can tell you.
Visiting Dominion
Dominion Homecare Assisted Living is a licensed assisted living home in North Laurel, Maryland, in an intimate setting on a residential street. We hold Maryland license AL-00038 at Level 3, and we are approved to care for residents receiving hospice.
Our answers to the five questions above are Level 3, yes we can keep them, awake every night, a staff member on duty on every shift, and the licensed manager is here day to day.
Tours are arranged with two days notice so you get unhurried time. Call 240-360-5755 or send us a message and we will call you back within one business day.