Summary: A discussion about the differences between large assisted living
facilities vs. smaller, residential assisted living homes. When
choosing an assisted living facility, size, or number of licensed
beds, does matter, and can say a lot about what a facility may have
to offer, and how it is managed. Written By:David
Besnette - Founder/Editor for Assisted Living Directory
This article may hover
more in the realm of personal opinion, rather than fact, but
it is something that I have thinking about for some time. I
hope this article invites an open discussion about the differences
between assisted living facilities relevant to size.
video interview with the owner of a small, residential facility
discussing the benefits of a smaller, more home-like assisted
I see a lot of listings
for facilities come through my site, and I have to say, a large
number of them are for facilities that are very small in size
- facilities that, to me, have more of a 'bed and breakfast'
feel to them. These facilities probably list with me since our
site is free, primarily, and since the larger, national assisted
living companies already have a wide reach in terms of their
advertising and promotional efforts. The large chains also have
the benefit of name recognition.
I have always wondered
about the "psychology" (for want of a better word)
of choosing a facility. I do believe that often times, families
are faced with this decision rather abruptly - so prioritizing
features and characteristics of a facility would be a necessity
- for saving time, and to find the right facility at the best
Size, to me, would be
a very important consideration for many reasons. Of course,
size in and of itself means basically the number of residents,
or licensed beds that a facility offers. However, if I dissect
this a little further, I believe that how big or small a facility
is creates, or inhibits further considerations.
An analogy that I think
works for this is to compare bed and breakfasts against larger,
more corporate feeling hotel chains. I'll take my parents, for
an example. My mom and dad are they type of people that love
to travel, and if the opportunity presents itself, they will
choose a bed and breakfast over a motel/hotel any time. They
love the intimacy, and they are ok with the (at times) lack
of complete privacy. My mother is able to strike up a conversation
with anyone, and doesn't need a lot of personal space. My parents
savor the adventure of not knowing what is on the menu in the
morning, or what they might encounter in the night as they walk
down the hall towards the shared bathroom. They have had some
great experiences by doing this, and admittedly, some truly
uncomfortable ones. Nevertheless, they chalk it up to life experience
- which, in hindsight, is always what counts to them.
I (their son) am not
such a person who is comfortable with the relative unknown.
I shutter at the prospect of sharing a small space with strangers,
and I do need a fair degree of personal space and privacy -
which is not offered by the bed and breakfast environment. I
feel more comfortable knowing that if I choose to stay in my
favorite "chain" - I, for the most part, will know
what to expect. I can also expect that I have a pretty well
defined personal space, and staff that are supposed to act according
to a well defined set of rules and standard operating procedures.
Many of the smaller
assisted living facilities that I have seen posted on our site
seem to have that 'bed and breakfast' feel to them. Often times,
they are located in a residential neighborhood, or perhaps out
in the country. Many of these facilities are owned and operated
by a single person/owner/operator who may or may not have a
lot of experience in health care, aging issues, Alzheimer's
disease, or even management or people skills. Others may run
perfectly and are well regarded in the assisted living community.
Smaller facilities often
times don't have the deep financial pockets that the larger
national companies have - thus, they may not be able to provide
a continuum of care, or may not be able to provide many services
or amenities beyond simple day-to-day assistance like housekeeping
and laundry. Many times, smaller facilities have visiting doctors
or nurses - not a full-time or in-house staff available 24x7.
However, there are a
fair percentage of smaller facilities that seem to be able to
pull it off - and offer most of, if not all of the amenities
and services that a larger, more corporate feeling facility
may offer. It all comes down to research - finding out what
the smaller facility offers; visiting the property; speaking
to current or past residents; and carefully reading any contracts
or agreements that they might give you.
the prospective resident will need to also think in terms of
your health, and the future. Will a smaller facility be able
to manage your condition as it progresses, or, if your mild
dementia turns into full-blown Alzheimer's disease, will they
still be able to offer adequate care for you - or - will you
be forced to move to a different facility (not an easy thing
to do if your family lives far away, and if you, the resident
with a condition like Alzheimer's
has become comfortable and familiar with your surroundings).
Just as important -
you will have to decide if the smaller, more intimate environment
will be right for you in terms of your personality - now, and
years down the road.
A final consideration
I will offer when deciding on the size of a facility is: "Will
the facility be around in 5 or 10 years?" I've seen a decent
number of smaller facilities list their properties on my site,
only to see them go out of business after a few years, obviously
forcing their residents to seek alternative arrangements. Again,
not an easy thing for residents with advanced age or health
issues. This does not seem to happen quite as often with the
larger, more established brands.
To be clear, and fair,
larger facilities tend to have their own unique challenges and
issues that seem to be more inherent to their larger sizes.
Larger facilities, I believe, can, at times seem much less personalized
in service, and can perhaps have more complex staffing and management
issues than a smaller facility. I read many news stories every
week about things happening in the assisted living industry,
and I often see stories about residents wandering
off of property, or getting lost, or outbreaks of illness -
stories that are most often associated with facilities having
larger bed counts, and employees.
In the end, I think
facility choice comes down to personal preference, some common
sense, what needs you would like to have met, your budget, and
a lot of research. If a smaller facility can provide everything
you need, and within your budget - and if that is the environment
you think you'll feel comfortable in - then you probably have
a winner...as long as they are in it for the long haul. If not,
you'd probably be better served by a Sunrise, Brookdale, Atria
or the like.
- by David at Assisted
to this article:
There are definitely pros and cons with each. With a larger facility, it's particularly nice for transitions. You can enter a larger facility during the Independent Living stage and transition to assisted living or nursing care with needed. That said, we are big fans of smaller homes for all of the reasons you mentioned - usually a higher caregiver to resident ratio, more personalized attention, and the ability to recognize and communicates change in health or demeanor when it occurs.
29 November 2016 at 11:24 am
One thing I see in the area where I live (the 'Valley of the Sun') should give you a hint - seems like smaller residential facilities go out of business much more rapidly than the bigger ones, but then again, there are far more residential options than large, corporate places, so maybe it is just 'scaled' to the numbers.
21 January 2014 at 10:22 am
I think there are pros and cons to both types. When I was researching
Village Sugarloaf assisted living in Atlanta GA for my folks
I really liked a larger facility. The setup was great because each
of the rooms had views of parks and courtyards. My parents really
liked that part about it. Bigger facilities have more ammenities,
but smaller facilities feel more like home, so it just depends on
the resident. Ella
4 December 2012 at 10:10 am
My mother seemed to do really well with the small-group setting
of a smaller home. The staff seemed to be more personable than what
I would expect from a larger place. Just a guess though.
14 September 2012 at 10:12 am
One needs to ask whether a smaller home can handle all stages of
things like dementia, PD, or Alzheimer's, or will they have to move
the resident to another facility as the condition progresses.
5 September 2012 at 11:10 am
I would like to advertise the perfect home for a small group assisted
living home. Please call me or email me at 512-216-8848, Mckenna.
firstname.lastname@example.org I would really appreciate it! Thanks!
12 August 2012 at 11:04 am
Smaller facilities definitely have a disadvantage when it comes
to things like advertising, marketing and getting the word out.
10 August 2012 at 9:51 am
Senior Housing Access Wrote
Nice photos and video. Look so clean this is a perfect place specially
for the senior citizen. Senior Housing Access
23 January 2012 at 9:20 am
Assisted Living Directory Wrote
Jean, I think there is a lot of qualities people like in the smaller
homes, and it seems to me that small, residential facilities are
really booming - they seem to be popping up everywhere, so there
must be a demand for smaller, multi-family style facilities.
31 October 2011 at 12:11 pm
Also, I am curious if the baby-boomers will lean towards smaller
multi-family style assisted living versus large hotel cahin-like
places. I think silent generation like the bigger (just a thought)
3 August 2011 at 1:18 pm
In my experience, it is definitely a lot harder for a smaller facility
to offer matching services that a larger facility has. I guess that
will be reflected in what the resident will pay (usually).
24 January 2011 at 7:41 am
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