Be A “Noticer”: Questions to Ask Assisted Living Providers & Notes to Take Part 1 of 5
By David Hahklotubbe, gerontologist
Congratulations and welcome to taking your first steps along the path of navigating senior care. You will find that your efforts to perform due diligence will result in a universally higher quality of life for everyone involved in this process. As your guide, I am committed to delivering knowledge that only a Gerontologist working in the field for 20+ years can obtain. In exchange, all I ask is that you follow through, and, on occasion, let me know that our collective efforts paid off. Now, let’s dig in….
There are a number of resources floating around giving advice on what questions to ask assisted living providers before making a decision. However, many fall short by not offering the WHY behind the WHAT and don’t drill down on what your take away should be. It’s great to know the questions to ask, but fruitless if you don’t know why you are asking them or what the ideal answer is. That is the heartbeat of this series.
One more solid bit of advice… Money is replenishable, time is not. Do not waste your most precious commodity by visiting Assisted Livings before you call them. Take a cleansing breath and relax. It’s not a question of if, but rather how much time you will save by getting your ducks in a row before hitting the road. I know it’s tempting, and your anxiety is likely propelling you to just go out and take care of this, but paradoxically, relaxing and being smart, will reduce the anxiety by way of being effective rather than scattered. So, let’s being there
Questions to ask and things to note when on the phone….A lot can be gleaned from a few seconds on the phone… tips on how to be a “Noticer”.
1. When calling to speak to the community relations director (sales or marketing), how long did it take the front desk to answer the phone?
WHY: Keep in mind that you will be calling this provider on a routine basis. If they are poor at answering the phone, that is a red flag and puts into question, if you were needing to reach someone in urgency, will they be there when you need them?
2. Did it go to voicemail?
WHY: If your calls go to voicemail, when will someone be listening and returning your call? This is often a reveal that they are short-staffed. Why would they be short-staffed? Perhaps they don’t pay well, perhaps they aren’t well-managed.
3. Was it answered by someone competent?
WHY: All providers are aware of what answering the phone translates to in terms of revenue, so if they can’t get that done effectively, what are the chances that the care is top-notch, food done well, and activities performed? First impressions are key. I have a ritual of using the bathroom in restaurants before I even consider ordering, if the bathroom is a mess, covered in graffiti, fixtures broken, out of soap or just poorly maintained, I leave. If the establishment can’t maintain the areas the public are exposed to, imagine what the kitchen looks like. This is very similar to your first inquiry call. If the person answering the phone seemed unpleasant or overwhelmed or disengaged, what is the likelihood that it’s isolated to that department? Are the caregivers also disengaged?
4. Were you able to communicate with them or was language a barrier?
WHY: If you found it difficult to converse in plain English, imagine being an elder, hearing impaired and urgently seeking to have your needs met. Would you feel confident that your wishes would be fulfilled accurately or that things would get lost in translation? If the front desk person is struggling, imagine that the care staff, wait staff, housekeepers, or worse, medications technicians, may also have this barrier. What if that person is responsible for communicating with 911 in the event of an emergency?
If you see red flags, you may not even bother speaking with the sales person. In most markets, there are enough options that you don’t want to “let it slide”. Keep in mind the gravity of this decision and what is at stake, there is no sense in settling. Move on and don’t look back.
Once you get a sales person on the phone, don’t allow them to control the conversation. Tell them that you have some specific questions. Politely decline giving them your contact information until you sense that there is a fit. These first questions will sculpt the remainder of the conversation, and determine whether these even is a conversation to be had.
1. Do you have current openings?
WHY: This is often overlooked and assumed. In certain markets, like San Jose, there are many providers that are at capacity and if you are urgent, it’s pointless to be placed on a waitlist. If there is no room at the inn, move on. (Yes, that was a biblical reference, couldn’t help myself as a eucharistic minister)
2. Do you offer a full continuum of care or will my loved one reach a point where they will need to move at their most vulnerable stage?
WHY: This is another assumption made by most consumers and not voluntarily revealed by most providers, but absolutely essential to know. Your aim should be to move your loved one but once. The trauma associated with each move can be tremendous, it’s actually got a name, “Transition Trauma” and it’s a real thing. Recall our collective goal is to increase the quality and quantity of life of your elder. If you are required to find a new provider whilst your loved one is in active decline, there is no question that this will threaten everyone’s quality of life who is involved. There is a growing trend for providers to deliver “abbreviated” care. With labor being the largest operating expense and liability increasing at the end stages of life, many providers have decided to reduce the level of “acuity” care they provide to cut back on expenses and exposure. Simply put, to save a few bucks, they leverage the quality of life of vulnerable and frail elders and choose to discharge them at their most critical time of need. So, it is absolutely crucial to find out before you move your loved one if the provider is willing to go the distance with you. If not, that conversation is over.
3. Do you offer memory care?
WHY: Similar to the discussion above, while your loved one may not have any signs of cognitive disruption, it should be assumed that they might. Statistically, there is a 1 in 6 chance at the age of 65 and at the age of 80 it increases to 50% that they will become afflicted with dementia. Better to be safe than having to go through the moving process while in crisis and your loved one not being able to comprehend what is going on, making their transition unnecessarily complicated. Important caveat – it’s critical that you ask the question properly. Many providers will claim they take care of those with memory impairment. The continuum of memory impairment is vast and spans from “Mild Cognitive Impairment” all the way through “End-Stage Dementia”. A provider can accurately claim that they care for those will cognitive decline because it does not require a special license to care for those with Mild Cognitive Impairment (MCI). You should be asking specifically if they have a dedicated area for those with dementia. It is illegal in California, for instance, to advertise that you care for those with dementia without having a dedicated program for it. If you are not seeing that on the website or in their collateral, or if the sales person confirms that they do not provide it, move on.
4. Do you offer hospice care?
WHY: Again, like the other questions, it’s assumed that the provider will facilitate end of life care. But shockingly, not everyone does. It’s still a head-scratcher for me, but it happens. Obviously, this is the worst-case scenario – to be actively dying and being evicted. If the provider doesn’t facilitate hospice, I’d hang up without even saying goodbye – it’s just thoughtless and cruel to not allow an elder to die in their home.
5. How much are all of these services?
WHY: This may seem obvious, but if the services exceed your budget, there is no point in touring the community – it’s a massive waste of your time. It’s unlikely that the provider will be able to bend their costs to accommodate you, especially long term. Many sales people are trained to get the elder to move in and worry about the future later. While this strategy is often effective, the elder is put in a position of creating a home, fostering friendships, getting familiar with the staff and a general routine, only to be met with eviction once they run out of money. Don’t roll the dice, assume your loved one will outlive their budget and be fiscally responsible. One note, many sales people are trained to not give out cost over the phone, but rather, like a used car dealer, set a tour for your to come discuss the rates face to face so they can close the sale. Very simply put, if they refuse to give rates over the phone or dodge the question, MOVE ON.
I love feedback and one of the bits of feedback I routinely get is that I can be long-winded or verbose, so in accordance with my adoring fans and critics, I am compartmentalizing my BLOGS. Be sure to return to read the remainder of this series. And, as always, on behalf of the elders I proudly serve as my calling, thank you for performing due diligence.