Once you have narrowed your decision down to a few facilities that are willing and able to care for your family member, you will want to visit them. As you tour the facilities, use this checklist to keep track of what you've seen and to remind you of important questions to ask. Put a checkmark next to each item if the facility seems to positively address that criteria or concern in your situation. (For instance, if your family member is a smoker, the question about whether the facility allows residents to smoke in their rooms may generate a positive response if the facility allows that activity, but if your family member dislikes or is allergic to cigarette smoke, a facility that allows smoking in public areas of the residence might trigger a negative response to that item.) Cross out items that seem less important in your situation and circle or highlight those which are highly important to you. When you are finished, you can scan the form our count the responses to see which facility seems to be the best fit overall.
| FIRST IMPRESSIONS |
| #1 | #2 | #3 | Item |
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| | | | Do you like the location and outward appearance of the residence? As you enter the lobby and tour the residence, is the decor attractive, comfortable, and homelike? Does the facility have good natural and artificial lighting? |
| | | | Are the living spaces and common areas clean and free of odors? Are kitchen and other utility areas clean and of adequate size? Are spills cleaned up quickly? Are the grounds and building well-maintained? |
| | | | Is facility located where family and friends can easily visit? |
| | | | Is facility located near physician and healthcare services, and shopping and entertainment? |
| | | | Do residents appear to be clean, groomed and odor-free? Do residents seem happy and engaged? Do residents socialize with each other and appear happy and comfortable? Does the atmosphere seem pleasant? |
| | | | How well will the potential resident fit in here? Do the other residents seem to be about as independent or disabled as your family member is? Do other residents have similar interests and backgrounds as the potential resident? |
| | | | How do other residents feel about this place? Were you able to talk with residents about how they like the residence and staff? Did you have lunch with residents? Did a resident guide your tour? |
| | | | Does this facility help residents feel that they are still a part of the community? Do you see lots of plants and pets? Are children and young adults actively involved in programs and activities? Are family members and people from the community actively involved in programs and activities? |
| | | | Will this facility will continue to be appropriate in the future as the resident's health declines and care needs increase? Have you asked enough questions to be able to understand how long this facility is likely to be suitable and what events might trigger a need for another change in residence? |
| AUTONOMY |
| #1 | #2 | #3 | Item |
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| | | | Does the facility allow residents to use their own furniture? Is there adequate space for personal belongings for each resident? Is extra bulk storage space available? |
| | | | Do units have telephone and TV hookups? Is there an extra charge for these? Is telephone use accessible and conducive to privacy? Do telephones, and televisions work? |
| | | | Is each unit provided with a refrigerator, sink and cooking equipment? Do units have individually-controlled heating/cooling? Do faucets and other equipment work? |
| | | | Are pets allowed? What types of pets are allowed? Who is responsible for their care? |
| | | | May residents smoke in their units? In public spaces? |
| | | | Is the facility designed so spouses with different care needs can be accommodated? Will they be in the same room, or in different parts of the facility? |
| | | | Must the resident share his/her room with another person? Does the resident have the right to refuse a specific roommate or ask for them to be moved? |
| | | | Can a family member or guest spend the night in the resident's room or elsewhere in the facility? |
| | | | Does the resident have a choice in the selection of medical/health care providers if additional services are needed? |
| | | | Does the resident have a choice about when to rise and go to bed? About when to get dressed? About what to wear? About where, when and what to eat? About what activity programs to participate in? |
| | | | May a resident handle their own finances? Is the facility able to manage resident financial affairs, if the resident prefers? |
| | | | For what reasons may a resident be involuntarily discharged? If they are temporarily discharged to a hospital or another facility to receive more care, will their room be held? Will there be a fee to hold the room? Can a resident be discharged for refusing to comply with a care plan? Can a resident be discharged because they need additional care? Can a resident be discharged because they have run out of personal funds? What kinds of help will the facility provide in finding another facility if a transfer is requested or required? What notice is given for involuntary discharges? Are discharge policies available in writing? |
| | | | For what reasons may a resident be involuntarily transferred from one room or section of the facility to another? Can the resident be transferred because of a change in the type of care they require? Can they be transferred because of a change in who is paying for their care (i.e. from Medicare to Medicaid?) Who makes transfer decisions? What notice will be given for involuntary transfers? Are transfer policies available in writing? |
| | | | Is there a resident council? A family council? Do they have a voice in setting facility policies, procedures, programs, activities and charges? Is there a reasonable grievance procedure? |
| | | | Is a written statement of resident rights and responsibilities available? Are there house rules? Do they seem reasonable? |
| PRIVACY |
| #1 | #2 | #3 | Item |
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| | | | Are private units available? Are different sizes and types of units available? Are room/unit sizes adequate for the needs of the resident? |
| | | | Do all units have windows to the outside? Do shared rooms have curtains or dividers to provide privacy to each resident? Do residents have their own lockable doors? |
| | | | Are private bathrooms included in each unit? Do unit bathrooms have showers or tubs? How many residents share community showers and tubs? |
| SAFETY & SECURITY |
| #1 | #2 | #3 | Item |
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| | | | Are the entry and parking area well-lit? Does the residence provide ample security? Is building staffed 24 hours a day? Are staff on duty and awake at night? |
| | | | Is a 24-hour emergency response or nurse call system accessible from each unit? How many are there and where are they located? Do the call buttons work, and how fast is the response? |
| | | | Does the facility have smoke detectors and alarms? Does the facility have a sprinkler system? Does the facility have portable fire extinguishers? Does the facility have emergency generators and emergency lighting? |
| | | | Is the facility in compliance with all state and local fire safety and building codes? |
| | | | Are regular fire drills held? Does the residence have a written emergency evacuation plan? Is is posted? Are exits clearly marked, unobstructed, and unlocked from within? |
| | | | Is a safe available for resident property? Does the facility provide a resident "bank" or ATM so residents can have access to cash for personal expenditures without keeping money in their rooms? Does the facility have procedures to protect personal property of the resident? Does the facility have a process to inventory the resident's property, equipment, and furniture and ensure it is returned to them at discharge? Is it clear who is responsible for property damage or losses? |
| ACCESSIBILITY |
| #1 | #2 | #3 | Item |
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| | | | Are walkers, wheelchairs, and scooters permitted? |
| | | | Does the floor plan allow for easy mobility? Are all areas of the facility accessible to wheelchairs, including entry and parking areas? Are hand rails available? Are elevators available? Are hard-surface floors made of non-skid material? |
| | | | Are bathrooms accessible to residents using wheelchairs and walkers? Is bathroom safety equipment installed? (grab bars, raised toilet seat) |
| | | | Are cupboards and shelves easy to reach? Are all appliances, equipment, and controls in easy reach of residents in wheelchairs? |
| HOUSEKEEPING & LAUNDRY |
| #1 | #2 | #3 | Item |
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| | | | Are housekeeping or maid services provided? Is there an additional expense? How often are living areas cleaned? How often are bathrooms cleaned? How often are beds changed? |
| | | | Are laundry services available? Are there additional charges for bed linens and towels, if provided by the residence? Is personal laundry provided? Is it an additional expense? Are washers and dryers available for the use of the resident? |
| FOOD & MEAL SERVICES |
| #1 | #2 | #3 | Item |
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| | | | Is the food tasty and appealing? Do menus vary from day to day and meal to meal? Are cultural or ethnic preferences considered? Are extra helpings and substitutions available? Are specialized diets available? May a resident request special foods? Does a dietitian plan or approve menus? |
| | | | Are residents involved in menu planning? Can residents help with meal preparation and have access to the kitchen? |
| | | | How many meals a day are provided, and at what times of the day? Are meal costs included or is there an extra charge? Are there set times for meals or can a resident eat at any time they like? |
| | | | Are common dining areas available? Is seating assigned, or may a resident sit anywhere and with anyone they like? |
| | | | May residents keep food in their units? May residents eat meals in their rooms/units? |
| | | | Are snacks/beverages readily available between meals? Is there a charge for this? |
| | | | Is there a private dining room for special events and occasions, if desired? May residents have guests for meals in the dining room? |
| | | | Does the facility provide assistance with eating for residents unable to feed themselves? |
| TRANSPORTATION |
| #1 | #2 | #3 | Item |
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| | | | Does the residence provide transportation to doctors' offices, the hairdresser, shopping and other activities desired by residents? Is transportation wheelchair accessible? What is the facility's procedure for arranging everyday transportation needs? Can residents arrange for transportation on fairly short notice? Are there extra fees for using transportation services? |
| | | | Are there any limits on how often residents can use transportation services? In many facilities, transportation is not available every time it is requested because the van is in use or there is no staff member available to drive it. How often does that happen here? |
| | | | Does facility provide assistance with shopping or accompany residents to doctor's offices, or do they just provide drop-off service? |
| | | | If the resident owns a car, may the resident's car remain in the parking lot? Are there any fees for parking? |
| ACTIVITIES & SOCIALIZATION |
| #1 | #2 | #3 | Item |
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| | | | Are there outdoor courtyards, patios, and porches for residents and visitors? Is sufficient outdoor furniture available? Is there space for gardening and other resident projects? Are there private areas other than the bedroom for visits? |
| | | | Are religious services held on the premises or does the residence assist in making arrangements for attending nearby services? |
| | | | Is a there a staff person specifically designated to conduct activities? Is there a written schedule of activities? Is there evidence of an organized activities program, such as a posted daily schedule, events in progress, reading materials, visitors, etc? Are the resident activity programs appropriate for the prospective resident? Did you observe residents actively using the activities facilities? |
| | | | Do residents participate in activities outside of the residence in the neighboring community? Do community volunteers, including family members, come into the residence to help with or conduct programs? |
| | | | Does the residence encourage residents to participate in certain activities or perform simple chores for the group as a whole? |
| | | | Does the facility take residents on frequent outings? Are residents with certain kinds of physical or mental problems excluded from these outings? Are there limitations on the number of residents that can be included on each trip? If so, how is priority determined and how many residents end up being excluded? |
| | | Does the facility provide designated space, supplies and equipment for: |
| | | | Exercise/fitness programs |
| | | | Library |
| | | | Woodworking shop and crafts areas |
| | | | Gardening |
| | | | Barber/beauty shop |
| | | | Games and cards |
| | | | Coffee or snack bars, gift shops, shops with convenience items |
| | | | Computer use, Web surfing, and email |
| | | | Fax and copy machine use |
| | | | Lecture programs, guest speakers or distance education |
| MEDICAL CARE |
| #1 | #2 | #3 | Item |
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| | | | Are pharmacy, physical therapy, dental, or other medical services offered on-site? Is there a staff person to coordinate home care visits from a nurse, physical therapist, occupational therapist, etc. if needed? |
| | | | Does the residence have programs for people with Alzheimer's or other dementias and disabilities? Are staff available to assist residents who experience memory, orientation, or judgment losses? Does the facility provide counseling and mental health services for residents? Does the residence have programs in other specialized areas? |
| | | | Does the facility provide assistance with transfers from wheelchair to bed, etc. |
| | | | Does the facility provide assistance with bathing? If so, how many times per week is bathing provided? |
| | | | Does the facility provide assistance with dressing? |
| | | | Does the facility provide assistance with incontinency? Does this include assistance with both bowel and bladder? |
| | | | Does the facility have formal programs for improving residents' ability to care for themselves, such as incontinence programs, medication management programs and occupational therapy? |
| | | | Does the residence use a pharmacy that provides delivery, consultation and review of medicines? Does the residence have specific policies regarding storage of medication, assistance with medications, training and supervision of staff and record keeping? How does staff supervise and assist a resident in taking medicine? Is self-administration of medication allowed? What is the residence policy regarding storage of medication, assistance with medications, training and supervision of staff and record keeping? |
| | | | Does a physician or nurse, visit the resident regularly to provide medical checkups? Is a private exam room available for use when doctors and nurses visit? |
| | | | Does the residence have a process for assessing a potential resident's need for services, developing a care plan, and reviewing it periodically? Does this process include the resident, family, facility, and personal physician? Are care planning meetings scheduled at times when family members would be able to attend? |
| | | | Does facility inform family/physician when an unusual event occurs? How are medical emergencies handled? |
| | | | Is there a family support group? Is family counseling available? How are communications with family members handled? How regularly is communication scheduled? |
| | | | Which hospitals and nursing homes does the facility have transfer agreements with? Are those facilities acceptable to the resident? |
| COSTS & CONTRACTUAL ISSUES |
| #1 | #2 | #3 | Item |
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| | | | Are the specific services offered clearly identified in the agreement? What is included in the basic fee? What is extra? Are there different costs for various levels or categories of services? Are any other services included in the fees, such as a specific number of days of skilled nursing care? Have you been provided with a complete schedule of charges? |
| | | | What extra services over and above the base charge are most commonly used by residents with interests and disabilities similar to the potential resident (i.e. beauty shop, transportation, meals, and other extra services), and what is the average monthly charge for those services? |
| | | | Do you clearly understand which of these extra charges would be covered in your situation by third party payors, like Medicare, Medicaid, or insurance, and which would be out-of-pocket costs? |
| | | | How often can fees be increased and for what reasons? Are there any caps on increases? How much and how often have fees increased in the last few years? |
| | | | Are there any government, private or corporate programs available to help cover the cost of services to the resident? |
| | | | Do billing, payment and credit policies seem fair and reasonable? |
| | | | Is a room deposit or entrance fee required? Are there any other pre-move-in payments? Is the deposit returned when the resident moves out? Are refundable deposits and entrance fees kept in escrow? Is the unused portion of the rent refunded upon transfer/discharge? |
| | | | Are residents personally responsible for other costs like utility expenses, external maintenance, or capital improvements? Are residents required to purchase renters/ insurance for personal property in their units? |
| | | | Are the terms of the financial/provider agreement reasonable? Can agreements or contracts be modified? Does the contract require the responsible party's signature, and does that signature improperly make the responsible party liable for contractual payments? Has an attorney reviewed the contract for compliance with state and national standards for resident rights? |
| STAFFING ISSUES |
| #1 | #2 | #3 | Item |
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| | | | Are the staff members that you pass during your tour friendly to you? Do you receive a warm greeting from staff welcoming you to the residence? Do the staff members treat each other in a professional manner? Does the administrator/staff call residents by name and interact warmly with them as you tour the residence? Do staff members speak directly to the potential resident as well as to family members? Do you feel comfortable talking with the staff? Does there seem to be enough staff available? |
| | | | What special training or certification do the staff have? Is there a formal staff training program? How many hours of training do staff receive? Do staff receive training to work with special needs or behaviors, such as dementia? What is the operator/administrator's training? Are direct care staff required to complete training before they are given personal care responsibilities? |
| | | | Is staff turn-over fairly low? How long have staff been with this organization? |
| | | | What is the ratio of staff to resident? How are nights and weekends staffed compared to days? Is someone on duty at all times of the day and night? |
| | | | Is there a full-time nurse on staff? Is this person a licensed RN? Is a nurse available 24 hours a day, 7 days a week? |
| | | | What languages do the direct care staff speak? Can they speak clearly in the native language of the resident? |
| PROVIDER QUALIFICATIONS |
| #1 | #2 | #3 | Item |
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| | | | If the state requires the administrator to be licensed/certified, does she/he have a current license/certification? Is the license displayed where you can see it to confirm that it is current and for the person who was introduced to you as the administrator? |
| | | | If the state requires the residence to be licensed, does it have a current license? Is it displayed? Is the facility subject to state surveys? Have they provided you with copies of recent survey results? |
| | | | Is the facility Medicaid certified? Medicare certified? |
| | | | Is the facility credentialed by any accreditation organization, such as the Joint Commission on Healthcare Organizations (JCAHO) or the Continuing Care Accreditation Commission (CARF-CCAC)? Are they in good standing? |
| | | | Does the facility have a formal quality assurance program? Does the facility conduct resident satisfaction surveys on a regular basis? Will they provide the results of those surveys? |
| | | | Is there a formal Staff training program? Do staff receive training to work with special needs or behaviors, such as dementia? What is the operator/administrator's training? |
| | | | Is staff turnover fairly low? How long have staff been with this organization? What is the ratio of staff to resident? How are nights and weekends staffed compared to days? |
| | | | Has the facility provided references? What religious or fraternal organizations are they affiliated with? |
| | | | Which hospitals and nursing homes does the facility have transfer agreements with? Are those facilities acceptable to the resident? |
| | | | Have the local Area on Aging, Better Business Bureau, and local healthcare providers been checked for negative reports? |
| | | | Has an audit report or other financial disclosure been provided to verify the financial stability of the organization? Are cash reserves adequate? Are deposits and entrance fees held in escrow? Are they protected from creditors or vendors in the event of a bancruptcy or sale? |