In this article, you’ll find simple ways to help you find the best retirement home in senior living.
We give you the inside scoopand answers all your questions on how retirement living works and help clear away some of the angst and anxiety that comes with this decision.
Having helped tens of thousands of seniors move into senior living, trust us when we say congregate senior living can be a positive life changing experience, to reignite the mind, body and soul.
We help you cut through all the noise and help direct you to the most important answers.
This article is a pretty long read (45 minutes last count!), and we understand not everyone enjoys senior living like we do 🙂
With that in mind, and so much to digest, – use the Table of Contents to skip to your burning questions.
You’ll Learn….
What to look for when touring a retirement home. The important stuff – not the drivel.
What questions to ask. You’ll be able to get a solid sense of the community culture.
Plus:
How to deep dive the most important factor in choosing a retirement home – the Executive Director – and how to uncover the good ones.
Why programming in the home is more important than you think.
Between bites, you’ll be able to identify if a home reallyhas a good foodprogram.
What to look for when it comes to protecting the vulnerable and the valuables.
Plusloads of extra insights to help make your decision clearer.
When I was the Executive Director of a retirement home, I remember a tour we had with a prospect who came to look at our residence for a possible move in.
During the tour, he looked at all the walkers in front of the dining room during lunch and remarked:
“I can’t live in this place – there’s too many old people.” He was 92.
Nobody thinks they are as old as they are – we all believe we’re younger in age and in spirit, even though our bodies sometimes tell us another story.
Like it or not, we slowly break down as time marches on – and with that – comes the emotional and physical need to rely on others for support. This is where a retirement home comes in.
Let’s face it, no one ever grows up wanting to move into a retirement home – it’s not on your bucket list and quite frankly it’s not an easy decision to make.
I can tell you with certainty, that life, laughter and love can be found in abundance in retirement living.
It can be an amazing part of the journey in life – especially if you find the right home to start.
What follows is an insider’s perspective on senior living from people who have worked in all facets of the business for decades.
From long term care to 55 plus communities, you can use this framework to help you in any search.
No retirement home will check all of the boxes below.
The senior living business is complex and fraught with obstacles, but there are ways to ensure you pick the best retirement home possible based on your own unique needs.
99% of the content you read on retirement homes is written by the retirement homes themselves or they have paid someone to write the article.
Tilted as the kids would say.
How close the home is to a hospital, or how many parking spaces the residence has, are irrelevant to the culture of the community.
Below, we’ll help you focus on the deliverables – the things that retirement companies and great leaders can actually alter or impact.
Don’t worry about the age of the building or whether a property is for profit or not for profit – it’s not going to influence the daily life of your loved one.
So how do you transition from the life your family has always known to a brand-new environment that you have no experience with?
This guide will help reduce your stress to find the right home – no matter your geography, finances or family situation.
Many factors collide when making the decision to move into a retirement home and none of them are ideal. Typical scenarios include:
Your father-in-law has recently passed away – leaving your mother-in-law heartbroken and shattered, unable to do the simplest of chores.
You’re worried Mom keeps having cereal or toast for dinner so – so you make frozen dinners so she can eat half decently.
Dad can’t drive very well so you ferry him to doctor’s appointments because he keeps falling during the night – but his appointments are starting to interfere with your work.
You feel guilty as hell because you’re prioritizing your own family – even though your mother-in-law sounds desperately lonely.
A desire and need to protect against these life-changing events often fuels the decision to move to a place where more support can be provided, and companionship can be found.
Don’t Let Circumstances Dictate Your Need For A Move
Having observed and helped thousands of seniors and their families move into retirement homes, trust us when we say it is far better to be proactive in deciding which home you want to go to than being forced into a decision based on immediate need.
The reality is, at some point in our lives we’ll need a retirement home to restore some equilibrium in our life and restore some quality of life for the seniors we care about.
Since no retirement homes are created equal, there are some critical points of consideration to help you choose the best place to live.
1 – The Absolute, Most Critical Reason For Choosing A Retirement Home
The person in the role of Executive Director (or General Manager as some companies refer to them) is by far the most crucial point of consideration when choosing a home.
When I say by far, I mean far. Like Alaska to Patagonia far. Other considerations may be important to your unique needs, but none of them come close to this one.
It’s so important that who the ED is should be your main focus when you do your research. Not the food. Not the staff to resident ratios. Not the spacious suite. Review that stuff – but focus on the ED.
You will see lots of pedantic advice out there like proximity to parks or community amenity space. Items such as these do not impact what is vitally important – the day to day life and culture of the residence.
What really sets a great residence apart from the mediocre ones, is a great Executive Director.
You can uncover who the good ED’s are – and sniff out the bad ones as well – relatively easily. Ways to do that are below – however keep this scenario in mind:
If you’ve ever decided to take on a new job, you definitely thought of a number of different factors to help you make your decision.
Money is always nice, but who you work for always determines your happiness and longevity in the role.
During your life, you’ve probably worked for poor leaders in good companies, and good leaders in bad companies.
The point being is that your boss sets the tone for your environment – and that tone ultimately decides your happiness in the role.
Think about how you have reacted in the past to a crappy boss. Grinding you down over time.
Do you think retirement home leaders – from the Maintenance Manager to the Executive Chef – are any different?
The Executive Director Sets The Culture – Not The Company
The ED in a retirement home decides what the day-to-day culture is going to be in the building – for better or for worse. The environment or “feel” of a home has nothing to do with the company name on the signage, where the building is situated or how expensive a suite is.
In fact, whether the home is for profit or not for profit, 40 years old or brand new is totally irrelevant and will have absolutely zero impact on the culture of the team and how they care for you or your family member.
Zero. Full stop.
Here’s the secret recipe to outstanding retirement homes – great Executive Director’s build great teams.
Great teams kick ass, invariably resulting in higher standards of service, better product quality and overall better value for your money – hands down.
Poor Executive Directors are part time caretakers. Some of them can present a desire to make the operation better – but never actually do anything about it.
Overall, a poor EDwill set the tone for conditions in a building that you don’t want any part of.
A great Executive Director does an excellent job of hiring the right people – or better yet – holds the poor ones accountable. They promote a team dynamic that focuses on supporting each other and don’t allow petty grievances to supersede resident satisfaction.
While this may seem to be a simple and obvious approach to running a retirement home, it is far harder to achieve in reality.
Two things get in the way of hiring the right ED to hire the right team.
Stupid Companies.
Stupid Leaders.
Stupid Companies And Stupid Leaders Get In The Way
Stupid companies stunt the development of a great team. They have overly onerous processes to hire leaders, effectively taking the decision of who works for them out of their ED’s hands by micromanaging the crap out of a decision.
These companies often talk about employee culture ad nauseum with hundreds of boring LinkedIn photo ops, proudly displaying stale muffins with lukewarm coffee and a poorly hung banner proudly proclaiming 100% property response for an employee survey.
The property got 100% survey participation because they were heavily pressured to do so.
Stupid leaders sometimes go hand in hand with stupid companies. Stupid leaders span across organizations in many senior management roles. In senior living, they can usually be found in charge of strategy for retirement home operations.
We have been in too many homes where they’ve had 6 regional leaders in 6 years – that isn’t a talent problem – it’s a leadership problem.
All that does is make a great Executive Director’s life harder – so they leave for a little continuity and stability whenever they can.
Good (or great) General Managers can sometimes survive in a stupid company or with stupid leadership but it’s not easy.
Just Ten Minutes Of Your Time
Have you ever met someone through casual conversation and you instantly like them?
Have you ever met someone and through casual conversation you instantly felt like they’re a bit shady? Full of crap?
Of course you have.
Understanding whether someone is a good (or great) Executive Director, will only come from having a conversation with them – kinda like a quasi-interview.
You’re not grilling them about their last 4 jobs – they don’t matter. You’re just going to initiate a casual question and answer session by asking them for 10 minutes of their time for a few questions.
If you do nothing else when you go to look at a retirement home – this is the one priority you should have no matter what.
Do this before you sign a lease.
Think about it. When you buy a car or house, when you invest in a stock or any other decision that involves a lot of money, you do your research and ask lots of questions.
While the salesperson at the residence is normally skilled at answering your questions around the day to day life in the building and how your loved one will be cared for, you have to understand that once the sale has been made – they will move on to the next sale.
That salesperson will not control, nor have any influence on, the many factors that will undoubtedly impact day to day life after a senior moves in – which is why you’re looking for a good home in the first place.
The ED sets the tone – dig into what that tone is before you sign on the dotted line.
Retirement placement companies – some local – some national (like A Place For Mom or Caring.com), often advertise about helping you find a home for free.
How do they make money if the service is free?
The truth is, this “free service” always comes at a cost to you and your family, one way or another.
Companies that advertise this type of help usually refer you to the home that pays them the most.
That’s right, retirement homes pay these 3rd party referral companies directly. Usually a month’s rent or more.
These companies only refer to retirement homes in their network – so you’re missing out on half the homes in your area (sometimes more), if you use their services.
Even worse, some homes raise the rent to the resident, to cover the cost of the referral.
When you call them, your lead just gets sent out to the retirement homes that agree to be in their network – irrespective as to whether a home is good at caring for seniors or not.
These companies get paid when you move in – and they move on to the next lead.
So you don’t get to tour the best retirement community, the one with the best food or the one with the best culture.
You might want to rethink your approach for any company that offers a “free” service.
Uncovering Good (Great) Executive Directors
Ideally when you end up touring a building, you might be introduced to the ED at some point during the visit.
If this happens, it is a good sign – a good (great) Executive Director will try to find you during the tour to say hello and make some small talk about the building and address what the needs of your family might be.
However, this quick introduction is not enough – you are responsible for influencing a substantial emotional and financial decision.
Hundreds of thousands of dollars will likely be spent. Use this opportunity to ask for 5 or 10 minutes more of their time.
Prepare ahead of time a number of questions that will give you a better sense of the home and how it operates (use the link above).
How have they thanked their team in the past – candy bars and coffee – average appreciation – but handwritten notes on their birthdays? That’s a different story because it’s time and effort.
What programs or fun have they had with the residents (played bingo with them – meh – acted with them in a skit – fun!).
What does a good day look like for them? How many team members have been promoted from within? How do you communicate with families – and how often? What are you most proud of in your role?
Observe them around your loved one – do they talk to them directly? Do they show genuine interest in their well-being?
Answers to these questions and more will help give you a good sense of what goes on when you’re not around and how your loved one will be treated – and that’s what you really want to know.
Think of it this way.
What happens in the retirement home when you’re not looking?
When Bad Things Happen
Troublesome scenarios seem to crop up quite often in today’s environment. Heat waves, ice storms and floods on one hand, crippled power grids, recessions and critical supply shortages on the other.
Demanding situations can develop quickly to challenge retirement homes in a blink.
No retirement home is immune to these types of events – they’ve had them and will continue to have them.
Smaller issues such as the breakfast cook calling in sick or suddenly having the water shut off during dinner seem to happen regularly.
How the team reacts to the large and small crises will regularly impact one’s enjoyment of a retirement home.
A strong leader thinks strategically about how to mitigate the impact those situations can have and works proactively to protect the safety and well-being of your loved one.
Bottom line – if the team has been trained well – they will respond well.
Good leaders can make those wrongs right or at the very least make those situations more manageable because they’ve trained their teams well and they lead their teams well.
They understand what service recovery means and are genuine in their approach to solving the problem.
If they’re not sure about what to do next they will communicate that they don’t have all the answers.
Great teams work together, support each other and challenge each other. This doesn’t happen without a good leader.
Challenging scenarios will invariably happen, which just reinforces why who is in the Executive Director role is so pivotal in your decision.
You’ve Worked Here How Long?
I can tell you with certainty that working in a retirementor long-term care home does not make you rich.
In fact, you’re probably well aware that wages for frontline team members (and most department leaders) are subpar for the work that they do. We all agree on this.
Working with seniors can be very fulfilling – what a lot of people would call a “second paycheck”.
There is intrinsic value to these roles – when you help seniors who are vulnerable to have a better day – it makes you feel good. It’s what our seniors deserve and it’s what they’ve earned over their lifetime.
However, that second paycheck can only go so far if you observe a home that is chronically understaffed, has poor processes and most assuredly poor leadership.
Remember the point earlier about who you work for decides your happiness in the role and your longevity in the position?
Team members in a retirement home are no different – and given the transitory nature of low paying jobs – the longevity of team members in the homes you review should be a part of your considerations.
Having long tenured leaders and long tenured team members usually points to staff that are happy with what they do and in turn will deliver a level of service that is worthy of the money you will spend living in a retirement home.
Constant turnover is an issue with leadership – not the market.
Retirement Home Insider Tip:The Myth OfStaff To Resident Ratios
A common perception is that a higher staff to resident ratio actually results in a better run retirement home.
Most of the time, this simply isn’t true. Higher staff counts do not necessarily equate to a better experience.
If the team is not organized, or the department that is heavily staffed is not a department you’re using, then staffing ratios are irrelevant.
The only time it potentially leads to better outcomes, is with the number of nurses on shift, and the overnight shift.
Even then, they still need great leadership. They need to be organized in order to execute well.
Most staffing ratio discussions are a bit of a marketing schtick. Sometimes regulatory obligations on the care side will dictate staffing levels, or union sponsored collective agreements are structured to manipulate a staffing number.
Staffing ratios should be resident focused, based on their needs and security, not politics or marketing strategies.
Unfortunately, a higher staffing ratio doesn’t mean better trained team members, or more personalized service or guarantee that the extra team members are going to the department most important to you.
Don’t fall into the trap of thinking more staff equals better care or support, because it doesn’t guarantee better service.
2 – Programming Drives the Vibe!
I once picked up an “activity” calendar in a retirement home that highlighted each day the times when the community gift shop was open.
It was accompanied by a time clock graphic and according to the calendar, was one of two events that were to occur that day.
Rolling eye emoji.
Programming (or activities) are often overlooked in comparison to other aspects of a home’s operation.
Culinary & Dining are often front and center along with Care Services – these are aspects of the operation that gain considerable attention.
To be sure those things are important but if your loved one spends 3 hours a day at meals, what is engaging them the other 13 or so hours they are awake?
How will they get to know and meet with other residents? How does the building promote an overall sense of community? Isn’t that the reason that they’re there?
We are naturally social beings who are wired for social and physical interactions.
We need a balance between the times that we read a book or watch TV, with interactive events that entertain us through others.
These interactions provide us with the mental, spiritual and physical stimulation to keep the mind and body fresh – which becomes even more important as we age.
Unique events, classes for learning and simple entertainment provide additional opportunities to meet others, challenge ourselves and live fulfilling lives.
The most basic type of programming involves an exercise class – most homes have exercise programs of one form or another. Nothing special here.
When you tour a retirement home, ask for a current copy of their program or activity calendar.
The depth and breadth of the content will tell you a great deal about the time and attention they put into their residents’ complete wellbeing.
What to Look For In A Retirement Home Calendar
Hallmarks of an excellent retirement home calendar:
Programming should take place at all times of the day. Are programs repeated? 6-8 programs per day is a good start.
Do the programs look simplistic or childlike, or do they read like something you’d like to try?
Are programs themed – i.e. – do they crossover into the food menu, or run for more than one day? That takes time and organization – these are good indicators of a top-notch Recreation Director/Executive Director.
Is the calendar simply a calendar – or is there more to it (like a message from the GM, potted plant gardening tips, etc.).
Do weekends look barren? Programming on weekends should be just as fulsome as they are through the week. Strong weekend programming speaks to care for the residents, not the convenience of the management team because everyone is off.
Is there a wide range of activities? There should be a broad spectrum of physical, educational and spiritual programs to go with the usual card, bingo and fitness programs.
One way to double check the quality of the activities is to tour and be present when a program is being run. To paraphrase Yogi Berra – you can observe a lot just by watching.
You’re Downsizing to 65,000 sq ft.
Most older buildings were not designed with programming for congregate settings in mind.
This is unfortunate, as larger spaces tend to enliven buildings and promote community within the community.
In fact, since operators and banks use a revenue per square foot calculation to decide the size and scope of the property, operators aren’t incented to expand common area offerings.
Luckily, some operators realize the importance of this space or work around their limitations.
Newer buildings should have lots of open room and seating designed to encourage group gatherings or a series of smaller nooks for conversation.
Good operators in smaller homes will not only use outdoor spaces when they can – but they will use the dining room in between meal periods to stimulate a sense of community.
Newer buildings should have small sitting areas for conversation, with relaxing views of the outdoors and the ability to get some fresh air. Any garden space or walkway for seniors to get their own exercise at their own pace is always a plus and is usually well used.
Pools are of immense benefit for residents for a host of reasons, however, pools are more idealistic in nature than practical in use.
Everyone oohs and ahhs over a pool – they are strong selling features for sales directors, but rarely are they used by more than a dozen residents in a building with 150 residents.
It’s a great feature if you wanted to swim, however chances are good that your loved one won’t ever use it.
When you tour – look for common area spaces that are designed for seniors to use.
TV’s can be an important part of common area spaces – but shouldn’t be the central theme.
Areas for a greenhouse, communal kitchens, private dining rooms, a theatre for movies and presentations, puzzle/craft rooms and tiny nooks to read the paper or chat with a companion should be tablestakes when you tour.
Another sign of great programming is when the team members get into it.
Like half the team has a ridiculous wig on during “Crazy Hair Day”, or equally ridiculous sweaters being worn by the team during “Ugly Sweater Day”.
Events like Hallowe’en or St. Patrick’s Day are easy dress up days – everyone does them – but excellent homes find reasons to look and act a little silly with their residents.
Are team members participating in the home’s activities? Do they look like they are having as much fun as the residents?
You’re looking for a sense of community when it comes to programming. When the team and residents create that community together, you have something pretty special.
3 – Between Bites – How to Review The Entire Retirement Dining Experience
Think about the best meals you’ve ever had in your life.
You probably have a few fond food memories that make you swoon, hoping to one day recreate the magic of the meal.
The food was probably very good. It probably involved friends, a partner or family. It probably also involved either unique surroundings or a unique event. A destination restaurant, a hole in the wall bistro during vacation or a supper club with your neighbors.
Exceptional meals are never just about the food. It’s always about the entire experience.
Capturing the entire experience of a retirement home dining room, is something you want to learn about prior to moving in.
If you’re in the touring phase to see which retirement home deserves your money, having lunch during the visit is a staple of the sales process that every home uses.
Your salesperson will try their best to arrange lunch for you – even if you drop in unannounced.
However, lunch during your tour is probably the worst indicator of how good the regular meal experience is going to be.
The Tour is Staged – So Is Lunch
Lunch during a tour is a one-sided affair.
They know you’re coming. You get the best table – impeccably cleaned and perfectly presented. You get the best server, and the Executive Chef makes your meal.
You can have whatever you want, and they will generally put their absolute best foot forward.
This experience will clearly not be the norm. Another way to look at it – what would happen if your neighborhood restaurant knew when the local food critic was coming? Do you think their experience would be different than if they came secretly and unannounced?
They’d get the best server, with the best table, with the best cook….it would probably be a totally unique experience, as opposed to the common one.
Free food, however, is free food. Don’t turn it down. When you go for lunch, keep the below points in mind.
If you can, go more than once. This time, go for dinner when most of the management team isn’t there.
You want more than one staged meal experience. You’re looking for consistency in service, food quality and ambiance.
You’re looking for clues to figure out what the “regular” resident dining experience is.
The Five Hallmarks Of Genuine Hospitality
Most of us have a favorite restaurant we love to go to. The mainstay when you just don’t want to cook. Do you ever think about how your favorite restaurant came about?
The food is consistent with excellent value for your money. You like the vibe and ambiance. You definitely have a favorite server and lots of regulars to chat with. There’s probably a general sense of community that makes you feel welcome.
You go there for the overall experience because of how it makes you feel.
We would call that Genuine Hospitality.
A number of senior living homes manage to do this very well. You get a sense of professionalism and empathy when you walk through the main doors and hopefully the dining room doors.
Many homes, however, struggle from poor leadership leading to significant turnover with nonexistent onboarding and training. These properties are doomed to repeat their mediocre offerings to seniors.
When you’re dining and touring, keep an eye out for these five hallmarks of Genuine Hospitality:
Authenticity – is the server or host greeting you with natural warmth and easy conversation?
Details Matter – when you pull out your chair are there crumbs on it? Sugar Bowl mostly empty? Tired and greasy salt and pepper containers?
Personalization – does anyone know your name, and do they use it? Do they ask about potential allergies? Can they alter menu items to accommodate differing diets?
Anticipation – does the server refill your water glass before you need to ask? Do they know the ingredients of a dinner special when you ask because they’ve already seen the meal and they’ve tried it?
Guest Service – Do they walk you to the table? Pull out your chair? Smile when you talk? Wait until you’ve finished talking before speaking?
There are of course additional traits in Genuine Hospitality, but this is the essence of what you’re trying to uncover.
In the end, do you feel like you are their guest or are you their customer?
Care In Presentation – Means Care In Preparation
“You Eat With Your Eyes”, is one of my favorite sayings.
Early in my career, I worked with an Executive Chef who said that during a banquet because I didn’t wipe a plate properly and stopped me from leaving with it. It stuck, because he was right.
When a retirement home takes care in their presentation, you can safely assume that means they put care into their food preparation.
From the glassware you’re drinking out of, to the color/heights and props on a lunch buffet, or the way the food is coming out of the kitchen on a dinner plate, it all tells a story.
Putting effort into these aspects of the operation requires forethought and care. Someone, somewhere, really gives a shit about how the food looks before you’ve taken a bite.
That’s because if a meal coming out of the kitchen already looks great – you’re naturally inclined to think it tastes good. Chances are better than good that the same give a shit approach that was taken with your food presentation, is also taken with food quality.
I would posit that care in presentation also extends to food safety, because the food operation in this environment is definitely not an afterthought – it’s a centerpiece.
Please! No More Chicken!!
I was once doing meal checks at lunch at a retirement home and one of the residents said to me “If you put any more chicken on the menu I’m going to grow feathers.” The point was a good one and a common complaint in senior living foodservice.
It’s tough to execute well balanced and nutritional meals with variety,7 days a week.
Everyone has either made their own meals for decades with recipes that have been passed down for generations, or they have certain meat or starch rotations in their menus, that just won’t be replicated in a retirement home.
There’s too much garlic in the mashed potatoes. Why are you putting raisins in the bread pudding? The soup is too spicy – the soup is bland and tasteless.
You’re usually serving a hundred odd food critics every day, twice a day, 365 days of the year.
With that comes the monotony of sitting down and getting tired of the same old meals.
Strong operators have a lot of variety in their a la carte menu and standard menu.
Homes should offer 2-3 menu choices per meal and should have at least 5 “main” options on the a la carte menu for residents to choose from if they don’t like the daily offerings.
Options for your menu choices is a good thing. Sometimes you just want a grilled cheese or fried eggs for dinner.
One last item here – ask for a copy of the last food committee minutes. That will tell you a lot more about what goes on when it comes to menu development and quality complaints.
Looking The Part!
When you go for a job interview, a first date or a nice dinner, you want to look the part.
You put your best foot forward in terms of how you present yourself. You care about how others view you.
First impressions are a thing.
Dining Rooms and Bistro’s should be no different. Those areas should be arranged beautifully to put their best foot forward so you’re already assuming your experience will be a good one.
Care in presentation definitely extends beyond the plate. For instance, ask whether the community has seatings or can residents eat whenever they wish?
Seatings are like a cattle call and not very pretty to watch. However, some residents like the comfort of knowing when they will eat and that they’ll get their favorite seat.
Assess the overall image of the space – when you walk into the dining room, are you greeted with a smile?
Do the team members look professional with nametags and a clean uniform? Hair tied back?
When you go to the table, use the “Rule of Three” to evaluate the table setting:
One – the tabletop – is the cutlery setting clean and square – not tossed on the table?
Condiments (if any) clean and well presented? Glassware clean? Some sort of centerpiece? Look at tables other than your own….
Two – the chair – no crumbs on the seat when you pull it out? No stains? Does the chair itself feel sticky?
Three – the floor and table base – does the table base look like it’s been cleaned recently? The floor around it has been vacuumed?
Finally, look around the room. From plastic plants, to decorations, to valances – are they clean and well presented?
Does the room look like it has been purposefully arranged or does it look like a collection of randomly placed knick knacks?
4 – Your Peace of Mind Starts with Safety & Security
We’d all love to live a long healthy life – surrounded by family and loved ones – stay active and have a lot of fun while doing so.
Except we don’t get to choose what our later years look like. The reality is that all of us will need some support along the way.
We definitely don’t like to think about it. It’s uncomfortable. We’re wired for today and we always think we’re younger than we really are.
Support for a seniors wellbeing can be simple and emotional – like a reassuring smile at the dinner table or getting to see an old friend who you haven’t talked to in a while.
Support can also be functional, in the form of daily med reminders or getting driven to the grocery store.
But the tangible support of the entire retirement home team is something your family is counting on when you’re not around.
Many properties have nursing and personal support workers staffed and on site based on the acuity of the residents in the community.
More independent retirement communities should still have access to local medical support – companies they partner with to help their residents as they age.
When you’re touring – ask yourself – what support does your family need, and is this home meeting it?
When You’re Sleeping – Who’s on Guard?
If there was a sudden emergency, any company worth their salt will tell you that it’s all hands-on deck.
The GM lives close by, our emergency plans are up to date, here are our emergency supplies and so on.
We all know emergencies happen – sometimes we can prepare for them (like a hurricane or an ice storm), but sometimes we don’t see them coming (like fires).
It would be super helpful if emergencies conveniently occurred during the day when there’s a couple dozen people around.
Murphy’s Law would like a word – it rarely happens that way.
How many staff are actually on the property – not available – but on site – during the overnight hours?
Usually, the home’s fire plan mandates how many staff need to be on site, but we have been in way too many homes where the fire plan wasn’t followed. Regulated does not always mean enforced.
Overnight staffing is an area where some operators try to cut costs. They see it as wasted labor and a straightforward way to save a few bucks.
Simply put, however, the size of the home – and the bigger the footprint – the harder it is to evacuate.
The more complex the needs of the residents are, the more resources are needed in an emergency.
The bottom line is that the more team members that are there during an emergency, the better the outcome – especially if an evacuation is required.
But overnight staffing is not just about emergency preparedness.
Retirement Home Insider Pro Tip: The Myth Of Safety Pendants
Almost every retirement home provides or offers safety pendants or call buttons, which, in theory, is a very valuable safety measure.
However, in practice, a tiny minority of residents actually use these pendants during an emergency.
This is attributed to various reasons, such as cognitive issues causing residents to forget they have the pendant to a reluctance to “trouble” the team.
The good news is that advancements in technology are transforming this area.
Intelligent in-room monitoring systems that can detect falls and trigger alerts are becoming much more sophisticated and effective, all the while maintaining residents’ privacy and dignity.
Protecting The Vulnerable And The Valuables
One of the most rewarding aspects of working in senior living is that you’re tasked with protecting the vulnerable.
When you work in the sector, you can see why people become doctors or nurses – careers in senior living make you feel good.
The flip side is that there are always those who look to take advantage of vulnerable seniors – unfortunately thieves and scoundrels abound.
Even innocuous events can lead to disaster – like contractors who prop open a little used door and forget to close it, happen on an astonishingly regular basis.
While this list is not exhaustive, in order to delve into a home’s safety measures, look for (or ask about) the following practices:
How many team members on the overnight? When do they lock the front doors and how often do they do perimeter checks? (checking to make sure all exterior doors are locked).
Do they sign off on the perimeter checks? Do they ever employ security guards?
Cameras – how many do you have and where are they located – (all exits should be covered). How long is footage kept before it overwrites itself?
Is the footage stored onsite or in the cloud? Are there certain areas of the community where access cards are required?
How often do they do fire drills? (Three a month should be the standard – one per shift). Do they practice fire drills on the overnight – and how?
What does the entire team get trained on?
Resident Education programs – how does the home help seniors avoid cyber scams, mail fraud and telephone fraud?
Proactive support around safety is what you want to see from your retirement community.
Nurse On Site – Not “Nurse on Duty”
Many retirement home websites refer you to their checklists to help you get a better handle on retirement living.
One common checklist asks you to tick some boxes on what physical amenities a home does or does not have, from private dining rooms to Bistros.
This is a mostly useless exercise and not the important part of your tour.
Aside from a pool, almost all homes have the same amenities – they’re just a different shape, size or color.
In mostly independent living communities, one of the most important questions in a checklist should be whether there is a nurse on site 24 hours a day, 7 days per week.
Some homes try to cheap out and say a nurse is only a phone call away and say a nurse is always on duty….what you want is a nurse that is always on site.
Nurses are not only trained in what to do in medical scenarios, but they are trained in all aspects of emergency response.
They take charge when emotions are high and that’s exactly what you need in an emergency situation.
Nurses also have a wide scope of life and death/critical thinking experience and training that helps them navigate situations that you and I would have trouble with.
Having a nurse available 24 hours a dayis irrelevant when it comes to resident safety.
An on-call response lacks the presence of a composed leader when navigating a crisis.
In an emergency during the overnight hours, when there are the fewest team members around – having a nurse present immeasurably reduces risk and harm to the home and to the residents.
Wellness Checks
Residents in retirement homes have always complained to their managers that “This place is turning into long term care!”, as they see their fellow neighbors age in place and new residents struggle with adjusting to the home.
It’s always fascinating to see the cognitive dissonance that occurs between what people see in others and how they view themselves.
Often residents don’t recognize their own aging, which is where the support piece of living in retirement comes into play.
A number of homes will have some sort of “wellness check” written into their lease that compels the operator to “check in” on residents at mealtimes, usually through a census to ensure residents are doing ok.
This is an excellent operational exercise even for fully independent residents because of one common concern in particular – falls.
Falling represents one of the greatest dangers to seniors as they age. One fall can lead to a host of health-related issues that impact their quality of life for months or that they potentially never recover from.
Wellness checks are mandated in some states and provinces for a variety of senior living communities.
Mandated or not, the process of wellness checks is often boring and mundane, and the proper execution of these checks sometimes get lost in the shuffle of day-to-day responsibilities.
Ask what a home does for wellness checks – how often do they do it and is the compliance of wellness checks in the lease?
The Sum Of The Parts Is Always Greater…..
Try taking away a senior’s driving license.
It is often about as contentious as selling the family home.
It has become one of those thresholds for independence that most people cling to as long as they possibly can.
How independent your loved one wants to remain probably factors in heavily when choosing a retirement home.
That’s why some full – no care – independent residences can thrive,while other seniors opt for full continuums where residents can maintain some measure of independence, but the support is there when they need it.
Both styles of home can benefit your family, as long as there is a safety net in place.
Irrespective of the type of residence you’re considering, make sure you understand what medical support is available – both for consultation and for an emergency.
Outbreaks are another consideration.
One of the issues of concern living in retirement, has to do with outbreaks.
Outbreaks occur when there is the spread (or potential spread) of viruses in the home.
These usually come with restricted activities/gatherings, enhanced cleaning protocols and restrictions on meal service and confinement to your room.
The longer the outbreak – the harder it is on residents – isolation and loneliness is a real killer.
Homes well practiced in infection control, limit the size and duration of outbreaks.
Does the home have access to a variety of practitioners from dentists to podiatrists? What was the property’s protocol during their last outbreak if there is no nursing on site?
Do they have a network of volunteers established to support the residence?
If a resident fractured their wrist – is physiotherapy available either in house or through a third party?
If you wanted to reduce your salt intake, can you talk to a dietician for some tips?
Skilled operators provide as wide a safety net as possible that is proactive in providing support either in house or through external partners.
Discover what services are available to you, as the support your family needs today may be quite different than the support you need tomorrow.
In 2019, according to the US Fire Administration, there were almost 107,000 fires in the United States in multi-family residential buildings which include retirement and long term care homes.
Still Important – Odds & Ends
Proximity To Friends & Family
If this is your first move into a retirement community, understand it will be emotional and trying at times.
Being close to your family really helps when they need the support – especially in the early days, or if there’s been a health scare/loss of a loved one.
If you can, have friends or family make frequent visits during the first couple of weeks – there is an adjustment period as it takes time to get used to the new surroundings.
Dollars & Sense
Companies chase month and quarter ends to meet their budgeted goals.
This is especially true for companies that are publicly traded. Use this knowledge to extract the best possible deal.
Reducing rent as an incentive should always be your goal. The compound impact from rent increases over time is just too great.
Carefully review the lease at your leisure. Pay attention to exit terms, credits for being away and what condition of the suite you are responsible for when you depart.
Most properties will give you a blank lease to review.
Finally, find out what is included in the rent. Find out what are costs are associatedwith services not included by asking for their CHIP or Fee Schedule.
Doctor Doctor
Most retirement homes have a doctor or nurse practitioner (or two) that are available to roster new residents to a community. This is much more prevalent in communities that offer care.
Some properties may have access to specialized medical care from gerontologists to dentists.
The larger the network of specialized medical assistance available – the better. What you always want, are options.
Those of you in the US with medical insurance, your policy should layout what practitioner referrals are covered and what costs may be out of pocket for those outside of the network.
The more specialists that visit the property, the better.
New Builds vs. Older Buildings
Trying to decide between a new build and an older building? Both have their advantages as well as their share of potential problems.
One is not necessarily better than the other – it’s all about personal preference, and of course the Executive Director.
With new builds you really want to do your due diligence on the company or operator.
Operators will usually appoint an ED 6-8 months prior to opening.
With older buildings you really want to do your due diligence on previous annual capex investments, and upgrades. Are the owners milking the property or are they reinvesting to better support the residents and their families?
Transportation
The residence should have some semblance of safe and reliable transportation arranged.
Most homes will have a bus or car that goes on local trips for sightseeing and groceries.
Upscale properties should have a car service available for sign up for appointments and trips. Sometimes these are included in your rate – sometimes it is available at an extra cost.
If the community doesn’t have a vehicle, they should have an arrangement with Lyft or a cab service. Sometimes they can bill the resident account directly.
Property Audit History & Reviews
Audits in the United States vary from area to area with the state regulating what thresholds trigger an audit and how often regular compliance audits occur.
These audits are more care based and focus a lot on assistive living and skilled nursing facilities, as opposed to day-to-day operations.
Audits in Canadian provinces are a bit broader in nature and focus heavily on training, record keeping as well as the care aspect of the property.
Google or Perplexity will help you do a bit of digging on how reviews and audits stand with the property you’re considering.
Use the company name for properties that are new builds.
Keep in mind – any audits older than 2-3 years may not be relevant if the leadership has changed.
TL;DR
Community senior living can be a wonderful experience. Don’t wait to get forced into a choice.
The person in the role of Executive Director should be the most important determining factor in choosing the Best Retirement Home possible – focus on this during your tour.
You want to ensure the programming calendar is fulsome and meaningful, engaging your loved one throughout each day.
You’ll want to review the overall dining experience of the residence, looking for attention to detail and Genuine Hallmarks of hospitality, not just the food when having a meal.
Dig into whether the overnight staff are trained well – emergencies are going to happen – but is the home prepared, and is the home safe?
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