People to Meet on Your First Community Tour

Meeting new people has never been a problem for me. But when I arrived in the parking lot of the first community, I found myself very nervous. I spent many hours on the Internet looking for the right questions to ask, the right people to meet, what safety metrics to ask about, etc. I met with the admissions director, took a tour and was back in my car 60 minutes later. I saw the entire community and even met a few of the staff members. I still had no idea of why that community was better or worse than any of the several I was planning to visit.

While I summarized our plan in the last blog, it makes sense to add more detail regarding the people you need to meet during each of your initial community visits. Your first community visit will be overwhelming. Assisted living is just like any other business. In the world of assisted living, beds are products and the goal of the admissions department is to sell that product.

Unless you arrive prepared, you’ll leave with nothing but a sense of completion and a shiny new brochure. What you won’t leave with is any useful information that will help you either eliminate that community from contention or move it on to the next round of consideration.

Try visiting during the week so you can get a feel for the full staff level. When you visit your short-list a second time, you can validate the weekend team.

Who You Need To Meet

When you set up your appointment, make it clear to the admissions representative that you’d like to meet with several members of the staff. I’ve listed below the ones I believe are crucial to meet on your first visit.

Admissions director: The admissions director will likely be your primary contact at the community. At many communities, this person is also responsible for sales and marketing. As such, you should expect an upbeat conversation with little or no negativity. The admission director’s primary role is to fill the beds (product) in the community, but they more than likely care a great deal for the people they place in the community. That being said, expect to get the pros, but not a complete picture of the cons during your discussion. I do recommend that you leverage this person’s knowledge of the staff to learn more about their backgrounds.

Activities director: The job of the activities director is to provide entertaining and stimulating activities for the residents. The demeanor and attitude of this person is tremendously important. Their patience, creativity and tenderness can make a world of difference in residents’ daily lives. Find a grumpy one, and your loved one could be looking at days of old movies and bus rides. The following chapter discusses the right way to implement an activities program.

Registered nurse: Assisted living communities are not required by law in all states to have a registered nurse (RN) on staff during some portion of the day. The RN will likely be the one to follow up with your doctor if your loved one is not feeling well, and they’ll also be the one to call an ambulance. Spend some time with the RN to clearly understand his/her hours. Get a feel for their philosophy. At all costs, avoid those who have that “tough it out” attitude.

Medication manager: The medication manager (also called a “med-tech”) is responsible for getting all medications to your family member on schedule. In assisted living, residents are usually not allowed to keep medications in their rooms – over-the-counter or prescription. Spend some time with the medication manager to understand their experience and communication skills. Make sure the night shift med-techs have the same training and language skills as the day shift.

Physical therapist: Depending on your family member’s ambulatory skills, the physical therapist may, or may not be, of value. Aside from my mom herself, the physical therapist had the most impact on her recovery and ongoing mobility.

Most communities have a therapy room, and you should visit it. If you time your visit in the morning or early afternoon, you’ll likely get to see the therapist with one of the residents. Speak to the therapist to get a feel for the experience they have working with seniors. If you family member has a specific condition, make sure they have successfully worked with that condition. In the case of my mom, it was important the therapist have experience helping stroke victims learn to walk.

Head chef: The head chef is responsible for planning the menu and managing the chefs who cook it. Look at the menu and ask how they plan for sodium, cholesterol and sugar-restricted diets. It always struck me as odd that with many older people suffering from heart disease and diabetes that chefs would serve food that I wouldn’t eat myself.

Executive director: The executive director has ultimate authority over all aspects of the community. They are also the one responsible for passing on and maintaining records for state health inspections. The executive director should have a deep and profound connection to helping the residents. You’ll run across executive directors that are all business. While it’s obviously important to take a business approach to the community, make sure this demeanor doesn’t come at the expense of the patience and compassion required to make the residents happy.

Don’t Forget the Residents

The biggest barometer of a community is the residents themselves. Pay close attention to the way residents interact with each other and with other residents. If you notice a group of residents in front of the TV with no real engagement in the show, ask questions. This could be a sign of a disengaged activities director.

It is also perfectly reasonable for you to speak to the residents. As I mentioned, you’re unlikely to get honest answers about the quality of the community. In fact my mom has told me on several occasions that residents feel pressure (perceived or not) to not speak negatively about the community. So, take their words to heart, but with that proverbial “grain of salt.”

Photo credit: Sahaja Meditation

What to Look for in Staff Training Part 4: Consumer Questions


  1. How does the staff interact with the residents?   Is there an overall climate of respect?
  2. Does the staff look content?   Are they rushed or irritated?
  3. Do they address the residents by their names?   Calling an elder “honey” or “sweetie” is not acceptable, unless that is the resident’s preferred nickname.
  4. How much training has the staff received?   Ask to see the training logs.  Do they have some measure of competency showing that not only did staff attend a training session, they actually understood the material?   Pressure ulcer prevention, elder abuse education and dementia care are essentials that all staff should master.
  5. How is training delivered?  Is it lecture or computer-based “PowerPoint”?  Is there a hands-on or a multimedia computer program that brings life to the training sessions?
  6. What is the staff turnover rate in the facility?   Is it more than 30% per year?  More than 50%?  How does this compare to other facilities in the region?
  7. Is there potential for good employees to move up the ladder?  How does good work get rewarded?

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What to Look For in Staff Training Part 3: The Training Differential

trainingWhy is poor training such an important issue?   Is there any evidence that effective training would improve quality of care for the residents?  A recent study reported a 70% reduction in pressure ulcers when staff were properly trained and given incentives to perform better. (1,2)  Other studies have shown a direct effect on resident care or safety as a result of education on reduction of restraints without increasing injuries. (3,4) In addition, researchers also found reduced resident aggression through staff behavioral training as well as the ability to use behavioral interventions with aggressive residents. (5)

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Introducing Contributing Writer Debra Fox

One of the more frequently asked questions I receive from families involves training of assisted living community staff.  What are the training requirements?  How to do communities train their staff?  What tools are used?  What expectations should families have regarding training?

I’d like to introduce an addition to our group of contributing writers  — a true expert in the field of elder care and assisted living training.

Welcome, Debra Fox!

Debra is the founder and CEO of Fox Learning Systems, a company dedicated to changing the culture of elder care through e-learning that uses engaging, documentary-style video to connect with both caregivers and consumers. Debra founded the company in 1997 after personally observing the overwhelming challenges providers face in training and retaining staff to care for vulnerable older adults.

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