The tour, in depth: what to look at, what to ask, the red flags, and what happens after

Before you go

Book one visit and, if you can, drop by a second time unannounced at a different hour. The Alzheimer's Association gives the same advice for memory care. Go at a mealtime or mid-morning when the building is working, not during an event staged for visitors. Bring the person if they are able; watch how staff talk to them, not to you.

Look the community up the night before on NYS Health Profiles and, for nursing homes, on Medicare Care Compare. Our inspection report article explains what you are reading. Write down two things from the report you want to ask about.

Bring

• This list, printed or on your phone, and a pen.
• The current medication list and a one-paragraph description of the help needed on a normal day.
• The monthly budget you can sustain, so the price conversation is real.
• The names of any insurance: Medicare, a supplement or Medicare Advantage plan, Medicaid, long-term care insurance.
• A second person if you can. Two people notice different things and one can sit with the resident while the other asks questions.
• A phone with a camera for the room, the menu, and the activity calendar. Ask first.

The first five minutes

• Smell and light. A clean building can be old. A strong air freshener over another smell is worth noticing.
• Are residents up, dressed, and doing something, or parked in front of a television?
• Do staff greet residents by name and stop when a resident speaks to them?
• Call lights. Ask what the target response time is, then count for yourself while you sit in a hallway.
• Is there a nurse on the floor? Ask when you shake hands with the first staff member.

Ask about care

• What license does this building hold, and what happens when needs grow? Can they stay, and under what conditions would they have to leave?
• Who is in the building overnight, and is there a nurse or only aides?
• How many residents does each aide care for on a day shift, an evening shift, and overnight?
• How are medicines given, by whom, and how are refills and changes handled with the pharmacy?
• What happens after a fall or a change in condition? Who calls the family, and how fast?
• Can hospice come in, and can a resident stay through the end of life here?
• How is the care plan written, how often is it reviewed, and can the family sit in?

Ask about money

• What exactly is in the monthly rate, and what costs extra? Ask about medication management, incontinence care, escorts to meals, and each level of care.
• How and when do rates go up? Ask for the last three years of increases.
• Is there a community fee or deposit, and is any of it refundable?
• What happens if the money runs out? Do you take the Assisted Living Program or Medicaid, and is there a waitlist for those beds?
• How much notice is required to move out, and what is charged after a death?

Ask about daily life

• Can we see the room that would be theirs, not the model, and can they bring their own furniture?
• What does a Tuesday look like? Ask to see this week's activity calendar and watch part of one activity.
• How does the kitchen handle special diets, and can we eat a meal here?
• How do residents get to doctor visits, church, and the store?
• What are the visiting rules, and can family stay for a meal?
• How do you handle a resident who refuses a shower or is upset in the evening?

Red flags

Any one of these is a reason to slow down. Two are a reason to walk away.

• You cannot get a straight answer on what is included in the rate, or you are told to sign today to hold a price.
• Staff cannot tell you who the nurse is or when one is in the building.
• Residents calling out with nobody responding, or several residents asleep in wheelchairs in a hallway mid-morning.
• The community will not show you the state inspection report or discourages you from reading it.
• Turnover: the administrator, the director of nursing, and the admissions person are all new this year.
• Pressure to skip the physician's forms or to have them signed without an exam.
• Nobody asks about your person. A good community wants to know if it can meet their needs before it sells you a room.

The same evening

Write down three things while they are fresh: one thing that reassured you, one thing that worried you, and one question you forgot to ask. Call the next day with the question; how they handle a follow-up call tells you how they will handle you as a family. In CarePair, the case page asks how the tour went once the date has passed. Your notes go to your advisor, never to the community.

After a tour you liked

Ask the community what it needs to offer a bed: usually the physician's forms, a nursing assessment of your person, and financial information once a bed is offered. Our admission forms article explains each one. Keep touring; a second community you like gives you a real choice and a fair price.