Choosing an Assisted Living-- so hard to know what goes on "after you sign the paperwork". Any advice on how to make your best decision?

Re the 'nanny' cams - make sure you talk to each of the facilities you are considering. Not sure which state you live in, but that also is a factor whether allowed or not. Mostly because the cam will record other people who enter your mother's room - and those individuals have not given permission to be recorded.

In choosing a facility, yes, how things 'are' at the facility is important - clean, activities going on, meals that are pretty decent (no, they will never be like home cooked or what the resident is used to). What is staff to patient ratio? What is the staff turnover - how long have the most senior staff members been there (very telling as to how the employees are treated.

Room wise - Yes, a window might be very important - to see nature, the birds, the weather, and sunlight! But most certainly what is important for and to your mother. What are the activities that are offered and that she could participate in- are they activities that she is interested in? Are there others she can form friendships with?
Check with your state/county to see if the facilities have been written up/fined and for what/how long ago.
Finally, it all depends with what attitude your mother goes into the new living arrangement. Mine resisted and fought the change - no mental health issues but was unhappy and bitter because of the change and treated the staff like servants (and me as well but I am family and dealt with it for 30 years) (the place was very nice - not the most expensive around here but lower upper level, with staff who had worked there 10+ years). She never greeted the staff, nor asked how they were doing, never thanked them for helping her, etc etc. As a result - she was was not their first priority, nor were they as attentive and responsive as they were with those residents who interacted with the staff more positively and with gratitude.
I get that my mother wasn't happy that she was unable to live in her own place anymore, but she took it out on everyone around her. Thus, the place was unacceptable and everything and everybody about it as well.
If you can, even with Covid restrictions, see if you can go for a visit, have lunch there, stay and witness an activity, etc. That could tell you alot as well.

Your mother is mentally capable of telling you how she's liking the ALF you decide on! She will tell you how things are going, how she enjoys the food, the entertainment, the care she gets or doesn't get, etc. THAT is how you determine how the quality of the place is: by her direct experience with it. Nothing is perfect, but as long as she's enjoying her lifestyle there, you're all set. A nanny cam is not appropriate for an elder with all of her senses intact; I'd consider that an invasion of privacy myself. Unless she's chronically complaining about something other than the food at the place she moves into, I wouldn't worry about a thing. Speak to the RESIDENTS of the ALF you're interested in placing her at to find out what THEY think of life there. That is your best bet and the surest way to find out what life there is REALLY like.

Good luck!

Can you and your mother take a tour of the facility? (I took the tour first, and liked it, then brought my mother to see it.) Will they let you talk to some of the residents? Sometimes you can get an idea of how it is on the tour. I also recommend looking into Assisted Living that also has a Skilled Nursing facility (and Memory Care), if your mother's heal declines further. My mother is in a facility where we can visit at any time, without making an appointment. It's a way of seeing that they are taking care of my mother as a matter of course, not just to impress visitors. You might want to ask how they did during the pandemic.

KateyG: Make sure that you ask enough questions before you sign off on the AL.

You can check out the facility online and read it's reviews or arrange for a tour in person.

My dad lives in Assisted Living and has for the last 3 years. He is 82, has late stage dementia, diabetes 2, heart failure and now his colon cancer came back and it's terminal. I have him on Hospice (comfort care) which provides him with pain meds, nurse as needed, etc. in the comfort of his own "home". He also has 24/7 caregivers that he pays for. However, when he has pain the facility gives him his pain meds. This has NOT been happening. His caregivers push the pendant button and pull the cord in the bathroom and no one comes or they show up hours later! Also, they recently had a Covid outbreak (3 residents) and the whole facility was on lockdown for over 2 weeks...no family or visitors allowed. My dad's doctor says he has 4 -7 months left to live and 2 weeks were taken from us. If it wasn't for his 24/7 caregivers I wouldn't know about the neglect that's been going on (too much to list here)! I DO NOT recommend AL!! We were promised many services that NEVER happened. All they want is your money. My dad's rent is $4500/month and over $20,000/month for 24/7 caregivers. Moving him now would kill him and he is happy there. Because of his Alzheimer's he isn't aware of all the problems. Please consider something else like hiring occasional caregivers or senior volunteers like "Interfaith Caregivers". Talk to the department of aging for resources.

One reason that responses are so different is that expectations are very different. Another, of course, is that the needs and wants of the residents are very different. My sister's MIL wanted a social life and found one in her AL facility. Another older relative wanted solace and rest. Obviously they reacted differently to very similar situations.

I would suggest that you carefully analyze both your expectations and your mother's. Also consider what services will be important to your mother's needs. This involves her emotional needs as well as simple physical care. Write everything down in bullet lists. Also consider the attitudes you expect between residents and staff. "Gentle persuasion" to one person may be "aggressive" and "pushy" or "bossy" to another.

Even the concept of "neglect" is a very personal one. If you expect that staff will check in on your Mom every half hour or so but the facility only does a check if a resident misses a meal you will have some issues. Sometimes, for a person of your mother's age and medical issues it is better to pay more for a regular nursing facility rather than Assisted Living. In "Assisted Living" it is usually assumed that the resident is capable of most of the tasks of daily living and requires little monitoring or supervision. In nursing facilities there is more interaction between staff and residents. For my uncle, who required no medications, it was still a better choice to place him in nursing care because he had difficulties with motor skills and hearing problems that required a higher level of supervision/interaction.

Do discuss your preference for a nanny cam when you visit your list of potential residences. The staff can give you pointers on what they allow and what approaches have worked well for others.

Also, don't be too put off by those who will insist that all such places are horrible and not an option. They are simply wrong. Whatever bad experiences or (worse) unfounded prejudices on which they base their opinions, there are many really good facilities. Those people are not going to step in and take care of your mother when her needs become more than you can meet. You are taking the right steps. I only wish we had looked ahead and found a place for my Mom when she was still sufficiently "there" to make a sound decision. I know that our visits with Mom in her last 4 or 5 years would have been much more joyful if we had visited her in a nice, clean group residence instead of her increasingly dirty and disorganized home. The change will be much easier for your mom to accept now. We waited too long and when she really NEEDED residential care she was no longer able to understand what she needed.

Look for IN HOME care! There are programs out there like IRIS which SHE can be the director of. She should be able to make her own decisions on WHO and WHAT she wants. IRIS was the best program in Wisconsin that I found because it lets the FAMILY be in charge and not the government. What is happening in homes right now is a disgrace! PLEASE do NOT put her in there. They have gotten much worse. Killed my sister during the lockdown. I mean that literally! Please consider income care where your mother and her children have more say.

IRIS can help with your financial needs. Even family can be caregivers. Whoever she wants.

Yesterday I visited the assisted living home where my mom went when she first had to move out of her house. I wanted to thank them for the flowers they had sent and for attending the gathering to celebrate my mom's life. They were so welcoming at the door and invited me to come visit the other residents on occasion, saying they really missed my mom, but also my visits, and told me their special stories about my mom's sense of humor. If I were to go to the memory care home that she had to move to eventually, I know I would get the same response. Both places are very small and the caregivers have worked there for many years. There is practically no turnover in staff. At the very large nursing home that she had to be in toward the end I think I would be recognized at the front desk and maybe the head nurse's office in the wing my mom was in, but no one else would even take notice of me if I were to show up there. And I was there every single day for 4 months. I got her moved into another very small end of life home, an actual house in my neighborhood before she died. They too still greet me with warmth. I think the large facility has good caregivers and they do their very best, but the atmosphere was just so different in my experience and the large assisted living and memory care places I have visited over the years also felt to me impersonal. My mom was very much happier at the small places, even in the end of life home.

When looking for places over the years, one thing I made sure to look for was a view from a window in her room, where she could watch people with pets and see the weather and seasonal changes. And that detail was really important with covid, as I could have window visits with her, which was the highlight of every day for her.

The other thing I'd like to point out is that since your mom is still mentally sharp it would be good to know if others in whatever home you choose have the ability to be friends with her. At the assisted living place I visited yesterday, they mentioned that they had a professor there who had no one to talk to, since all the others have dementia and can't enter into the sorts of conversations he'd like to have.

Good luck with your search.

At this stage and with all of her problems, the woman should be in a medical facility vs. you taking care of her. You have no idea what you are in for if you keep her in your home. The problem is with any place you put someone, you never know the whole story. Some people absolutely love these places and make lots of friends. However, you must realize that no matter where you go, they are going to be short-handed. They do their best but they can do only so much. I would go and physically sit there for a few hours and observe and talk to other residents before you choose. For me, living in assisted living is sheer hell (I can't walk) but I am l00% high functioning and am so lonely and bored. Almost all have dementia and it is useless to talk with them. Thank god, I still work two jobs at nearly 88 (51 years doing animal welfare work local to international and for l5 years I serve as a power of attorney). For me, I have learned I take care of myself 100% - I just live here. But for her, it would be a good place to be.

I don't think you're overthinking, I think you're being a concerned daughter, (as I was). My mother lived with us for 5 years until she passed away from Alzheimer's (at 94), but my mother-in law (also with Alzheimer's) lived in 2 different facilities. I would visit the facilties that you're interested in at different times during different days, to see how different staff members act, react and interact with patients and their families. Also, during this time of Covid still being an issue in some areas, check on visitation policies, when can you take your mom out of the facility, (for a ride, for lunch, for any reason and any length of time, etc.). I guess I'd also check on vaccination status of the workers and residents, if that information is available. Of course, staff changes, so that information could be in flux, unless it's mandatory. I'd also check with your Division on Aging, State ombudsman, etc., to see if there are any complaints lodged agaisnt the facility. We also learned, that if a facility had a bad reputation, sometimes they'd change their name. Also, sometimes they're bought out by another facility, also resulting in a name change. On another (but related) note, I wrote a book about taking care of my mom (in our home) called, "My Mother Has Alzheeimr's and My Dog Has Tapeworms: A Caregiver's Tale." I tried to write it with humor and heart, since you need both when dealing with Alzheimer's. Good luck.

I’ve said this before on another thread. Worth repeating.

I’m a State Ombudsman.

Five Stars ratings Mean Nothing.

People with loved ones in a facility will mostly give you compliments about said facility. Otherwise, they would be admitting they put their loved one in a mediocre place.

The key is to stay proactive. Keep your nose into everything. Ask questions. Do not fear retaliation.

My mom has a private apartment in AtriaSeniorLiving. The reviews were/are great. They did have a staffing turnover with covid but now things are stable. Because mom does not share a room. I put a couple of Blink cameras in her place and also an Alexa Show. The Alexa show is really nice. I told it to speak slower and now mom can understand it. When mom tripped she said Help and it texted me. I was able to look at the Blink camera and see she was on the floor sitting and then I dropped in on Alexa and talked to her. Mom had a pendent to call for the staff but forgot so I was able to stay on the Alexa until someone got her up.
When interviewing the facilities/communities, I got all of the info and amenities like podiatry, hairdresser, PT in house, in-house doctor/nurse visits monthly, dermatology, psychiatry and I asked “what does mom have to do to get kicked out?” This helped me see the parameters. It is assisted living and they do have transfers to hospice if needed and a memory care unit if she begans to wander. I chose Atria because of the price, amenities, food is delicious, clean, friendly people no matter what job they do, and the entry fee is transferable to any Atria if we have to move and want mom to move…or if this Atria isn’t doing well (not likely but nice to not have to shell out more entry fees)

mom loves it, she is independent, she has wonderful tablemates, she has privacy and safety. The flu shots were give and it was apartment to apartment. I got a fax number (FaxBurner) so I can get messages and requests to the nurses staff in writing. I am involved when I need to be and they know my name. Mom and I will talk and she will forget to ask for a Tylenol. This allows me the ability to advocate for her via fax.

The list of “tools” I use have made mom’s time with Atria a good experience for her and me. I put events on the calendar for Alexa to announce to mom so she can have more activities in her life.

I recommend independence for mom in Atria. We lived together for 8 months before she moved to assisted living and I think she is enjoying her assisted living because it is hard for family members to live together. I get to be a advocate daughter and she gets to have privacy and independent. She chose this place out of the 3 I had scheduled for us to visit. It has been a good experience (except for the turnover of staff during covid). Most staff have been there 8 plus years.

I have items sent to her via Amazon and she gets her teas, dry mouth lozenges, creams. i got her a DVD player and the staff set it up for her.

She is checked on several times a day with trash pick up, medication management, and if she doesn’t go to a meal, they check on her. I am pleased.

All of this has been prayerfully done. Mom and I prayed about it and all the doors were opened for this place. I am glad she is happy with her home.

Nursing Homes are the Last choice you should consider for a loved one.
Believe me when I saw they are Awful!
They are understaffed and your lived one will be sitting in their own urine and feces until it's the Aida time for their rounds.
Your loved one will more than likely be abused in some way anywhere from mental to physical.
They will fall trying to do something on their own because no one will answer the call to the Nurse Station button.
Patients won't want to tell because fear of retribution and ir's true they can be meaner to you.

The only time things get done in a timely manner is if you're there and ask.

Clothes, blankets. Ect just vanish, even if you have your name in it.

Please, for the sake of your loved one, find another solution.

Your Loved one should have happiness in their last years on earth, they deserve it.
Family members should come together and find another solution.
Don't believe most of what you see or hear as ir's mostly show, they are just trying to get your business and will tell you what you want to hear.
Maybe mom could stay living in her home with Caregiving help or move in with a family member and use Caregiver help.
If she goes in to a Nursing Home, You will feel and think you made a mistake the minute you leave the place and will know you made a mistake by within a day or two.
Prayers

In addition to the excellent advice already provided by others, you might consider:
1. Being officially made your mom's health proxy, Power Of Attorney and Resident Representative. This will make all other parties legally bound to keep you informed. Ask her if she would want you to be that person, and get an attorney to help you draw the papers.
2. Get your mom an Echo Show to stay in touch with you and also to enable you to "drop in" without needing her to answer the call, if ever there is another lockdown that disables easy access to communications (like fewer staff to help her make or accept a video call, for example).
3. Know your mom's rights as a resident in Assisted Living. Technically, facilities are no longer supposed to be suppressing residents' rights to 24/7 visitation, especially among mutually vaccinated parties, yet they are still widely restricting this right (among others), effectively making your loved one a prisoner in a highly polished cage, so please visit your state's legal code and licensing regulations to get educated on all her rights.
4. Find your local advocacy groups for people in long-term care homes (all types). A national advocacy like Consumer Voice is a great start and they can point you to state specific groups (most important, since Assisted Living is regulated almost exclusively at the state level). For example, in California there is CANHR. These organization exist for very good reason and they will offer you ample insights. When I first learned about these, I was blown away by all of the information available. Unfortunately it was already months into my mom's first experience in assisted living. I wish I had known sooner.
5. Visit the website of your local licensing agency for Assisted Living. Check out the homes' records for how many investigations have been initiated, the nature of those investigations and the final assessments. Keep in mind that even the cases labeled as unresolved or unsubstantiated tell a story of some kind. Especially if there is a pattern of similar investigations.
6. Be at the initial care planning meeting and politely insist on having these annually and also anytime you notice any type of issues, any changes in your mom or any evolving needs.
7. Join the family council. I'm pretty sure every state includes this in the long-term care resident rights law. It is the family equivalent to the resident council.
8. Find out how to connect with your state and local Ombudsman and do it before mom moves. Ask them for advice and who would be assigned to your mom should she have any need for their support. Keep their direct contact info handy. They can also help you start a family council anonymously if there isn't already one at the home, among other resources.
9. When mom moves in, get to know every caregiver and frontline staff member who might interact with your mom. Know their names and show a genuine interest in them. Help your mom do the same. Leave your number conspicuously in your mom's room. In my experience, staff would text me when they had concerns. To my surprise, the caregivers also told management but nothing was done to help until I intervened. BTW, If they do text you, be discreet about it. Retaliation is real and crafty, and it can be blown back on you or your mom.
10. Also, remember to take care of you and know that you're doing your best with what is available to you and your mom. We lose a lot of control over our loved ones' wellbeing once they enter those doors, even when we do everything right.

A lot of good advice here. I narrowed it down to three for my dad to look at - it would be great, since your mom's mind is good, to have her make the final choice. One thing to be aware of is that there are always going to be complaints - always. Even if it's a great place, it is not the home that they loved. The food is not cooked the way they cooked it. There are a lot of new people that they might love to meet, but are still strangers at first. And they are grieving for a life that they are leaving behind. I tried to remember this when I got frustrated ("I hate the food"), and be understanding that losing control of your life is difficult. So, if it's a pleasant, clean place that keeps your mom safe, provides activities and - importantly - a staff that is willing to actively help her adapt to the new environment, I'd say it's a good option. Another point - you can always move if it ends up not being the right fit. I wish you all the best.

My husband worked in customer service for an automobile manufacturer for several years, and I always remember him mentioning the statistic that a customer who's had a bad experience will tell nine people for every one person a customer who had a good experience will tell. It artificially inflates the negatives, so a company has to be that much better than you expect to overcome some of those negative reviews. I always take negative comments with a giant grain of salt, because those are the folks who'll go out of their way to share their bad experience while also not recognizing that their experience was likely unique to their situation.

Ask the places for references, and call them. Of course they'll give you names of people who are really happy with the place, so make sure you ask them to tell you something they weren't happy about and how the place handled it. Ask about the food -- does their LO like it? (That's huge, since meals are the highlight of their days.) Ideally you want someone whose loved one has been there for a while, not just a couple of months.

Ask about communication -- does the place communicate well about the LO's situation? Do they welcome visitors at any time? What level of independence do they expect from the residents, and do they make accommodations for varying levels? For example, do they encourage the residents to come to activities, and if they don't, do they just give up or find ways to get them out of their rooms?

Go with the vibe you get, too. I had to put my mom in memory care, and I looked at a place that on the surface looked spectacular, but they had all the residents crammed in front of a TV in a fairly small common room. They also had a resident who was developmentally disabled and didn't belong in a memory care, but her parents(!) were in the assisted living wing and they decided to put the daughter in memory care. Totally different needs from what a MC resident needs, and that takes away attention from the properly placed residents. I also don't like places that use TV as a babysitter, so even though the place was 1/4 mile from my house and looked like a five-star hotel, I didn't go with it.

Since Mom's still with it, definitely involve her in the decision making, too, but at some point, let go of the worries. You're smart enough not to put her in a dangerous or abusive situation, so trust your judgement.

The best way is to BE THERE and to be there when you plan placement. You may ask about volunteer opportunities if you have the time. Or just sit, as I did, when I visited , watching the world go by. Observing over the lunch table as my bro's lunch guest. I am still in touch with some of those seniors two years after my brother's deaths. I know how good the staff is. They are SO good that, if they hear a phone ringing in the room of a senior they will pick up, go and get that senior from the community room to get the call. Some of the volunteer jobs I saw done were a.m. donut tray, dog walking, visiting, delivering mail to the cottages, and etc. I can now vouch for my bro's place whole heartedly. The problem with getting input from others is that some people live to complain, if you know what I mean. I am still in contact with my brother's place due to his ex being in care. I am amazed how good the care is.

I think that people go in expecting certain things from am AL and when those expectations are not met, they complain. There are things that are still the families responsibility. A lot of people don't understand that staff sticks to schedules. That Mom or Dad is not #1. I also think the personality of the person has a lot to do with their care. My Mom was no problem so the aides took very good care of her. You get one who is a pain, aides tend to do only what they have to.

So for me, I would go see for myself. Are the residents clean. Residents seem happy. No smells. The staff friendly. Rooms bright and clean. The facility bright and clean. Maybe Mom and you have lunch at each one.
My Mom was in a small AL were the residents were not separated. So Dementia residents mixed in with people that still had their minds. There were some residents that I felt should have moved onto skilled nursing. Since ur Dad was in one, you know that ALs are limited in their care. They don't have the aides or nursing staff that skilled nursing does. Some families don't understand this and expect the staff to do things they are not required to do. People need to realize that Mom or Dad will not get that one on one care that they would give.

This was pre covid, so I don't know if it would still work.
But when we were looking, I scouted out several places on my home, did the tour and narrowed down the choices. My mom was very hesitant and it was a challenge to even get her to go look. So I knew I didn't want her to see anything negative, as that would really send her back to " just let me go home by myself and whatever happens, happens."

So I narrowed it down to 3, and we toured. We ate lunch and talked to the ladies. Got an activity schedule and attended one, and talked to more residents. The residents will give you the lowdown.

Since your mom is still with it mentally, ask her what is more important to her in a place. Where would her apartment be, is it far to go to dining room, activities.

In my mom's place they had a resident council, that came around welcoming new people, giving them advice etc. They would come around to new residents and get them involved in whatever was going on.

Every one has a line on what makes a place "bad". Food? Communication with staff? How fast maintenance happens.
Activities?

While there have some people around since she went to live there in early 2020, there have been a lot of staff changes both in hands on everyday people, and administrators. So you might want to base your decisions on more the policies and procedures than the actual staff as they might not be there in a month.

Clean and well maintained, with multiple opportunities to socialize, decent food, is more important than shiny new to me.

Now, I'd also look as to how they handled the covid crises, outbreaks, lockdowns etc