BASA ASSISTED LIVING CHECKLIST
This checklist is designed as an educational tool to help consumers compare and contrast different assisted living residences. Assisted living has no formal definition, so you will notice a wide variety in the services offered, the physical environments, policies and protections, etc. It is up to you, the consumer, to decide what residence is best suited to meet your individual needs and preferences.
TIPS & SUGGESTIONS
(1) Visit several residences so you
have a
basis for comparison.
(2) Schedule a guided tour with a knowledgeable staff person.
(3) Review the checklist prior to your visit and highlight the questions most important to you.
(4) Do not be afraid to ask questions.
(5) Do several informal walk-throughs at different times of the day.
(6) Talk with current residents and family members.
Facility Identification Sheet
#1Residence
___________________________________
Address________________________________________
Telephone ( )_________
Contact Person_____________
Visit Date _____________ Appt. Time
_________am/pm
#2
Residence
___________________________________
Address________________________________________
Telephone ( )_________
Contact Person_____________
Visit Date _____________ Appt. Time
_________am/pm
#3
Residence
___________________________________
Address________________________________________
Telephone ( )_________
Contact Person_____________
Visit Date _____________ Appt. Time
_________am/pm
Checklist Note: For each residence you visit, check the box if the answer is "yes" to the stated question. If the answer is "no", leave the box blank.
Residence
#1 #2 #3 FINANCES
___ ___ ___ Is the residency agreement or contract in clear
and
understandable language?
___ ___ ___ Do you understand the terms and conditions
under
which the contract can be terminated?
(i.e.
health or behavioral reasons, inability to
pay,
etc.)
___ ___ ___ Is it clear what the monthly base rate does and
does
not cover? (such as cable television,
telephone,
utilities, beauty shop, personal care
items)
___ ___ ___ Is a price sheet available for non-covered
services?
___ ___ ___ Is there an initial entrance fee or security
deposit?
Amount $_____If yes, is all or part of
it
refundable?
___ ___ ___ Is a history of rate increases available for
review?
___ ___ ___ If a resident's care needs increase, does the
monthly
rate increase?
___ ___ ___ Is financial assistance available to residents?
Residence
#1 #2 #3 STAFFING
___ ___ ___ Do staff members appear courteous &
attentive
to residents and to each other?
___ ___ ___ Is there a licensed nurse on the premises?
Hours
on site: _____________
___ ___ ___ Is the nurse available for periodic medical care
and/or
treatment? (i.e. injections, dressing
changes,
etc.) Charge $_____
___ ___ ___ Are direct care workers licensed or do they
receive
special training on an ongoing basis?
___ ___ ___ Are background checks
performed on all
employees?
___ ___ ___ Are the services of other licensed
professionals
available? (i.e. social worker,
recreational
therapist, podiatrist, etc.)
___ ___ ___ Is direct care staff available on site 24/7
including
holidays? (Staff-to-resident ratio:
AM_____
PM_____ Midnight_____)
___ ___ ___ Is supervision of staff provided by a trained
professional?
___ ___ ___ Is staff able to accommodate special needs?
Residence
#1 #2 #3 SERVICES
___ ___ ___ Is there an initial assessment to determine
appropriateness
for placement? (i.e.
continency,
mobility, cognitive function, etc.)
___ ___ ___ Is there ongoing
assessment of resident
needs?
___ ___ ___ Are personal care services available? (i.e.
bathing,
grooming) Charge: $_____
___ ___ ___ Are health monitoring services available? (vital
signs,
glucose checks, etc.)
___ ___ ___ Is the residence part of a continuing care
community
or does it have an affiliation with a
nursing
home or hospital?
___ ___ ___ Does the residence offer medication
assistance?
Set-up _____ Reminders _____
___ ___ ___ If you need assistance with
medications, must
you
use a specific pharmacy?
___ ___ ___ Is a calendar of activities, exercise programs,
and
events available for review?
___ ___ ___ Is there access to religious services?
___ ___ ___ Is transportation available for individual
appointments?
Charge: $_____
___ ___ ___ Is staff available to assist with transportation
needs
such as scheduling, boarding, carry-ons,
groceries,
etc?
___ ___ ___ Are beauty/barber services available on site?
___ ___ ___ Are
housekeeping services available?
Daily_____
Weekly _____ Other _____
___ ___ ___ Are laundry services available?
Personal
_____ Linens and bedding _____
___ ___ ___ Does the residence have specialized programs
for
people with dementia?
___ ___ ___ Are the services of a physical, occupational, or
speech
therapist available or arranged?
___ ___ ___ Is a personal shopper or errand service
available?
___ ___ ___ Are separate overnight accommodations
available
to guests? Charge: $_____
___ ___ ___ Are you allowed to bring in services from
outside
the residence? (i.e. private duty nurse
or
aide, hospice, cleaning, etc.)
Residence
#1 #2 #3 PHYSICAL
ENVIRONMENT
___ ___ ___ Do all units have private bathrooms? If not, how
many
residents share a bath?
___ ___ ___ Do individual bathrooms include a tub or
shower?
___ ___ ___ Is the bathroom handicapped-accessible?
(including
tub & shower)
___ ___ ___ Is there a kitchenette within each unit? If not,
are
there cooking facilities available?
___ ___ ___ Do units come fully furnished?
___ ___ ___ Are residents able to provide their own
furnishings?
___ ___ ___ Are the fixtures/appliances in good condition
and
working properly?
___ ___ ___ Is there adequate closet/storage space?
___ ___ ___ Do units have individual temperature controls
for
heating/cooling?
___ ___ ___ Is the unit in a good location for your individual
needs
and preferences? (close to dining
room/activity
areas/pleasant view/quiet setting,
etc.)
___ ___ ___ Are there comfortable common areas for social
gathering
and activities?
___ ___ ___ Can more than one person live in a unit? (i.e.
spouse,
sibling) Charge: $_____
___ ___ ___ Is parking available? (covered/uncovered)
Charge:
$_____
___ ___ ___ Is the residence easily accessible to visitors?
(convenient
parking, handicap accessible,
visiting
hours, etc.)
___ ___ ___ Is location convenient to hospital and support
services?
(physicians, shopping, church, public
transportation,
etc.)
Residence
#1 #2 #3 POLICIES
AND
PROTECTIONS
___ ___ ___ Is there a process to address conflicts and/or
grievances
related to staff or care issues,
physical
environment, etc?
___ ___ ___ Is there a regular evaluation process or quality
assurance
program?
___ ___ ___ Does the provider hold a state-issued license?
(Michigan
issues licenses only for Adult Foster
Care,
Home for the Aged, and Nursing Home)
___ ___ ___ If licensed, are the
latest inspection reports
available
for review?
___ ___ ___ Are the house rules and standards, including
residents'
rights, available for review?
___ ___ ___ Are there restrictions on visits by children or
young
adults?
___ ___ ___ Are overnight visitors allowed in resident
rooms?
(Number of nights allowed: _____)
___ ___ ___ Are pets allowed? (If yes,
is there a limit on
number,
type, size?) Charge: $_____
___ ___ ___ Is smoking allowed in resident rooms or
common
areas?
Residence
#1 #2 #3 MEALS
___ ___ ___ Are meals covered in the basic rate? (Number
per
day _____
___ ___ ___ If not, can residents pay for a meal-plan
package?
Charge: $_____
___ ___ ___ Are meals in the dining room provided at
convenient
times? Breakfast _____
Lunch
_____ Dinner _____
___ ___ ___ Can meals be delivered to resident rooms?
Charge:
$_____
___ ___ ___ Are special diets accommodated?
___ ___ ___ Are residents involved in menu planning?
___ ___ ___ Does the menu provide interesting variety and
choices?
___ ___ ___ Is there assigned seating in the dining room?
___ ___ ___ Are guest
meals available? Charge: $_____
This checklist is supplied by the Bay Area Senior Advocates