Marketing personnel will tell you what they need to tell you to get you to select their CCRC; it’s what they are paid to do. They are not necessarily lying; they are just telling you’re the good stuff and skipping over the bad stuff. It is up to you to know what to look for and to ask the right questions. After a couple of CCRC tours, you will become proficient at getting the information you need.
Things to look for and questions to ask during a tour
There are lots of questions listed here and the list is by no means complete. If you ask them all on one tour, it will take all day. You may find the answers to most of them on the CCRC’s website or in its disclosure statement. Pick out the questions that are most important to you and ask those on each tour.
Facility questions
Ask for a copy of the CCRC disclosure agreement; it contains most of the important information.
- What is the age of the facility?
- How up to date are the furnishings, décor, artwork, carpets, etc.?
- Are the grounds well maintained, manicured, and easy to navigate and well lighted?
- Are common areas properly cooled/warmed, furnished, modern, clean, and well maintained?
- Is any renovation or construction planned? Proposed start and finish dates.
- Is this a smoke-free facility? Are there designated areas for smokers?
- Is there a 24/7 concierge service?
- Are tips allowed or encouraged?
- The number of residents? The percentage who are from the local area? The number of residents in each level of care?
- What are the occupancy rates for the CCRC? Occupancy rates on average should stay above 90%.
- Is the facility accredited by the CCAC (Continuing Care Accreditation Commission) section of CARF (Commission on Accreditation of Rehabilitation Facilities)? This is not that important since the CCRC pays for the certification.
Security questions
- If the facility gated or ungated?
- If the facility fenced or unfenced?
- Are there gate guards? What hours?
- Are there security patrols? What hours?
- Is there a 24/7 call center for security problems?
- Is there ample light in all indoor areas of the facility, and are rooms/homes equipped with security systems, sprinkler systems, and emergency exits?
- What are the facility plans in case of a disaster?
- Does the facility have emergency power?
Transportation questions
- What types of transportation, such as for medical appointments are offered by the facility and its cost?
- Is transportation provided for a medical appointment? Fee?
- Is transportation provided for personal trips? Is there a fee?
- Is scheduled transportation or public transportation offered nearby?
Parking questions
- Is there adequate parking near the type of housing you desire?
- Is parking assigned?
- Are parking areas well lighted?
- Is covered parking or garages available and what is the cost?
- Is transportation to parking provided?
- Are there covered walkways to parking areas?
- Is additional parking easy to find for visitors?
- What are the procedures for snow removal in parking areas?
Recreation questions
- What types of fitness facilities on the premises?
- What services and activities do you offer?
- Which ones have an extra cost?
- What types of recreational activities are offered? How often? Who plans them? Fee? Ask for a copy of the activities calendar.
- What types of recreational trips are offered? How often? Fee?
Pet questions
- Can residents have pets?
- What types and sizes?
- How many?
- Are there limits on which type of housing units may have pets?
- Are pets allowed in assisted living?
- Is there a pet deposit? Refundable?
Administration questions
- Check the CCRCs website for background information on executives. Request a copy of the Annual Audit Report for executive compensation. For non-profit organizations, also check the IRS 990 filing on the salary levels of executives. Basic 990 information may be found on the Guidestar website.
- What is the experience and competence of the CEO and other top management staff? Check to see if they have experience in aging services, and in managing long-term care services.
Staff questions
- What training and qualifications are required for staff? Do staff members attend ongoing training programs?
- What credentials do staff members hold?
- How long are the work shifts for caregivers?
- What are the staffing levels on weekdays, weekends, and evenings?
- Are staff criminal background checks performed?
- Are you warmly greeted by staff? Are they professional and happy to help? Are they approachable?
- Ask other residents whether staff members handle requests in a timely way?
- Are the administration offices easy to find?
Resident/staff relations questions
- Whom do I call with questions or complaints? Is there a 24-hour telephone number with a person on duty I can call?
- Does the CCRC subscribe to a set of resident rights and responsibilities? Is a printed copy of resident rights and responsibilities available?
- Is there a social worker or ombudsperson available?
- What types of community rules and regulations exist?
- Is there a resident or family council that allows residents to voice concerns, offer input in the CCRC decision-making process, and help in managing the community? How often do they meet, and how are their concerns handled? Ask to speak with a leader or member of the council?
- Ask residents about their relationship with the administration and staff. Do they feel they are heard, respected, and have input into decisions?
- Ask residents whether the administrator/director practices an “open-door” policy.
- Are your rights restricted by limited provider liability or by requiring binding arbitration?
- Is there a facility ombudsperson to mediate between management and residents with problems or concerns?
Application process questions
- Is there an application fee? Fee?
- Is there a waiting list? Fee? Refundable?
- How is the list managed?
Cost questions
Entrance fee
- What is the entrance fee and under what circumstances is the fee refundable?
- Are there plans for delaying the entrance fee until the current home sells?
- Is the entrance fee due to increase soon?
Monthly fee
- What are the monthly fees?
- Who decides when the fee will increase?
- How often and by how much do the fees usually increase?
- How much notice is given when fees increase?
- What services are included in the monthly fees?
- What happens if there is a late payment of a monthly fee?
- What actions are taken if your financial resources are nearly depleted?
Extra fees
- What services required an extra fee?
- Deposits
- Are there any security deposits, damage deposits, pet deposits, etc.? Are they refundable?
Acceptance process questions
- How long may it take to be accepted and admitted to the various types of housing?
- What are the paperwork requirements, the time frames involved, times where funds are due to be paid?
- Can service contracts/agreements be amended or modified?
- Moving questions
- Is there a moving coordinator to assist new residents?
- What does the process of moving in entail?
- Does the community provide any assistance with move in?
- How big of a truck is permitted?
Spiritual questions
- Is there a facility chaplain?
- What spiritual services are available?
- Are counseling services available?
Atmosphere and culture questions
- How are new residents made to feel welcome in the community?
- Do residents seem happy and well cared for?
- Are residents social and interacting with one another?
- Do the residents seem aloof and formal or are they friendly and casual?
- Are residents moving about the buildings and grounds or do they seem to be holed up in the housing units?
- Do staff and residents seem to know each other by name?
- Are the residents dressed up when you see them around the facility or are they dress relaxed and casually?
- Does the facility have a volunteer program? If yes, what types of activities do the volunteers perform?
- CCRC brochures always picture active, happy, interacting residents. Is this what you see during the tour?
- Ask if you may spend some private time with a resident/s in their quarters to talk about their experiences at the CCRC.
- Does the CCRC’s environment match yours? Is it a formal or a casual environment?
Meal plan questions
- What meal programs are offered?
- Do meal credits carry over from month to month?
- May leftover meal credits be used for other services.
- What types of dining areas are offered? How much to average meals cost in each area.
- What meals are provided each day e.g., breakfast, lunch, dinner, and snacks?
- Is there a bar that serves alcoholic beverages?
- Does a dietician or nutritionist review menus?
- Do the assisted living facilities offer group meals or in-room meal programs?
- Are special diets accommodated?
- Can residents make special requests?
- How many entrée choices are offered daily?
- What is the meal schedule and is there any flexibility with it?
- Are meals/snacks available at any time?
- Are snacks included in any of the meal plans?
- What are the criteria for residents to eat meals in their rooms?
- Are meals delivered to housing units? Fee?
- Can guests dine in with their loved ones?
- Is there a private dining room to use for guests?
- Ask to see a menu for the month to see how meals vary.
- Have a meal to sample the food and the service.
- Another important meal issue is the CCRC’s policy on the use of canes, walkers, or wheelchairs in the dining room. Surveys have shown that independent residents frown on their use in dining rooms. What is the policy for these devices in the dining rooms?
Independent living questions
- How many types of housing units are there?
- How many housing units are available now and may I tour them?
- Are residences equipped with modern conveniences, such as laundry, dishwasher, microwave, etc.).
- Do they have full kitchens or kitchenettes?
- What are the remodeling and decorating rules?
- What are the rules on visitors? Are there general visiting hours or do they depend on the type of residence?
- Do multi-level residences have sufficient elevators?
- Are furnished residences available?
- Do residences have outdoor living space (balcony or patio)? Extra cost?
- Since people are generally in good health upon entry, they often do not consider accessibility features in the independent living units that might allow them to safely remain in their apartments. Do units have grab bars by the toilet and in the shower, doorway dimensions that would permit wheelchair access, non-slip floors, etc.
- What happens if a couple moves in and one of the individuals falls ill and must move to a nursing home? Is the other required to move? What happens if the spouse gets well after the other has moved?
- How long will the community maintain a living unit if a resident is temporarily placed in assisted living or skilled nursing care?
- Under what conditions might a resident be asked to move?
- What are the options and restrictions for receiving assisted living services in the independent units, and associated costs? The area of greatest tension is the CCRC’s policy of allowing assisted living services in the independent units. Many residents understand that they can live in their units as long as they are able or as long as they have a spouse and/or can hire outside caregivers to provide needed assistance with activities of daily living like bathing, toileting, dressing, and so forth. However, this is usually not what the CCRC thinks, or in fact, what the contract stipulates. When a resident needs a higher level of care, they are moved to the assisted living or nursing home level based on an assessment and care transfer process.
- What are the rules applying to relocation to higher levels of care? If one spouse goes to a higher level of care, what consequences does it have on the spouse in the independent living unit? Will the spouse have to move to a smaller unit within a specific time? What impact will this have on your monthly fees?
- Do residents purchase or rent the housing units? What is the cost?
- What are the floor-plan options?
- Are the apartments/homes furnished or unfurnished?
- Do the apartments/homes include all-electric appliances? Are light fixtures included?
- Do the apartments have individually controlled heating and air-conditioning?
- Are window treatments provided?
- What is the policy about personal belongings in the apartments/homes?
- Are bed linens and towels provided and laundered?
- Do you provide personal laundry services?
- If I need to go to the hospital for a short stay, will my residence be held? What are the associated fees? Will I receive a discount for unused services, such as meals?
- What is the policy for overnight guests? Are guest rooms available? What is the cost?
- Is additional indoor storage available? Is there any extra fee?
- Is there a storage area for bicycles?
- Is an area available for me to garden?
Medical care questions
- How is the initial health assessment managed? Who completes the assessment?
- Do you have an onsite medical clinic? How is it staffed, staff doctor, PA, nurse, or visiting ones? Hours of operations? Lead time in getting appointments?
- Is there a rehab facility? What are the procedures if rehab is needed?
- Do you take Medicare/Medicaid health insurance?
- How are medical emergencies handled?
- What is the protocol for contacting family members should an emergency or another important issue arise?
- Are there special programs for persons with my health conditions?
- Are the services of a physical, occupational, or speech therapist available or arranged?
- Do staff members assist residents in administering medication? If so, who does that?
- Do staff members assist residents in making doctor appointments?
- Who is the contact when the family has questions about patient care?
- Is home health care offered? Is outside home health care permitted?
- Are family members, residents, and CCRC administrative, services, and medical staff involved in the care planning process?
- Can private-duty companions be hired? What is the procedure for that type of service?
- Is hospice care offered? If so, does the facility coordinate that care with my physician and family?
- Who decides what type of care individuals require? How often is this reassessed?
- What type of health care is provided at the facility? Short-term? Long-term?
- What are the limits, if any, to the health and medical care covered by the regular fees?
- What are the policies for transferring an individual between levels of care? Get these in writing.
Assisted living, memory care, and skilled nursing.
- What level of care is provided in assisted living? For example, what health setbacks would surpass its capabilities?
- Is there a written plan for the care of each resident, and is there an ongoing process for assessing changing needs?
- What is the ratio of staff to residents?
- How difficult is it to secure an assisted living space when necessary?
- Who makes the final call about a long-term move to or from assisted living?
- What health setbacks would trigger a move from assisted living to skilled nursing?
- What about specialized services like dementia care and hospice care?
- What happens when a facility is full, and you need to move to it?
- Are residents from outside the CCRC accepted?
- Are Medicare beds available in skilled nursing? This will be advantageous for you if you need skilled nursing. Medicare will pay for 100 days if you meet the following:
- You need skilled nursing care seven days a week or skilled therapy services at least five days a week.
- You were formally admitted as an inpatient to a hospital for at least three consecutive days. You must enter a Medicare-certified skilled nursing facility within 30 days of leaving the hospital.
- You have Medicare Part A before you are discharged from the hospital.
- You need care that can only be provided in a skilled nursing facility.
- In urban locations, particularly where high-rise construction is the norm, what about the floor location of the assisted living and skilled nursing in an emergency evacuation.
- What personal items are allowed?
- Is there an intuitional odor or a masking odor in the rooms or hallways?
- What are the qualifications and training of staff, and the ratio of staff to residents at each of the three shifts?
- Are the staff friendly and helpful, even when they don’t know you are touring?
- What are the lengths of service of the administrator, director of nurses, and charge nurses, and what are the turnover rates for Certified Nurse Assistants?
Questions to ask residents
- How long have you lived here?
- How do you like living here?
- Do you feel fulfilled live here?
- How are the services?
- Is there anything you wish the CCRC offered that it doesn’t now offer?
- Do you the staff care for you?
- What are some of the unexpected costs you have incurred?
- Is the staff attentive without being intrusive?
- Are the doctors and nurses helpful and accommodating?
- Has it been worth the cost?
The most important thing to consider
The physical facility, the administration of the facility, the quality of the food, and the health care offered are important things to consider, but the most important thing about a CCRC is the quality of the staff and staff-resident interaction. These are the people who you will deal with all day, every day. They provide all the services you pay for and expect. They will determine whether you will love your stay at the CCRC, or you will hate it.There are always some bad apples in the basket, but there should not be many of them and they should be removed as soon as they are identified. A genuinely caring staff is what makes a CCRC a great place to live.
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