Assisted Living Community Evaluation Checklist

Community Name: _________________________________________________ Contact Name: ____________________________________________________ Address: ________________________________________________________ Telephone: ______________________ Email: __________________________ Date Visited: ____________ Circle: First Visit Second Visit Third Visit

Day of the Week:________ Circle: Morning Afternoon Evening

Floor Plans and Accommodations

Is the floor plan logical and easy to follow? Is the property compliant with the Americans with Disabilities Act? What different sizes and types of living units are available? Are the available units an appropriate size for the resident’s needs? What is the square footage? Do any living units have kitchens or kitchenettes? Does the bathroom have grab bars and emergency call buttons? Circle the utilities that are included: Electric Gas Water Trash/Sewer Other Circle the in-home amenities that are available. Is there an extra cost? Phone TV Cable Internet Other Circle common areas in the facility: Living Room Dining Room Den Library Snack Area Game Room Other Are living units furnished or unfurnished? Can residents and visitors come and go at will? Is there a parking fee for residents or visitors? Does the community have parking options such as carports or garages? Is there an extra cost? What kind of security is provided? Key or code access, gated entry, security patrols, etc? Is smoking allowed? If so, where? Is there an emergency generator or alternate power source?

Healthcare Services

Is there a written care plan for each resident? What role does the resident have in developing the care plan? How is the appropriate level of care determined? What services are included for each level? Does the community offer other levels of care (e.g., nursing care) if a resident’s health changes? Are wellness checks made regularly? Are nursing services available for breathing treatments, diabetes monitoring, and injections or wound care? Is there an additional charge?

Memory Care

Does the community offer memory care with specially trained staff? Is there a dedicated memory care unit? Are rooms private or shared? Are there separate activities geared specifically for individuals with dementia? What is the community’s philosophy on dementia care? Does the community focus on person-centered care? What safety and security measures are in place for residents with dementia?

Services and Amenities

What special amenities are available (e.g., on-site beauty salon, exercise facilities, computer lab, etc.)? Is there an extra cost? What special services are available (e.g., housekeeping, laundry/linen services, etc.)? Is there an extra cost? What kind of planned activities are available? Is there an extra cost? Are transportation services available? Is there an extra cost or any restrictions? Circle meals that are served daily. Is there an extra cost? Can special dietary needs be accommodated? Breakfast Lunch Dinner Snacks Can residents have pets? Are there any restrictions? Is there an extra cost? Does the community offer worship services? How often? Which religions and denominations are served?

Things to Pay Attention to During Your Visit

Are the common areas clean? Does it smell clean? Is there a resident notification area? Are there current activity and meal calendars posted? If so, do the activities and meals sound appealing? Do residents appear happy and engaged in life? How do staff and residents greet each other and interact?

Financial Obligations and Processes

Is a contract available that details all fees, services and admission and discharge policies? Is the contract easy to read? Do you understand it? What levels of care are addressed in the contract? Is there a buy-in fee? How much is the monthly rent? How much is the security deposit? Which deposits are refundable? What is the total move in cost? How are services and utilities billed? How are rate increases and late payments handled? Under what conditions would a resident be asked to leave the community? How much notice is given?