One of the more difficult times for a retiree and his family is coming to grips with the fact that he may no longer be able to live safely and comfortably in his home. Such realizations typically come after holidays, Christmas and Easter, when adult children are home visiting, and recognize that their parent’s physical appearance and surrounding environment have changed for the worse. Failing health, forgetfulness, inability to keep up with home maintenance, worries about driving, and too much time being spent alone, appear to be the specific "triggers" that motivate a family to explore assisted living communities in earnest. As a result, these communities typically see a seasonal spike in interest and visitations during first and early second quarters of the year.

DSG recently conducted qualitative research that focused on seniors who are considering assisted living facilities or senior communities, as well as the children of such seniors. The remainder of of the article derives from that research.

What are the key attributes in selecting an assisted living facility
It is interesting to note that many seniors and their adult children have typically been researching viable assisted living facilities years before the need actually arises. There is recognition that the day will eventually come, but much resistance when it actually arrives. The search begins within limited geographic areas, where the seniors are most familiar. Typically the acceptable geographic radius is no more than 10 miles away from their current residence. The research activities tend to start with "word of mouth" information gathering from friends and family. The Internet is also used, particularly by the adult children. Information is then requested from the most desirable facilities, followed by scheduled visits to the top choices.

We found it somewhat surprising that in-home health care appears to be a less desirable option. To the seniors, the increasing demands of home maintenance dictate a move to a senior community, and to their adult children, there is greater peace of mind when their parents are being cared for in a professional facility, without the daily worry of possibly new and unfamiliar caregivers entering their parents’ homes.

In general, most seniors prefer facilities that offer a continuum of care, starting with independent living apartments, progressing to various levels of day-to-day physical and memory assistance, and, if necessary, nursing care.

In interviewing the management from a variety of assisted living communities, we found that their chief selling points were:

• Lifetime/continuum of care
• Quality of care
• Attractiveness of the facility
• Breadth of services and programs
• Social atmosphere

We then spoke to seniors and their adult children to determine which attributes were most important to them in selecting an assisted living community. They were first asked to score the following attributes on a scale of 0 to 5, with 0 being Not Important At All, and 5 being Extremely Important.

As you can see, aside from "knowing people already in the facility" and it being a non-profit, the remaining factors in selecting an assisted living community were considered to be very important and tightly bunched across both groups.

We then asked the respondents to indicate the two most important selection attributes from the above list. Three attributes emerged for the seniors and the adult children from this exercise:

What does Quality of Care mean?
Not surprisingly, the most important attribute for both the seniors and adult children in selecting an assisted living community is "Quality of Care." But what exactly is quality care? What are the tangible benefits that make up this term?

While this attribute needs to be explored in much more depth, we did probe our respondents to provide us with some examples.

1. The Facility Staff
• Getting to know the staff and feeling comfortable with the staff beforehand.
• The staff’s credentials. For example, the number of registered nurses vs. licensed practical nurses.
• Personality traits of the caregivers, e.g., treating residents as if they were family; patience;empathy; sense of humor; personal touch; upbeat.
2. The Residents
• Meeting and talking with the residents beforehand.
• Making sure they are alert, happy and well taken care of.
• Having similar backgrounds to mine.
3. Wide Array of Activities
• Having many types of programs inside and outside the community to keep the residents engaged.
4. Cleanliness
• The facilities are clean, bright, and organized.
5. Transportation
• Provided by the community for shopping, doctor visits, and trips.
6. Quality of the Food
• Healthy food need not be bland and tasteless.

A word about price
Financial issues were a significantly greater concern for the seniors than for the adult children. Perhaps this is because the children simply presume that paying for an assisted living community is the responsibility of the parent. Paramount among the senior’s financial concerns was the assurance that residents are able to stay in the community even if they run out of money. Respondents believe that the up-front financial screening conducted by assisted living communities should be structured to ensure that once accepted, each resident has a home for life.

Implications for financial service providers
For those of you currently offering or planning to offer more holistic advice and services to your retired clients, there are a number of observations worth noting:

• Begin those difficult discussions of your clients’ future living arrangements long before his/her health and faculties begin to deteriorate.
• Utilize geriatric caseworkers to better understand and recognize the signals that your client may no longer be able to live independently.
• Incorporate the children of your retired clients into the decision making for assisted living communities. It is clear that one or more of the adult children in the family will have a major influence on the selection of a facility and many of the children do the research and investigation themselves.
• The search for potential assisted living communities should be limited to a localized and familiar geographic area.
• Work closely with your clients to establish their most important criteria for selecting an assisted living community. While it will be difficult to define, try to understand your client’s definition of quality care.
• Make sure your clients visit preferred assisted living communities more than once and are able to meet, question and get comfortable with administrative staff, caregivers and residents.
• Recognize that long term care insurance may not be the ultimate product solution for many of your clients. Should your clients no longer be able to live independently, but not need assistance with multiple activities of daily living (ADL’s), a variety of annuity products would be a much better fit. In addition, a life annuity better addresses the client’s primary concern of running out of money while living in the community. DSG

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