| Your Observations about the Living Space and Accommodations |
| A |
B |
C |
|
| ____ |
____ |
____ |
Is the building well-lit? |
| ____ |
____ |
____ |
Is the building clean, well-maintained and free from unpleasant odors? |
| ____ |
____ |
____ |
Are there adequate community areas for resident use? |
| ____ |
____ |
____ |
Are events such as activities and dining menus posted in an easy- to-read location? |
| ____ |
____ |
____ |
Are there handrails in the hallways to aid ambulatory residents? |
| ____ |
____ |
____ |
Are the resident rooms furnished or unfurnished? What is the policy about personal belongings? |
| ____ |
____ |
____ |
Can residents have automobiles on-site, and if so, is there assigned parking or an extra fee? |
| ____ |
____ |
____ |
What types of security does the residence provide? |
| ____ |
____ |
____ |
Are pets allowed, and if so, are there additional fees or deposits? |
| ____ |
____ |
____ |
Are the rooms and bathrooms large enough to easily accommodate residents who use a walker or wheelchair? Is the building easily accessible for those using a walker or wheelchair? |
| ____ |
____ |
____ |
Is the temperature in common areas comfortable? (Remember: Many seniors prefer a warmer environment.) |
| ____ |
____ |
____ |
What systems are in place in the event of an emergency, i.e. a call system or other emergency alert device(s)? |
| Your Observations about Staff |
| A |
B |
C |
|
| ____ |
____ |
____ |
Did you receive a warm greeting from staff welcoming you to the residence? |
| ____ |
____ |
____ |
How do staff members interact with residents? Are they courteous and friendly? Do they smile and address residents by their names? |
| ____ |
____ |
____ |
How do staff members interact with you? Are they friendly to family members and willing to interact and answer questions? |
| ____ |
____ |
____ |
What training programs and qualifications are required for staff? Are there ongoing training programs provided for staff? |
| Questions to Ask about Services Offered |
| A |
B |
C |
|
| ____ |
____ |
____ |
Does staff assist residents in administration of medication? If so, what kind of staff? |
| ____ |
____ |
____ |
Are there professional nursing services on site, and if not, does the staff assist residents and families in making arrangements through a home health agency? |
| ____ |
____ |
____ |
Are physical, occupational, and speech therapy available or arranged? |
| ____ |
____ |
____ |
What types of housekeeping services are offered or available, i.e. linens, towels, laundry, etc.? |
| ____ |
____ |
____ |
Is transportation provided for medical appointments and recreational purposes? |
| ____ |
____ |
____ |
What are the options regarding meals? Are three meals offered daily? Are meals available only at set times, or when the resident requests them? |
| ____ |
____ |
____ |
Does the residence accommodate special diets? Does a dietician or nutritionist review the menus? |
| ____ |
____ |
____ |
Are physician services offered on-site and will your insurance cover those services? |
| ____ |
____ |
____ |
Are meals only offered in a common area or are they available in resident rooms? Can guests dine with the resident in his/her room? Is the option of private dining available? |
| ____ |
____ |
____ |
Are there scheduled activity programs that meet your needs? |
| ____ |
____ |
____ |
What systems, if any, are in place to accommodate dementia or other cognitive impairments? |
| ____ |
____ |
____ |
Does the community offer spiritual/religious programs to meet your needs? |
| ____ |
____ |
____ |
What levels of service are available? Are there different packages offering varying levels of service based upon need? |
| Questions to Ask about Residence Procedures |
| A |
B |
C |
|
| ____ |
____ |
____ |
Does the residence perform criminal background checks on employees? |
| ____ |
____ |
____ |
Does the residence have a "visiting hours" policy, or are family members welcome at any time? |
| ____ |
____ |
____ |
What is the residence's billing procedure? Request a copy of basic monthly costs and a schedule of additional service fees. Are financial disclosures necessary to determine fees? |
| ____ |
____ |
____ |
Under what circumstances may the fees change? How much notice is given about a fee increase? |
| ____ |
____ |
____ |
Can contracts or agreements be modified as needed? |
| ____ |
____ |
____ |
If you need hospital or nursing home care, is your room held? What are the associated fees? |
| ____ |
____ |
____ |
Do residents need to purchase renters' insurance for personal property in their units, or is it covered by the establishment? |
| ____ |
____ |
____ |
Is there a resident council and how often does it meet? What are the procedures for filing a complaint? |
| ____ |
____ |
____ |
What are the community's discharge policies? What are the limits on the type of care it is able to provide? |
| ____ |
____ |
____ |
Does the residence subscribe to a set of resident rights and responsibilities? If so, ask to see them. |
| ____ |
____ |
____ |
Be sure to ask for a copy of the disclosure contract for later review. |
| Licensure and Certification |
| A |
B |
C |
|
| ____ |
____ |
____ |
Is the residence required to be licensed? |
| ____ |
____ |
____ |
If yes, ask to review the last licensing/certification report. |
| What to Take Home with You from Your Visit |
| A |
B |
C |
|
| ____ |
____ |
____ |
Financial disclosures, services disclosures or a sample contract |
| ____ |
____ |
____ |
Brochures about the residence |
| ____ |
____ |
____ |
Names of individuals to contact with questions |
| Your Comments and Observations |
| Residence A: |
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Residence B:
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Residence C:
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