After 30 years in Senior Housing, I have met with many, many families over those years in all phases of the decision making process when it came to choosing the senior living option that best met their needs. Most often I would coach my team to interact with those that were making the decision to move to a senior living community for the first time, but a growing number of our inquiry calls and tours trickled in from those that had chosen unwisely in the first place and were now in the unenviable position of having to start the process all over again only this time with the added inconvenience and stress of having to transition somewhere new and far often all too soon after the first move into senior living.

There have been a lot of great articles published about what to look for when choosing the right community, but I thought you might like the opportunity to learn from those that didn’t feel they chose well the first time around.

Here are the most commonly cited reasons residents and families I encountered found themselves disappointed with their original senior housing choice:

1. Doctors Recommendation

Families were sometimes referred by their physician to a specific community because their MD was the facility’s ef3159cfc43e9ec6909fe5d8a6a646ebMedical Director, an affiliation that generally comes with a monthly stipend paid to the physician for serving in that role.  This paid affiliation can compromise objectivity. Sometimes the opinion of the MD and their staff is based upon ease of communication between the MD office and senior housing provider, or can be influenced by the quality of care the MD feels their patients are receiving at the community. Who the primary care physician thinks is a good senior housing provider is important, but it’s even more important to learn why they feel the way they do.

Sometimes this opinion can be very helpful, other times it may be affected by factors that have no bearing on your loved ones future experience there.   Some additional information may help you balance MD input with your own needs. Instead of asking the physician or their nurse for a specific community they recommend (many will even refrain from answering that question all together) instead find out the answer to these questions to help guide you in your search:

  • What level of supervision or level of care is recommended for my loved one? Assisted Living, Memory Care, Skilled Nursing, for example. Why?
  • What skill set or credentials would staff members need to adequately meet my loved one’s care needs?
  • What type of interventions would be most important in supporting the best possible quality of life? Special diet, therapy services, exercise or supervised medication regimen or other?

2. Apartment Size

Ok, this is a touchy one. The senior who is downsizing from a large home into the smaller living quarters of a senior housing setting may instinctively want as much personal space as possible and family members eager to ease the transition may be trying to bring as many accumulated possessions as they can along for the ride. Memories are an important part of the life story that travels with us wherever we go and sometimes our memories are represented by items we treasure that remind us of something or someone important. Those items do matter. The challenge is to differentiate between things that are familiar and things that are important. Is the goal to have as many familiar things around them as possible (even that lamp that no one ever really liked but it’s been on the end table by the sofa so long that it’s become an honorary family member?) Or is the goal to have the most important things nearby?

I’ve seen just about every move in transition strategy imaginable and one of the least effective is picking the largest apartment or room. I’ve met folks who held out for a certain floor plan for so long that their loved one declined at home past the point of being appropriate for admission when the desired accommodations were finally available. Families who picked a community with the largest available room/apartment, but that maybe didn’t have the best care. It may not be necessary to pay all year for an apartment with an extra room for the few weeks each year that visitors stay over. It may not be necessary to have a room big enough for a breakfast table if most meals will be enjoyed in the dining room.   It may not make sense to have half of Mom’s apartment taken up with a love seat that only gets sat in a few hours a week when what she really likes is a recliner to watch TV in. The idea here is to really have some good conversation around what items are most sentimental, which items would be enjoyed regularly and how the personal space in the apartment will be used most often.


3. Beautiful Décor

Many families are impressed with a new community, a beautifully decorated community, you know the one I mean, every town has one. They are the newest, shiniest most HGTV interior design magazine worthy place with lobbies and common areas that look like magazine covers. It may be tempting to make the assumption that if the community put all that attention into detail when it comes to the gorgeous look of the place, then the quality of care must be equally superior to other options too, right? I can understand why some families felt this way, but what they found was that quality care comes in many packages and the old adage “You can’t judge a book by its cover” is very appropriate here. Some new communities do have excellent care, but just because it is new doesn’t make that a given. Physical environment can impact quality of life but it doesn’t have the power to determine it. Do your homework and try not to be overly swayed by the physical plant—this isn’t a decision to be made based upon architecture and color scheme, art work or amenities-this is about care.

4. Location

Some that regretted their initial choice picked the community closest for family members to visit. Visits from loved ones are an important part of overall well-being; however proximity to family shouldn’t be the top reason for selection. Even families that visit a community every single day (and most are unable to be there that frequently),  were typically only there for an hour or so each visit. These visits leave the resident of the community on their “own” at their new home at least 23 hours each and every day. It’s more important that the community is a comfortable place for the person living there 24 hours a day/7 days a week over whether or not it is closest to a frequent visitors’ home. They’ll be living there, we won’t. What’s better for the resident should be more important than what’s convenient for the family. Some care levels and top notch special programs just aren’t offered everywhere and it may be worth traveling a little further for them because of the positive impact these services can have on your loved one’s overall well-being.  Please don’t rule out a solid contender because it’s farther from your home, it may be the best choice.

5. Reputation

This was the hardest one to help families through. They thought that had done their due diligence.   These families had asked every neighbor and friend in town that ever had a loved one in any type of senior housing setting for a recommendation; they asked every healthcare provider they could find for a referral to quality provider, they read reviews and everything they could online. But, reputations are organic living things that evolve every time there is a change in facility ownership, management, or key staff members. Reputations can be made or broken anew with each annual state compliance inspection or survey results. They can improve or decline with every family member’s individual experience.  Have you ever tried to visit a favorite chain restaurant while traveling only to find the meal and service are simply awful compared to your hometown location? Well, the same can be said for the senior housing industry—sometimes the parent company has an excellent reputation but that quality isn’t consistently offered at your neighborhood location. Or maybe the excellent reputation your top choice is said to have was in fact actually based more upon their past performance not their current capability.

Here are some objective ways to better measure quality than reputation:

  • Take time to review their state survey report (available to the public) when you tour.
  • Ask to meet or talk with 3 family members of current residents unsupervised so you can ask them anything you want about the community and staff.
  • Ask to talk with the care staff that would be assigned to your loved one in addition to the Director of Nursing and Administrator.
  • Ask to speak to a resident (if applicable) to learn their perspective on care, meals and overall and quality of life.

arizona-assisted-living-facilities-accommodations-e1310619852717-1024x524There’s no surefire way to avoid choosing the “wrong” community, no way to guarantee that even the most thorough research will prevent future dissatisfaction. However, knowing what’s most important to you, having realistic expectations and being aware of these common pitfalls may help you on the path to finding the best solution for your loved one.

Be prepared to “try on” a lot of options before you find the best fit.

And lastly, remember when you do visit that your tour isn’t about what the staff wants to show you, it’s about what you want to see. You are driving this decision and it’s OK to learn more about what you think is most important and ask any questions you need to as you make this decision.

Do you have questions about selecting senior housing? Please share them in the comments below.


  1. Lauren

    Great tips! It is important to make the best choice for the person who will be moving into senior living. Just because it was wonderful for someone else doesn’t mean it would work for you as well and should be your only choice. Thanks for sharing.

  2. L.Leena

    The size of room or how nice the garden is has NOTHING to do with the care or staff. I had to make decisions based on COST first and then try finding reliable CARE information. NONE of the assisted living OR nursing homes in my state ALLOW you to talk with the residents UNTIL YOUR FAMILY MEMBER IS ACTUALLY IN THEIR FACILITY. You can try talking with some of the other residents family, outside in the parking area but that sometimes ends up being the family member from out of town and not one that is THERE on a weekly basis. Its at best, a guessing game and all you can hope for is to find what is affordable and SAFE for your family member. The place Mom was at had horrible food and on weekends barely had staff (even though on the ‘tour’ I asked and was told they are FULLY STAFFED 24/7. NOT true. Night shift and long holiday weekends were at best 3 people on ANY shift in a facility that had over 60 residents. NOT the state standard but they always had reasons for short staffing (unexpected people quit, or had to be let go OR my favorite, had their OWN family emergency but I guess THEIR families only had issues at HOLIDAY time . Coincidence? NOT when it happens more than ONCE a year it isn’t.) Good luck to anyone having to make this decision. Mom is now back home with me, and I am trying to deal with Dementia and wading thru the caregivers that are available so I can work 2 days a week. What our country has allowed to happen to our older generation is a CRIME. Believe me , its nationwide too. There ARE some truly good places, but sadly those are far and few between and MOSTLY out of financial reach to the normal income families.

  3. Maryann

    Tip #3 is especially important. Choose the place that the future resident will like, not the one you’d like to move into.

    Also, L.Leena is absolutely correct. There is little if any financial help to pay for assisted living. Insurance, Medicare and Medicaid don’t pay for assisted living, though they pay for nursing homes, which are much more expensive. Unfortunately, it often must come down to resources, and keep in mind that your loved one may be living there, God willing, for 10 or more years. Are the finances available to pay for a place for that long?

  4. Drew

    Everything you said is exactly right. Moving from a single family home into a small apartment style room can seem like a huge downgrade but it’s important to remember that it’s more than just a room. The ideal scenario would be your loved one not doing much more than sleeping in their room and having activities to enjoy outside those four walls. Thanks for posting.

  5. Ellen Banks

    When it comes to finding the right senior living facility, I agree that bigger is not always better. A small space can be organized in such a way as to optimize space. A smaller, nicely decorated apartment may feel more comfortable than a large crowded house.

  6. Carol t billington

    We just had terrible time t one place. All you write are the wrong reasons to choose a particular site.

  7. B. Paris

    I’ve lived in (what is now) Community living for ten years. Mostly, we had a terrific Director. Now we have the worst ever. Seldom here, is having a not so discreet affair with the Maintenance guy (formerly our Chef) and anyone with money in the bank can move in. No more Independent living. Moving is not an option for me. Some prospects stay here for a day or two, and I recommend that. Activities (mostly) would appeal to children. All in all — I guess one facility is as bad as the next.

  8. Chris R.

    Good article. My mother-in-law visited a few places with her daughter and narrowed her choice down to two places that were continuing care facilities. My husband and I looked at them once we found out mom was even looking around. One facility was near both our family and her daughter’s family – equal distance from both without having to negotiate freeways and downtown Seattle. The other facility was new, shiny, downtown Seattle with a good sales team. She chose the city living facility – the most expensive of all options – because it would be easy for her daughter to walk on the ferry and visit often. Well, 3.5 year later, we fight four hours total of travel time to visit fighting traffic and trying to miss heavy commute hours while the daughter may come in every 3 – 4 weeks for an afternoon visit. It’s frustrating…and being the daughter-in-law it’s more frustrating because I just have to ‘go with the flow’ while being very frustrated. The first facility also had walking trails, was near trees and a small shopping center – much more in line with mom’s favorite activity – nature and walking. Downtown she is right in the heart of four hospitals, sirens, I-5 and a trek do go into downtown Seattle. Looking back at the time when my Dad had to move I am so thankful that my sister and I were able to find a wonderful place for him to move to with great care, in a small community and ten minutes away from both of us. He was so happy there and had the best care ever. Every family is different.

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