Visit assisted living facility before deciding to move in

Make sure to discuss payment for care with administrator

The decision to move out of one’s home and into independent living or assisted living is one of the most difficult to make and typically is made after a series of events or observations, often by an adult child.


Linda MowBray, director of the Kansas Center for Assisted Living, said adult children often see deficits with their parents when they come home for the holidays that aren’t as obvious when they’re just speaking on the phone.

“The house isn’t kept quite as it used to be, or medications may be a little askew,” she said. “Lots of things will trigger that conversation of ‘Is it time to either get more help for mom or dad in their home?’ or ‘Is it time to move them to another setting where the care is coming to them?’”


RELATED: Read more retirement stories in our special section here.

MowBray said assisted living fills the gap between the ability to stay at home and needing full-time, 24-hours-a-day nursing services at a nursing home. A physical impairment or a cognitive issue will determine what kind of facility is right for a parent or parents.

“Those are very different types of care and very different settings,” she said.

When touring a facility, it’s imperative the adult child take into consideration what is important to his or her parent, not what is important to the adult child, MowBray said. It’s good to visit before moving into a facility to see if the physical, living space is comfortable, or in the case of a potential resident with a cognitive issue, if the social gathering spaces feel inviting.

Paying for care

One of the first questions that should be asked, MowBray said, is how the fees for the assisted living facility are going to be paid.

“Medicare does not pay, because these (assisted living) homes are licensed by the state only,” she said. “They’re not federally licensed like the nursing homes, so Medicare is off the table for paying for room and board.”

Medicaid, the state’s KanCare program, also doesn’t pay for the room and board of a resident of an assisted living facility, MowBray said. However, KanCare can pay for assisted living through the Home and Community Based Services waiver program.

“They can help pay for some of the nursing care or meal preparation or things like that,” she said, “but it’s very limited and not all assisted living (facilities) accept the HCBS program, the KanCare program.”

MowBray said ways to cover the cost of living in an assisted living facility include:

• Private money.

• Long-term-care insurance.

• Veterans Affairs’ Aid and Attendance.

The cost of the care will depend on the model chosen by the individual or family, she said. Some of the models include an all-inclusive rate, and some have room and board costs with add-on charges.

MowBray said an individual needs to ask how the facility prices their services and how often they have rate increases.

“The state does require a 30-day notice when rates are going to change,” she added.


Looking critically at a facility

The key to evaluating an assisted living facility is to determine “what the facility isn’t” rather than what is currently there, MowBray said. She and KCAL staff talk to the organization’s members about ethical marketing and being honest about what services are available and which aren’t, which she calls the “deal breakers.”

“The care that the person needs and the care that they might need in the future — those are things you have to consider,” she said.

Security is a key component of any facility, particularly if there are cognitive issues for the resident. MowBray said the following questions should be asked:

• Is it a secure environment?

• Is wandering an issue?

• How will my loved one be kept safe?

• How will other people who don’t have cognitive issues still be able to come and go and have access?

It’s a good idea to ask the facility staff what they do with people with dementia who might be at risk for wandering. MowBray said they should be able to articulate their protocol for handling those types of situations or be able to say they aren’t a locked facility.

“If cognition and wandering becomes too great of a risk for the individual, that’s a deal breaker,” she said. “That would be a time when we talk about moving to another location. Knowing that on the front end can help you.”


Facility inspections

MowBray said assisted living facilities in Kansas are regulated and are supposed to be surveyed annually by the Kansas Department for Aging and Disability Services.

“The regs are a framework to keep people safe and autonomous, but they’re not prescriptive,” she said. “Unlike a nursing home, there’s not a staffing ratio. The regulations say you have to have adequate staff to meet the needs of the people in your care.”

If a complaint is filed against any one of the 212 assisted living facilities in Kansas, she said, there is a process that KDADS follows to respond to the complaint. Information and inspection reports are available on the KDADS website, Go to the “Adult Care Home Directory and Inspection Reports” link under “Quick Links.”

While each facility is supposed to be inspected annually, they can be inspected more often if there’s a complaint or other issue. However, MowBray said, if a survey team “gets a little bit behind,” a particular facility may not get an inspection in a given year.

“Right now, about 35 percent of all assisted livings are deficiency-free,” she said. “That’s a wonderful thing.”


Inquire about staffing

Questions about the longevity of upper-level staff at a given facility are fair to ask. MowBray said a Core Q survey that is conducted by the facility and assesses the satisfaction of residents and their loved ones should be available.

“That Core Q program comes down to the basics of ‘Would you refer this facility to someone else?’” she said. “The facilities that have a high Core Q score, those are the ones your friends and neighbors … said, ‘Yes, I would feel comfortable telling you to put your loved one there.’”

MowBray and other assisted living professionals indicate an industry-wide recommendation says it’s OK to visit a facility unannounced, even on a weekend or an evening. However, the administrator or upper-level management personnel likely won’t be there.

“(They) should still have somebody there who is willing to show you around, give you a business card, give you a brochure,” she said. “Then call and make that appointment to come back in and talk business with the business people.”

MowBray said the feel of a facility is important.

“Different settings please us in different ways,” she said, adding that the buildings should be clean and well-kept. “But they don’t have to be the Taj Mahal.”

Related: See the digital copy of the 2016 Retirement Special Section here.

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Here are some questions to ask before signing a contract with an assisted living facility or skilled nursing home:


When is a nurse on duty in the facility?

Who pays for transportation for medical purposes?

How much will it cost, including add-ons to the rent? Is there an extra cost for specially prepared meals or laundry services? A parking fee?

What is the cost and policy on telephones/televisions and cable TV hook-ups?

Are pets allowed? If so, is there an extra deposit?

Will the home or facility accept Medicaid payment for service?

Can the rent be based on the resident’s income?

Are there any restrictions on visitors or overnight guests?

How are cleaning standards maintained? Does someone inspect the apartments? Are the inspections announced or unannounced?

What is the policy on retaining the apartment if the resident needs to be hospitalized for a while?

What are some situations that may cause an increase in the rent and services?

What are the conditions under which the resident can leave the facility?

Before signing a contract with an assisted living facility or skilled nursing home, read the contract thoroughly and fully understand its terms. Keep a copy and refer to it when questions arise.

Source: “Explore Your Options: A Kansas Guide to Information and In-Home Services,” by the Kansas Department for Aging and Disability Services


Prime Time, a special section in Sunday, Oct. 10, 2016's issue of The Topeka Capital-Journal, explores the issues facing individuals as they approach retirement age, including downsizing and housing options, financial planning, questions to ask when transitioning into an independent living or assisted living facility and caregiving considerations.

The special section also features a directory of amenities at independent living and assisted living facilities in northeast Kansas, as well as a list of community resources that senior citizens and their families may find helpful. Additional stories and photos can be viewed at