Considering Large vs. Small Facilities

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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.

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.

An original video interview with the owner of a small, residential facility discussing the benefits of a smaller, more home-like assisted living environment:

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 price.

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.

Small assisted living facility

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 24×7.

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.

Large assisted living facility

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 Living Directory

Responses to this article:

Sheila Wrote

You know all depends on what type of senior you have. Seniors that are more capable would probably be more comfortable in a larger facility. Smaller homes seem to fit those who feel out of place in a larger facility. The ones that stay in their rooms and are very reluctant to socialize. Small homes seem to bring them out of their shells.

27 January 2017 at 12:21 pm

Eric Wrote

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

Cassie Wrote

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

Ella Wrote

I think there are pros and cons to both types. When I was researching Noble 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

Orran Wrote

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

CJ Wrote

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

McKenna Wrote

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. [email protected] I would really appreciate it! Thanks!

12 August 2012 at 11:04 am

Marshall Wrote

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

[email protected]

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

Jean Wrote

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) Jean

3 August 2011 at 1:18 pm

Maria Wrote

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