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| Has the license ever been revoked?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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| Are background checks completed for all staff? |
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| Does your guide providing the tour know residents' names and is recognized by residents? |
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| Is there at least one full-time registered nurse (RN) on duty around the clock in addition to the Administrator or Director of Nursing? |
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| Who is Director of Nursing? |
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| Does he or she hold a current state license? |
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| Is the administrator or Director of Nursing available to answer questions, hear complaints, or discuss problems and concerns? |
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| Does the same team of nurses work with same residents most days of the week? |
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| How long are shifts? |
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| Is the ratio of Certified Nursing Assistants to residents reasonable? How many during the day? At night? On weekends? |
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| Is the ratio of aides to residents reasonable? How many during the day? At night? On weekends? |
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| Is the staff expected to handle emergencies? How are they trained? |
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| Is there at least one full-time social worker on staff? What services does he/she provide? |
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| Is a licensed doctor is on staff, on site daily and can be reached at all times? What hospital is he or she affiliated with? |
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| Has the management team worked together for at least one year? |
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| Residents' Room and Apartments (Note: some of these questions only apply to nursing facilities.) |
Yes |
No |
Comments |
| Is the living space big enough? |
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| Is it well lit? |
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| How often is it cleaned? |
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| In the apartments, what furnishings are included? |
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| Can residents have personal belongings and/or furniture in their rooms in the nursing facilities? |
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| Does each resident have storage space in his or her own room or apartment? |
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| Do residents have access to a personal telephone, Internet and television? |
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| Is there a cable TV connection in each room? |
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| Do policies and procedures exist to protect residents' possessions? |
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| Are doors shut when a resident is being dressed or bathed? |
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| Are water pitchers within a resident's reach? |
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| Are call buttons near each bed or do residents wear a device instead? |
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| Is there a private bathroom? If so, how often is it cleaned? |
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| Is there a call button in the bathroom? |
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| Are the rooms private or shared? If shared, do residents have a choice of roommates? |
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| How many roommates to a room? |
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| Is there a privacy curtain around each bed or between beds? |
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| What is policy if roommates are not getting along with each other? How does facility deal with problems when they arise? |
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| Menus and Food |
Yes |
No |
Comments |
| How many meals are served a day? |
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| Do residents have a choice of food items at each meal? |
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| Is the meal schedule flexible? At what times are meals served? |
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| Are favorite foods offered? |
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| Does the food look and smell good? |
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| Are special dietary needs accommodated? How? |
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| Are nutritious snacks available upon request? |
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| Can staff help residents eat and drink at mealtimes if needed? |
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| Does a nutritionist or dietician review meals and special diets? |
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| Can a meal tray be delivered to a resident's room? At what cost? |
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| Is the food preparation separated from the dishwashing and garbage areas? |
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| Is food requiring refrigeration properly stored? |
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| Do the kitchen workers observe sanitation rules? |
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| Activities |
Yes |
No |
Comments |
| Are residents, including those who are unable to leave their rooms, able to choose to take part in activities? Are residents encouraged, not pushed, to participate? |
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| Are activity schedules varied and include resident's interests? Do residents provide input? |
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| Is there someone who develops and supervises recreational activities? What is his or her background? |
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| Is reading assistance available? |
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| Does the facility have pleasant outdoor areas for resident use? Patios to garden? If necessary, does the staff help residents go outside? |
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| Are there protected/enclosed areas for residents with dementia? |
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| Are residents involved in the community (e.g., volunteering) outside the facility? If so, how? How is staff involved? |
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| Are there recreation facilities on site (such as a game room)? |
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| Can residents exercise? What are the exercise facilities like? |
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| Does the facility have an active volunteer program? Are volunteers from the community? Are they screened? |
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| Are dogs and/or cats allowed? |
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| Are birds or other small animals allowed? |
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| Does the facility have pets? Or can family pets come with visitors? If yes, what are the restrictions? |
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| Does the facility accommodate religious or spiritual needs? |
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| What is the visiting policy? |
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| What is the overnight guest visiting policy? For adults? For children? |
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| Safety and Security |
Yes |
No |
Comments |
| What kind of security is provided? |
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| Are apartment residents given their own key for internal security? |
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| Are there others that have a key to the apartment? Who? |
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| Is there a security checkpoint at the entrance? |
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| Does the facility meet local, state and federal fire codes? |
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| Are emergency exits clearly marked, accessible and easily opened from the inside? |
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| Are there fire safety systems? (For example, smoke detectors, fire extinguishers and sprinklers are in each room.) |
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| Is there an emergency evacuation plan? Is it posted? |
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| Does the facility hold regular fire drills that include bed-bound residents? |
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| Are the facility's doors locked? When? Are exit doors alarmed? |
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| Are there safety locks on windows? |
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| Are there handrails in the hallways and grab bars in the bathrooms? |
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| Are stairway doors kept closed to prevent potential spread of fire? |
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| Is the facility wheelchair accessible? (Example: hallways are wide enough, there are wheelchair ramps) |
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| Is floor covering made of nonskid material? |
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| Is the building generally free of clutter? |
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| What safety measures are in place to protect residents from wandering? |
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| Is there an emergency generator or alternate power source? |
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| Are there written policies about when 911 is called and who decides to call? |
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