Choosing a Facility- Section Two:

Visiting the Facility  

It is crucial to visit all of the facilities that you are considering.  By visiting several facilities, you have a basis for comparison.  If you are doing the legwork for a family member, try to make another visit with them if at all possible.  After visiting several facilities, a person will have a gut feeling about what environment  seems right for them.

How do I find facilities in my area?

You can access a list of nursing homes,  boarding homes (assisted living) and adult family homes on the Department of Social and Health Services (DSHS) home page:

 www.aasa.dshs.wa.gov

Click on “Locate Nursing Homes In Your County” or “Locate an Adult Family Home in your Zip code or county.” 

To obtain a hard copy list of nursing homes, boarding homes, or adult family homes, contact Senior Information and Assistance at (206) 448-3110 or 1 (800) 972-9990.  

You can also download a directory from Senior Information and Assistance at their website:

Senior Services Online Downloadable Document Center

What to look for:

Here are some tips on what to look for when you visit a facility.

Atmosphere:  What is the atmosphere like?  Are residents up and about?  Are they socializing with one another?  Are staff actively engaged with residents?  Do staff treat residents with respect? 

Physical environment:  Is there good natural and artificial lighting?  How is the temperature?  Are there any unpleasant odors?  Does the facility meet your standards of cleanliness?  Is the facility wheelchair and walker friendly?  Are there handrails to help with walking?

Outdoor areas:  Is there a nice spacious outdoor area for residents?  Is there a covered outdoor area in case of rain?

How is the food?  Visit facilities at mealtime.  Does the food look appetizing?  Do residents appear to be enjoying the mealtime experience?  Is there adequate assistance and supervision for those residents who need it?  Ask if you can sample the food.  What do you think of it? 

Talk to the residents 

Who could better tell you about a facility than the people living there?  If you can, ask the residents about the facility.  What do they like about the facility?  What don’t they like?  Be open and frank, telling the residents that you or a family member are considering moving to this facility.  In a larger facility it may be easier to talk privately and candidly with residents.  Smaller facilities may afford less privacy and residents may not be comfortable speaking about the facility.  If a resident is uncomfortable discussing these issues, don’t pursue it and move on. 

After you get the official tour of the facility and establish some trust and rapport with the provider, you may want to ask if you could mill about on your own for a while unaccompanied; this may provide a better opportunity to chat with residents privately.  Be sure to respect the residents’ personal space:  never enter a resident’s room without knocking first and then asking and receiving permission to enter their room.

Most nursing homes have resident councils that meet monthly to review and attempt to resolve complaints.  Ask for the name of the president of the council and speak to him/her in private.  Ask the resident council president about the strengths and weaknesses of the facility.

Talk to residents' family members

Family members generally know the facility’s strengths and its weaknesses. Some nursing homes have family councils. These are generally comprised of involved family members who know the facility well.  Ask the nursing home if they have an ongoing family council and if you can attend the next meeting.  Ask for the name and number of the president of the family council and contact him or her.

While you’re visiting a facility, you may see other family members visiting.  Introduce yourself and speak with them.  This is a great opportunity to gather more valuable information.  You can also ask the provider for names of former residents and/or family members who can act as references.

Questions to ask about -- Nursing Homes

Is there stability at the top?

Four key positions in a nursing home are the Administrator, Director of Nursing Services, Director of Social Services, and the Activities Director.  It is important that these positions are permanently filled.  Ask for the names of the people in these key positions.  How long have they been in their positions? 

What percentage of the nurses aids are permanent vs. temporary agency workers?

Nurses aids perform the majority of direct care in a nursing home.  Over time, they get to know the particular needs of individual residents.  Generally, there is a high rate of turnover and on any given day a scheduled aid may not show up.  Consequently, nursing homes turn to temporary agencies to fill in the gaps.  A temporary aid cannot know the residents as well as permanent workers. 

Ask the facility what percentage of the aids are permanent vs. temporary and compare this to other facilities.  A facility that retains its nursing aids may reflect a favorable working environment and this should impact favorably on resident care.  In some nursing homes, staff come and go like a revolving door.  In other facilities, many staff (not just the nursing aids) have worked there for many years.  (Read more about the Staffing Crisis in the Critical Issues section.)

What activities are provided in and out of the facility?  

A nursing home can be a very boring place without a strong activities department.  Take a look at the activities calendar, which should be posted.  If there is an activity scheduled during your visit, check it out.  Is the activity happening as scheduled?  Is it well attended?  Is there adequate staff supervision?  Are the residents engaged?  Are they having fun? 

Consider what opportunities you will have to engage in the activities you enjoy at each facility.  Are there interesting activities planned on a daily basis?  Are there any evening activities?  Are there trips outside of the facility for shopping or entertainment?  If you spend most of your time in bed, what music, art, religious or other activities would be brought to your room?  Is there a resident garden, a computer with Internet connection, or a good selection of movie videos?  (You may also wish to ask residents some of these questions, too.)

Find the Activities Director and speak to him or her.  Is there an assistant activities director?  A mid- to large-size nursing home would need more than one person to plan and lead activities.

Questions to ask about -- Boarding Homes (or Assisted Living) and Adult Family Homes

How long has the facility been open and what percentage of beds are filled?

New assisted living facilities (licensed boarding homes) are opening all the time.  If you move in when many beds are as yet unfilled, the facility may experience financial pressures depending on how fast they can increase occupancy. 

What services are offered and at what cost?

Assisted living facilities and adult family homes typically charge a base cost for room and board and additional costs for personal care services.  Many facilities offer three or more levels of care at various price points.  Other facilities use more complicated point systems.  Make sure you understand the pricing systems, as they can be complicated.  Facilities are required to inform you in writing of all services offered and the cost of those services. 

Before you make a decision, review the entire admissions packet, which must include a complete schedule of fees and services. 

In addition to the services you need today, think about the services you may need tomorrow.  Make sure that services you may need in the future are available when and if you need them.

What happens if my personal funds run out? Can I stay at the facility on Medicaid?

The short answer is:  that depends. 

If you are residing in a boarding home (assisted living) or an adult family home and your funds become depleted, you may have to move.  Even if the boarding home or adult family home has a contract with the state which allows them to accept Medicaid as a payment source, these types of facilities have the discretion not to accept Medicaid and can discharge residents who can no longer afford the private pay monthly rate.  (Note:  This is in stark contrast to Medicaid-certified nursing homes, which are obligated to convert private pay residents to Medicaid when their funds run out.)

If you anticipate spending down your resources, ask these questions so you know where you stand: 

Some boarding homes and adult family homes simply do not have contracts with the state to accept Medicaid.  In this case, you will have to move when and if your resources are depleted.

Find Information about the Care Givers

One factor that really defines each facility is the people, day in and day out, who give the care.  Ask questions about their experience, training, and availability.  (Read more about the Staffing Crisis in the Critical Issues section.) 

Adult family homes are small operations with a maximum of six residents.  How many caregivers are there?  Is one person doing all the work:  the cooking, the cleaning, and the direct care with the residents; or do they have several staff dividing the work?  How long are the shifts?  If the work is divided amongst a group of staff, the caregivers may be more alert and energetic.

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