3 Ways to Assess Assisted Living Quality

How does one assess the quality of care provided in a specific assisted living residence? This is a concern held by many families and especially by those who are seeking care in less expensive assisted living residences. While there is no substitute for visiting the community, doing so only provides one view. Furthermore, as tours are most commonly given by marketing directors, a visitor is likely to only see the highlights of the community.

Fortunately, there are options to help families determine the quality of care their loved one will receive. Unfortunately, accessing this information is not always easy and the data can be inconsistent and confusing. There are three methods by which one can evaluate the quality of care and the quality of life in general in assisted living. In this article, we examine the pros and cons of each approach as well as the "how-to's". Our recommendation is families pursue all three approaches to gain a well-rounded view.

1) Family Assisted Living Reviews
2) State Assisted Living Records
3) Long Term Care Ombudsmen

Pros & Cons of Each Approach

1) Family Assisted Living Reviews

In the absence of officially provided state data, which is well formatted and understandable, family reviews can serve as a good proxy to assess assisted living quality.  The largest advantage of family or 3rd party reviews of assisted living communities is, by far, the ease of access to the information.  One can simply visit any of number of websites that offer reviews and search for their community of choice.  Reviews are available for nearly all residences with the exception of minor adult foster care home with 1-4 residents.  Reviews are easy to understand and it is simple to compare several residences to determine those that provide the best care.  The primary drawback of family reviews is that they not very detailed.  Reviews tend to be brief.  One must take caution to find a site that verifies its reviewers because false reviews abound.

Assisted Living Review Websites

Caring.com - Recommended. This site has a large number of reviews and is regularly adding more, is free to use and pre-screens reviews to proactively enforce their guidelines and avoid fake reviews.
Yelp - Typically reviews are more in depth, but most communities have not been reviewed.  Best used as a secondary source.
Angie's List - highly verified, in depth reviews.  Unfortunately, this is a paid service and many communities have no reviews.  

2) State Assisted Living Records

Assisted living records maintained and provided by the states have one large advantage, and unfortunately, multiple disadvantages.  The advantage is that the data in completely verified.  However, because only complaints are collected and violations tracked, the view tends to be biased towards the negative.  A wide range of types of data may be provided such as inspection reports, violations, citations, complaints, investigations and plans of correction.  As of 2016, 36 states and Washington DC were making assisted living quality data available to the public online. 

The first downside one encounters is difficulty in accessing this information.  Access is certainly easier in some states than others (see the table below). But in all states that make the information available, a clunky and confusing database search is required.  If information is available, it can be difficult to understand.  Violation codes may be used without definitions, scoring scales might not be provided and inspection reports may be hand-written and scanned.  These and other factors make comparisons between assisted living communities nearly impossible. 

If one is looking for positive information about the communities, the state records are not the place to look.  Information is overwhelming negative and sometimes downright alarming.  This is due to the fact that vast majority of information the state collects is from inspections, enforcements and complaints.  Should a search encounter a lack of information from the state, the meaning is ambiguous.  It might be interpreted positively as a lack of complaints and violations means there is nothing to report. On the other hand, it could mean that state inspections are infrequent.  For example, California only requires one inspection every 5 years.  A third possibility is that it is simply a reflection of shoddy record keeping.  Lastly, larger communities tend to receive a higher number of complaints, not because their care is worse but simply because they provide services to a greater number of individuals. 

State assisted living databases are best used when one has already selected a community and they just want to make certain that that community has no major history of resident neglect.  The table below lists what information each state provides online and links to that state's database. 

State by State Assisted Living Records Access

3) Long Term Care Ombudsmen

LTC Ombudsmen are state employees charged with investigating complaints in residential care and providing information to help families find quality care.  The big advantage of Ombudsmen is that one can speak with a real human about the quality of care provided in an assisted living residence.  The downside is that many Ombudsmen are simply overwhelmed by requests and gaining access for an in-depth conversation may be difficult. 

There are over 1,100 persons working in the ombudsman program nationwide.  Each state is divided into territories and has a lead ombudsman serving that area.  One can find their local ombudsman here.