Considering Large vs. Small Facilities

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.

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.

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