Senior Living: How to find the right assisted living community

By David W. Hart, Ph.D.

Contributing writer

My mother Carrie and I cared for my grandmother Janice, who was diagnosed with probable Alzheimer’s disease when I was 15 years old. For nearly eight years, the disease ravaged her brain and eventually her body.  Over that course of time, my family found there were physical and emotional limits to our ability to competently care for my grandmother at home, especially as she progressed into the later stages of Alzheimer’s.

Trying to find an appropriate assisted living community for her was tedious, to say the least.  I knew nothing going into the process and experienced a steep learning curve.

I mostly remember the number of facilities I had to visit before making a final decision: 13.  Yes, 13.

Beyond my personal experience, our organization helps families find that special home for their loved one. I guess you can say I’ve learned some lessons along the way.  Here are some of them in no particular order.

First, it’s critical to understand the differences between the types of assisted living communities available to older adults.

Under California law, Residential Care Facilities for the Elderly (RCFE) are facilities of any capacity that provide 24-hour non-medical supervision, room, meals, and depending on the needs of the resident, may assist with activities of daily living, including medication reminders, meals, bathing, grooming, dressing, etc.  Please note the expression non-medical. RCFEs are intended to support older adults who do not require acute medical care, which falls under the purview of a hospital or skilled nursing facility. For the purposes of this column, I’ll focus on assisted living.

RCFEs are regulated by the California Department of Social Services (DSS) and Community Care Licensing (CCL).  Information regarding regulatory requirements, facility locations, and health and safety inspection records can be found on the DSS website.  Licensing regulations are may not necessarily be described as stringent but there is a system – albeit one of the weakest in the nation – that allows for inspections, complaints, and grievances.

When explaining RCFEs to clients and consumers, I have found that discernment between types of communities under the umbrella has been helpful.

 Assisted living communities

Assisted living communities are the larger “hotel” like facilities that are generally licensed for more than 50 beds. Residents are mostly ambulatory and need minimal assistance with activities of daily living. These facilities have a common dining room that serves breakfast, lunch, and dinner and the large majority of residents live relatively independently on site in small studio apartments.

One of the benefits of this type of community is exposure to multiple social opportunities, whether formally organized by the facility or informally between fellow residents.

Board-and-care communities

Board-and-care communities, otherwise known as six-packs because they are generally licensed for six beds, are most commonly found in neighborhoods that look like yours.  These homes are commonly non-descript – no signs or visible indication that they’re providing more acute care for their aging residents.

Board-and-care facilities are usually appropriate for individuals who require more acute levels of care, including managing cognitive impairment, bathing, dressing, grooming, feeding, transferring and needs associated with end-of-life because hired caregivers have less residents to care for.

By no means does this mean that every board-and-care facility solely serves older adults with greater needs. Depending on several contextual factors including attrition and just plain luck, you may find the perfect board-and-care facility with higher functioning residents.

Memory care communities

Memory care communities are generally secure facilities designed specifically for residents with cognitive impairment related to Alzheimer’s disease or another dementia. These communities have specialized programming for residents in various stages of dementia, which also requires their care staff to receive specialized training. The quality of the programming and training, though, is not regulated and not every memory care community is the same.

How to choose

What factors should you look for to help you determine whether or not a memory care community is solid or not?These are just some of the question I would ask:

• Does it provide a continuum of care (early stage to late stage)?
• What degree of education is prevalent throughout the organization?
• Do they have a medical director or registered nurse of staff?
• Do their care managers have master’s degrees?
• Who provides training to their care team?
• How does the team manage challenging behaviors common in the later stages of the disease?
• Do they use behavioral techniques or medication?

Paying for long-term care, including RCFEs, is not inexpensive and generally paid for out-of-pocket.  If you purchased long term care insurance, your policy may have a benefit that covers the cost of RCFEs. Fees range on average between $2,500 up to $13,000 per month, depending on several factors.

Find out what specifically is covered in the monthly rate; what, if any, additional costs might come up along the way (e.g., in-continence care); and whether or not the community provides transportation for errands, healthcare appointments, etc. Medi-Cal also has a special assisted living waiver to fund RCFE placement for eligible members but the homes approved as waiver participants are often full and waiting lists are prevalent. The waiver is only funded through fiscal year 2019.

How to find these homes.

You can identify RCFE facilities on your own by visiting the DSS website and searching for “care facility search”. My recommendation is to seek out placement agencies that have prequalified RCFEs in your community. These services are generally free and they can help you to find homes that fit your budget and level of care required for you or your loved one (disclaimer: my family’s company,

Always Best Care South Bay, has a complimentary assisted living finder service). You can also Google “assisted living finder” to identify a list of organizations that provide this service.  It’s important to think about what factors will ultimately help you decide on the best facility.

For most of my clients, budget, activities, cleanliness, skill of the administrator and caregivers, menu options, transportation, and open visiting hours are most commonly identified as crucial.

For a comprehensive list of questions that may assist you in your decision making please visit our website at www.AlwaysBestCareSouthBay.com/assisted-living-finder.

The South Bay Dementia Education Consortium is hosting a free workshop from 5:30-7:30 p.m. on Oct. 23 at the Redondo Beach Main Library.  Dr. Mario Mendez, Professor of Neurology at the UCLA School of Medicine and an expert in frontal temporal dementia, is speaking on the topic of “Dementia Beyond Typical Alzheimer’s Disease: Strategies for Both Patient and Caregiver.” To RSVP, call 310-374-3426 ext. 256.  Seat are bound to go quickly. Call today!

Be well.

David Hart, Ph.D., is the director of clinical services at Always Best Care Senior Services in Torrance and is a faculty member in the Department of Counseling at California State University, Fullerton.  Hart, founding chair and member of the South Bay Dementia Education Consortium, specializes in working with older adults with dementia and their families. For more information, go to alwaysbestcaresouthbay.com or contact him at dhart@abc-seniors.com or at (310) 792-8666.