Residential assisted living facilities are generally single family homes with between two and ten residents. They vary in size, luxury, setting and amenities. Because of their small size, they are also not regulated in the same way as large assisted living communities, and this leads to a wide variation in care levels. And because of this lack of regulation, there may be often be very little objective information you or your loved one can find online. To make a comprehensive and accurate assessment when you visit any residential assisted living facility, keep the following things in mind.

For simplicity's sake, assume that any reference to "you" is generally directed at the prospective resident, because that's whose opinion matters most. Having said that, any visit should include the prospective resident and a family member. One of you can ask the questions, but both of you should be making as many of the following observations as possible.

Initial Impressions of a Facility

You are not going to be happy in a place that doesn't feel like home. Residential assisted living provides an intimate atmosphere, but it needs to fit right. Do the living spaces seem like somewhere you'd be comfortable spending lots of your time in the years ahead? Is there evidence that the activities you currently take pleasure in are available? Do the residents seem friendly and cheerful? This is particularly important in the small home environment because you will be with these same individuals day in and day out.

Services of a Good Residential Assisted Living Facility

Residential assisted living facilities will usually provide all of the following services to some degree: help with daily living activities like personal hygiene, dressing, eating and walking; meals, laundry, housekeeping, medication management and transportation services. Ask the person showing you around the home about whether assistance is available 24 hours a day. What is the staff-to-patient ratio? Do you have a choice of menu options at every meal? How often is laundry done and when are linens changed? Is there a driver available every day? Can you enlist his services for outings, activities and shopping? Is he only there for basic residential assisted living services like doctor's appointments and prescription pick-ups?

Quality Living Facilities Need a Quality Staff

Observe whether the interaction between staff and residents cheerful and warm in both directions. Does everyone know each other by name? Do you see or hear people asking for assistance? Do they get an appropriate and timely response?

Sights, Smells, & Tastes of a Quality Living Facility

Are there any particularly pleasant or unpleasant smells in the bedrooms, bathrooms, dining room or common space? Do any surfaces look dirty or dusty? Try to plan your visit to a residential assisted living facility around a mealtime if possible, and when you're shown the dining room, observe whether the food looks and smells good. Are you offered samples? When you tour the bedrooms, are they shared or private? Is it obvious that the residents all add their own personal touches, photographs, paintings, throw-rugs, bedspreads? Or does each room have the same furniture, and seem antiseptic and cold?

How is the Residential Living Facility Administration?

Ask the person conducting the visit how long has the top person in charge been working at this particular residential assisted living facility? What happens if a resident has a complaint or problem? Are staff/family conferences scheduled during the year? Under what circumstances might a resident be transferred to another unit or room. What are the procedures and criteria for resident discharge?

Talk to Some of the Residents

Meeting a resident can be very helpful, and most will willingly share their knowledge with a friendly stranger. If you like the look of a place, introduce yourself, communicate this sentiment, and ask whatever questions spring to mind. All you really want to do is get a sense of whether the residents are generally friendly, open with their answers, not disgruntled, and not scared of the staff. If you're stuck for questions, and any of the following seem appropriate, they'll work as well as any: Scale of 1 to 10, where would you really rate the food? Does the menu change all year? Or is it predictable like some kind of chicken Thursday, fish on Friday and burgers every Saturday night? If a burger, or steak is on offer, can you ask for it medium-rare? And get it? Do they serve beer? Wine? Can we bring in our own? If it affects you one way or the other, you could ask if people smoke, and if so, where. And asking whether there's a house curfew might be a good idea too.

If you drive away from the visit having made all these observations, answered all the questions you needed to ask, of yourself and the staff, and you still have a good feeling about the place, you can assume you've been through enough to at least place it on the short list before a final decision is made.