Choosing an Assisted Living Facility or Care Home

Start with your parent's needs and wishes

Write down:

• Health: conditions, medicines, mobility, falls, incontinence, swallowing, wounds, oxygen, tubes, memory problems and behaviour; how much nursing and medical oversight is needed.
• Daily help: bathing, dressing, toileting, eating, supervision, night care.
• Social and emotional needs: company, privacy, language, faith, food habits, hobbies, pets, a need for a garden.
• Practical preferences: location close to family and a good hospital, a single or shared room, a place that allows personal furniture.
• Budget and who pays; see budgeting for elder care in india.
• Your parent's views: what do they fear and want? See talking to parents about ageing and care.

Types of facility

• Independent senior living or retirement communities: for people who are largely independent, with community services, security, meals and activities. Not designed for heavy nursing needs.
• Assisted living: for people who need help with some daily tasks such as meals, medicines, bathing and supervision, with a call system and some nursing support.
• Nursing homes or skilled care: for those needing regular nursing, medical oversight, rehabilitation, wound care, tube feeding or end-of-life care.
• Dementia or memory care units: with trained staff, secure and calming environments and structured activities; ask about training and approach; see dementia stages and what each needs.
• Old age homes run by trusts, religious bodies or governments: may be low-cost or free, with varying facilities; see government schemes for senior citizens in india and check what applies.
• Respite or short-stay care: for temporary needs; see respite care: how to take a break.
• Home-like small homes: may offer warmth but check safety, staffing and licensing carefully.

The best choice is the one that fits the person's needs now and, as far as can be foreseen, over the next year or two. Ask whether the facility can continue to care if needs increase, or whether the person would have to move again.

Before you visit: check the basics

• Registration and licences: ask which authority the facility is registered with, and ask to see the certificate; requirements differ by state and by type of facility. Check with the local health or social welfare department if unsure.
• Medical oversight: is there a doctor who visits, how often and who is on call? Which hospital is nearby, and how long does an ambulance take?
• Reputation: talk to current and former residents' families, the family doctor, the hospital social worker and online reviews, bearing in mind that they can be inaccurate.
• Fees: ask for a written, itemised fee list.

The visit: what to look for

Visit at least twice, once with notice and once without, at different times, including a mealtime and early evening. Take someone with you, and, ideally, your parent. Use your senses.

First impressions - Smell and cleanliness: the place should be clean without strong odours of urine or heavy disinfectant. Check toilets and bathrooms. - Atmosphere: do residents look comfortable, clean, appropriately dressed and engaged, or are many left in front of a television or in bed? Do staff speak to residents with respect and warmth? - Noise, light and ventilation. - Safety: non-slip floors, handrails, ramps, lifts that work, grab bars, clear corridors, fire exits and extinguishers, secure doors for people who wander, and good lighting.

Rooms and facilities - Rooms: space for the bed, personal furniture and a walker or wheelchair; a call bell within reach; a window; privacy for personal care; choice of single or shared rooms. - Bathrooms: accessible, with grab bars, shower seats and non-slip surfaces; see bathroom safety checklist for seniors. - Common areas: seating, garden, activity rooms, a prayer space. - Kitchen and dining: hygiene, menu variety, meals that meet dietary needs, assistance with eating, drinking water access. - Power backup and water supply, since cuts are common; see hospital bed electricity and power cuts. - Medical room and equipment: oxygen, suction, emergency trolley, wheelchairs.

Staff - Numbers and ratio: how many staff per resident by day and by night? Are there nurses on duty, and 24 hours? - Qualifications and training: nurses' registration, caregivers' training, dementia and first aid training; ask how long staff have worked there. High turnover is a warning. - Attitude: do staff stop to talk, knock before entering rooms and respond quickly to call bells? - Management: who is in charge, and are they accessible?

Care and daily life - Care plans: is there an individual assessment and a care plan, reviewed regularly with the family? - Medicines: who gives them, how are errors prevented and how are records kept? See giving medicines safely at home. - Falls, pressure sores and infections: what is the prevention routine, and how are incidents recorded and communicated? See pressure ulcers: stages and care and infection control for home caregivers. - Medical emergencies: what is the procedure, which hospital and how are families informed? - Dementia care: training, approach to behaviour, use of restraint or sedation, wandering safety; see dementia challenging behaviours. - End-of-life care: what is the policy, and are families allowed to stay? - Activities: a weekly schedule with exercise, music, outings, festival celebrations, and respect for religious practice; see caring with religion, fasting and culture in mind. - Food: taste, choice, handling of diabetes or low-salt diets, snacks and fluids. - Privacy and dignity: personal care behind closed doors, respect for modesty, same-gender carers where requested; see dignity and consent in care. - Visiting policy: hours, overnight stay, outings, phone and video calls. - Communication: how often will the family receive updates, who can be called any time, and how are complaints handled? - Residents' belongings and money: how are valuables and money kept safe?

Money and the agreement

• Fees: ask what is included (room, meals, nursing, laundry, medicines, supplies, physiotherapy, transport, medical visits) and what costs extra. Ask how and when fees may rise, and for notice.
• Deposits and refunds: what is refundable, and when? Be cautious about large non-refundable payments without a written contract.
• Written agreement: read every clause before signing, preferably with a lawyer. Look at the terms for discharge or eviction, notice periods, handling of medical emergencies, responsibilities in a death, liability and dispute resolution. Do not rely on verbal promises.
• Get receipts for every payment.
• Check how finances are handled if your parent has dementia: who has authority, and what safeguards exist; see managing a parent's money safely and legal basics: wills, nominations and power of attorney, checking current rules with a lawyer.
• Insurance: most health policies do not cover long-term residential care, but check; see health insurance for senior citizens in india.

Trial stay and settling in

• Ask for a trial period of a few weeks, with a clear process for leaving if it is not suitable.
• Prepare your parent: visit together, explain what will happen, and let them help choose items to take, such as photographs, a favourite chair, bedding, a radio and religious items.
• Label everything and keep a list.
• Be present in the first days, and visit often in the first weeks, at varied times.
• Expect an adjustment period of weeks, with sadness, anger or withdrawal; stay in touch and encourage but do not pressure.
• Share a profile of your parent with staff: history, routines, likes, dislikes and what comforts them; see training a new attendant: the first week for a similar profile.
• Give the doctor and facility a full medicine list and care summary; see emergency contact card and medical summary.

Warning signs

Be cautious about facilities where:

• you are not allowed to see rooms, kitchens or residents, or visits are heavily restricted without reason;
• the manager avoids questions or pressures you to sign quickly;
• staff seem few, hurried, unqualified or unhappy, and turnover is high;
• residents look neglected, unwashed, sedated or distressed, with sores or bruises;
• there are persistent bad smells, dirty toilets or unsafe equipment;
• there is no clear medical or emergency plan;
• fees are vague or constantly rising;
• complaints are met with defensiveness.

Trust your instincts. See how to stop elder abuse.

Keep watching after admission

Visit regularly, at different times. Check weight, skin, hygiene, mood, medicines and how staff treat your parent. Attend care plan reviews and keep a diary; see care diary and handover notes. Raise concerns early and calmly with the manager, in writing if needed. If not resolved, escalate to the owner and the relevant authority, and consider moving your parent. If you suspect abuse or neglect, contact the police; for senior citizens' information and support, Elderline 14567 is a helpline; check current availability. In an emergency, call 112.

When to ask a professional

A doctor or geriatrician can advise on the level of care needed. A hospital social worker or care manager may know local facilities. A lawyer can review the agreement. A counsellor can help the family with guilt and grief; see guilt, grief and anger in family carers. For an example of local questions to ask, see basic tips for choosing an elder care facility in kolkata.