The time has come where it is no longer possible to care for a loved one with Alzheimer’s at home. You are well aware there are assisted living residences specializing in caring for persons with dementia (called “memory care”), but how to find them and how to choose among them is a time-consuming challenge. This is where senior referral services can help.
Many different names are used to describe the service of helping families find residences for their loved ones with dementia so don’t be confused. The following all provide the same service.
• Assisted Living Placement Agencies
• Senior Advisors
• Family Advisors
• Placement Management Services
• Referral Agents
If you are looking for a senior living residence for a loved one with dementia, you need to understand how these placement agencies work. Like with everything in life, there are pros and cons, certain agencies have advantages and disadvantages and there are individuals who are good and bad at their jobs.
In a perfect world, you would call an advisor and they would answer their phone immediately. You’d tell them about your loved one’s personality, care needs, your budget and location. The advisor would ask several insightful questions you had not thought about and they’d present you with a short list of memory care residences that met your requirements. The advisor would go on to discuss the pros and cons of each residence and you’d narrow the list down to 1 or 2. The advisor would then schedule a tour on your behalf with your selected residences. All of this assistance would be free of charge.
The scenario described above is not far-fetched, this can be your experience, but it is important to understand what goes on behind the scenes and why the experience described above might not actually be ideal.
Referral agencies provide services to families free of charge. This is a good thing. Instead of charging a family for their time and effort, the agencies are compensated by the assisted living / memory care residence when an individual moves in. This approach can be a bad thing depending on the organization and the ethics of the individual who provides assistance. The negative consequences of this approach are:
1. The referral agent will only refer you to residences with which they have a compensated relationship. Most agencies have relationships with nearly all the largest and mid-size assisted living chains. Therefore, assisted living homes that are not corporately owned or smaller “board and care” homes (with 6 – 10 residents) are often not included in the conversation when speaking with a referral agent.
2. Because the referral agent wants to be compensated regardless of into which residence your loved one eventually moves, it is in their best interest to spread your information around to lots of assisted living residences in the area. If there are 5 residences in your geographic area, and they give your information to all 5, then they will be compensated regardless of into which residence your loved one moves. The negative impact of this approach is that salespersons from all 5 assisted living communities will immediately begin calling you to pitch their residences.
3. Agents are incentivized to refer you to a more expensive residence. A normal compensation fee the agent receives is equal to one month’s rent in assisted living / memory care. Therefore, the more expensive the monthly room, board and care costs, the greater the compensation the agent will receive. This will not always be a problem, but could be a problem depending on the ethics of the agent with whom you are working.
In a best-case scenario, working with a referral agent will save you time, money and find a home for your loved one where they are content, fulfilled and can remain for many years. A good placement agent should be able to help you with most, if not all, of the following services listed below. If they cannot or will not, don’t hesitate to find another agent. Prior to discussing all the ways agents can help, it is worth providing some tips to make sure you are working with a good agent.
Upon first speaking with an agent, they will start asking questions about your loved one who needs care. Before offering any information, re-direct the conversation to talk about the services the agent will provide to you. Ask them direct, difficult questions such as:
• What types of assistance you should expect from them? (Ask specifically about each item in the list below)
• Do they refer people to ALL the residences in your geographic area even smaller ones?
• How long in the process will they stay involved with you?
• How are they compensated?
Asking these questions will accomplish several goals. They help you to assess the agent’s integrity. By having stated how they will help, the agent is verbally committed to doing so. Asking these questions sets the expectations between the agent and the family and therefore lays the groundwork for a successful relationship.
Finding Residences in Your Area – What seems like it should be an easy task, can be surprisingly difficult. Outside state regulatory databases, there is no comprehensive list of residences. Even Google and the hundreds of free assisted living / memory care directory websites are not comprehensive. However, an individual who lives locally and has years of experience will know all the local residences.
Understanding Care Needs and Anticipating Future Needs – A good agent understands specifically the types of care a person with dementia requires and what is and is not offered at local memory care homes. Furthermore, an agent with experience should be able to anticipate future care needs as the condition progresses, perhaps even better than family members themselves. Agents should consider this information and speak to for how long a specific home can accommodate an individual’s changing care needs.
Matching Layout with Mobility – An agent should know the physical layout of the residences and match that to the individual’s mobility. For example, some individuals like or even need to walk a lot. A smaller home might not be appropriate nor would a larger home with long straight hallways. A residence with a circular indoor space and larger, secured outdoor space would be a better option.
Matching Preferences – Some persons prefer lots of other individuals with whom to interact and others thrive among just a few other residents. Some homes are affiliated with a religion, some allow pets. There are many amenities and nuances with which an agent should be familiar.
Providing “Insider Information” – Some information is more difficult for a family to obtain and an agent should have that information available at their fingertips. For example, the number of rooms, the number of empty rooms, proximity to hospitals, reviews and complaints about the residence, staff to resident ratios and staff turnover. A family contacting a residence directly may have difficulty getting direct answers, but an agent should have this information.
Arrange and Accompany on Residence Tours – All agents will schedule residence tours for the family but not all agents will accompany the family on tours. Nor will all families want the agent to accompany them. However, agents can be helpful asking questions the family might not think to ask or might not be comfortable asking.
Understanding Pricing Structures – An agent should know and be able to clearly explain the pricing models (all-inclusive, fee-for-service, hybrid models). The agent should help a family choose the model most economical for them. There can also be many minor fees associated with moving in. An agent should know all about these and which of these fees are negotiable or can be eliminated entirely.
Contract Review – Assisted living / memory care contracts are written in legalese and can be confusing to the family. An agent should understand the details and be able to explain to the family exactly what they will receive, what might cost extra, the resident’s rights and what, if anything, is grounds for eviction.
There are large, nationwide referral companies with 100s of employees, there are local, one-person businesses and there are hybrid organizations that can offer the best of both worlds. It is best to make a decision about which type of organization you want to work with prior to making contact because some organizations might elect not to work with you if you have already started the process of working with someone else.
Nationwide Organizations – There are benefits to working with a large organization and, of course, drawbacks. The large companies are connected with nearly all the mid-size and large assisted living and Alzheimer’s care homes nationwide. When contacting a large player, they will always have someone immediately available, and in all locations within the USA. However, these larger companies are not as connected with the smaller “Board and Care” homes (homes that service between 6 – 12 residents). Some persons have complained that the larger referral agencies have a call-center feel to them. Depending on the specific agent with whom you work, this could be a good thing, in that they can be very efficient. Or it could be bad thing, in that you may not feel as though you are getting the attention your loved one requires. The nationwide companies also have an advantage if you are looking for residences outside your immediate geographic area. As they are national, they can help you locate homes perhaps in more affordable areas of the country. The two, big national players are A Place for Mom and Caring.com. It should be noted that there are many, many websites with different brands that are fully owned subsidiaries of these companies or have strong affiliations.
Local Agents – Before the Internet, there were only local assisted living referral agents. Local agents tend to have a far greater knowledge about the communities they represent. They also tend to be better connected with the small memory care homes (Board and Care homes). However, because these agents are often single individuals working alone, they may be very busy at times and struggle to take on new clients. There also may be more rural areas of the country that cannot support a standalone business, in other words, no local referral agents. Generally speaking, families tend to have good experiences with local agents due to their level of knowledge and their longer-term commitments to the communities they serve. Finding a local agent is more difficult, Googling “assisted living referrals and your city name” is one way to start, although probably not the best way. Another option is to ask around at your local area agency on aging or asking local geriatric care managers (also called “aging life care professionals”).
Hybrid / Franchise Agencies – With the Internet allowing for the creation of nationwide assisted living referral companies, many local agents were forced to change their businesses. The hybrid and franchise models of assisted living / memory care referrals emerged. These are independently owned and operated referrals agents, but loosely associated with a nationwide network. The result can be a patchwork of coverage across the US. Because many local independents agents participate and because they are independent businesses, the consistency of experience with each agent is different. Therefore, it is difficult to generalize. That said, one can presume that a big advantage is how well connected the local agents are with local assisted living residences, memory care homes and board and care homes. The two larger players in this space are Seniorly and CarePatrol.