Directions: This checklist is intended for use when selecting a continuing care community. Complete this for each facility you visit to keep track of and compare different facilities.
| Basic Information |
Yes |
No |
Comments |
| Is facility Medicare-certified? |
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| Is facility Medicaid-certified? |
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| Does facility have state license? Is it posted? |
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| Is the latest state survey or inspection report available for review? |
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| Has the facility corrected all deficiencies (failure to meet a federal or state requirement) on its last inspection report? |
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| Has the license ever been revoked? If so, why? |
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| Is there a waiting period for admission for any levels of housing? |
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| How many independent living apartments are there? |
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| How many intermediate nursing beds are there? |
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| How many skilled nursing beds are there? |
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| Are special services (e.g., dementia, ventilator, rehabilitation) needed offered in a separate unit? |
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| Are the nursing facilities located on the premises? If not where? |
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| If one spouse needs to move to a nursing bed for more medical care, can the other remain in the apartment at no extra cost? If no, what charges apply? |
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| Is the facility nearby shopping, medical services and/or entertainment? |
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| Is facility located close enough to friends and family? |
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| Financial and Legal Contract |
Yes |
No |
Comments |
| What is the base monthly fee for each level of care? |
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| What services are included in that fee? |
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| Is any of the cost eligible for coverage under Medicare, Medicaid, another financial aid program or private insurance? |
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| Is a deposit or entry fee required? |
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| Is any of the entry fee or deposit refundable due to death or other issues within a certain period of time? |
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| Are there any refunds or credits for leaving for a vacation or entering a hospital? |
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| If resident is hospitalized or placed in other care, how long will his or her bed held? At what fees or charges? |
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| Are payment plans available? |
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| What are the additional services available and at what costs? |
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| What is the procedure for when fees are changed? Who is notified? |
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| Is there an internal appeal and/or grievance process? Are issues handled in a timely manner? |
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| What are the eviction procedures? |
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| Who has the authority to move a resident to a nursing bed if he or she becomes too confused or ill to care for him or herself? What are the procedures? |
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| Are residents with Alzheimer's or dementia accepted for admission? |
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| Are residents with mental health problems (depression) accepted for admission? |
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| Who is responsible for repairs or replacement after spills or accidents that destroy either the facility or resident's property? |
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| Does the facility offer a separate insurance policy that covers residents' personal property? |
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| Is the resident required to hold a renter's insurance policy? |
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| Do residents have to purchase a long term care insurance policy? |
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| Are the premiums included in the regular monthly fees? |
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| Personal and Health Care (Note: some of these questions only apply to nursing facilities.) |
Yes |
No |
Comments |
| May residents still see their own doctors? |
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| Will the staff set up appointments for residents? |
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| How will physician and facility communicate about resident's care? |
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| Does the facility have an arrangement with a nearby hospital for emergencies? |
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| Can the resident use another hospital? |
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| Does the facility call family or a personal doctor when emergencies arise? Under what circumstances? |
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| Are assessments performed on residents to assess needs? How often? |
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| Does facility have the ability to determine the cause of confusion a resident may develop (medications versus diagnosis of dementia or Alzheimers')? |
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| If the resident needs additional care, can he or she stay in the apartment? What services are available and at what cost? |
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| Does the facility have the ability to deal with a resident's behavior that may change and become abusive? |
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| Do residents receive preventative care such as yearly flu shots? |
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| Does the facility monitor residents' health including routinely monitoring weight? |
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| Does the staff routinely check each resident thoroughly from head to toe to avoid bed sores? |
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| Are there health care facilities available at the facility (physical therapy, occupational therapy, wound care, hospice care, social services, etc.)? |
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| Are there a variety of medical services available (dentists, podiatrists, optometrists)? |
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| Does the facility use physical or chemical restraints? If so, under what circumstances and policy? |
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| Is there a beauty parlor or barber? |
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| Are there laundry services? Is there an extra cost? |
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| Plan of Care (Note: some of these questions only apply to nursing facilities.) |
Yes |
No |
Comments |
| Does the facility prepare a written plan for how it will care for the resident? |
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| Are Certified Nursing Assistants involved in care planning meetings? |
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| Are care plan meetings are held with residents and family at convenient times if possible? |
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| How will my family be involved in the plan? |
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| What if I don't agree with the plan? |
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| What involvement does a confused resident have? |
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| Does the plan cover all aspects of a resident's life? (physical, mental, social and medical) |
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| Are the plan and any medical records stored? If so, is confidentiality guaranteed? |
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| Does a pharmacist review individual drug treatment plans? |
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| Residents (Note: some of these questions only apply to nursing facilities.) |
Yes |
No |
Comments |
| Are residents encouraged to be as independent as possible? |
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| Are residents clean, appropriately dressed for the season or time of day and well groomed? |
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| Are residents interacting with each other? Do they look content and engaged? |
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| What is the average age of the residents? |
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| What do residents like best? Least? |
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| What is daily life like? |
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| Are most residents at the same level of mental function as your loved one? |
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| Is there a resident and/or family council? How often does it meet? Has the council taken any action recently? |
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| Are residents' rights posted? Does the facility follow a resident's bill of rights? |
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| Do residents have the right to come and go as they please? |
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| Is mail delivered promptly and unopened? Can residents have subscriptions to magazines and/or newspapers? |
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| Environment |
Yes |
No |
Comments |
| Are there any overwhelming unpleasant odors? |
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| Is the facility clean and well-kept? |
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| Is the temperature comfortable for residents? |
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| Is facility well lit? |
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| Are there quiet and/or private areas for visiting with friends and family? |
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| Are noise levels in common areas comfortable? |
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| Is smoking not allowed or is it restricted to certain sections of the facility? |
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| Are furnishings comfortable, sturdy and attractive? |
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| Are the building and grounds well cared for and attractive? |
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| Staff |
Yes |
No |
Comments |
| Is the staff visible? |
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| Does the staff wear name tags? |
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| Does the relationship between staff and residents appear to be polite, warm and respectful? |
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| Is the staff friendly, considerate and helpful? |
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| If residents or staff not native English speakers, can they communicate effectively with each other? |
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| Does the staff have good morale? |
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| Does the staff refer to residents by name and knock before entering a resident's room? |
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| Does the staff respond quickly when residents push the call buttons? |
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| Is training and continuing education programs available to all staff? What are trainer's qualifications? |
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| Does the staff receive abuse prevention training? |
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