6 Pitfalls to Avoid When Searching for Assisted Living

As a residential assisted living home owner, the best way to fill your RAL home and keep it full is to understand what residents and their families’ are looking for and how you can meet their needs. Sifting through and evaluating assisted living homes can be foreign territory for those who are suddenly thrust into this decision. There’s a lot that goes into the decision to move a loved one into an assisted living facility and that decision becomes much easier as you expand your knowledge and understand the options available.

Because the decision for assisted living is such a momentous one, full of emotion and uncertainty, there is an abundance of checklists online offering help to those who are embarking on this journey. So to help families looking for quality assisted living and to help RAL owners understand what is important to these families, let’s take a look at some of the pitfalls to avoid when seeking out assisted living. The following are a few key points to consider and the common mistakes many people make when searching for assisted living for a loved one.

1. Failing to Anticipate the Senior’s Future Needs

It is a hard decision to have to make when a loved one is clearly in need of assistance with their ADLs (Activities of Daily Living). Most of us will probably tend to error on the side of optimism. But taking a moment to step back and assess the loved one’s current and future assistance needs in a more objective way will be a huge benefit later on. Some assisted living facilities might offer a more limited level of care and failing to look down the road far enough might end up requiring senior to move facilities one or more times. It is not very hard to see how relocating senior who needs daily assistance could become a huge disruption to their life and an additional burden on family members as well.

As difficult as it will be, it is best for families to have an open and honest dialogue about the future needs of their loved one. Be optimistic…for sure, but also anticipate their future needs, recognizing that a dose of realism can help clear the path forward to a decision that is best for the senior. And that should really be our primary concern. Also, don’t forget to include the senior’s doctor in the decision-making process and inquire as to what support they will need in the future. Having to move a loved one numerous times in their twilight years is not only a burden and costly to the family, but it often comes with detrimental effects to the senior’s physical and emotional health.

An added benefit of recognizing the future needs of the loved one is that they will be able to remain in an assisted living community much longer, rather than bouncing from one facility to another to accommodate their increasing assistance needs. Therefore, the relationships that they build and their familiarity with their surroundings will be greater source of peace and comfort, which also contribute significantly to a person’s longevity.

2. Choosing a Community to that Meets Your Needs Rather Than Your Parent’s

Far too often an adult child decides on the place for mom or dad based on what they liked most about an assisted living facility rather than making the main priority what is best for the senior. Extravagant amenities that an adult would enjoy might seem appealing on the face of it, but if the senior isn’t interested or can’t physically take advantage of those amenities, then they should not be included as assets in the decision-making process. A large, palatial backyard with a heated pool and a Jacuzzi, for example, might sound like great selling points, but if the senior isn’t very physically mobile then these amenities shouldn’t even be a factor.

As much as is possible, encourage cooperation and work with your loved one to involve them in the decision-making process. And if the senior is too frail or already significantly affected by memory loss, the family should take care to consider what they know about their loved one’s preferences and include them as they weigh up the options.

3. Judging a Book by Its Cover

Searching for the right assisted living home for a loved one is much different than shopping for a family residence. Beautiful and lavish amenities are all well and good but they are not your main priority, and they are certainly no indicator of quality care. The most important element in “assisted living” is the “assisted” part. What kind of care is being provided?  How attentive and accommodating is the care staff?

Don’t make the mistake of assuming that an assisted living facility is the right fit because it is expensive and offers the best amenities. Luxury doesn’t equate to quality when it comes to senior care. A beautiful, modern and upscale facility can be just as prone to neglect and oversights as a more homely-looking facility.

Take the time to fully research the assisted living homes you are considering. Ask others in your community about their experiences with the facilities. Take a tour of the homes and do more than just kick the tires. Take notes and ask lots of questions. If you have the opportunity during your visit, speak with residents and staff about their level of satisfaction working and living there. A satisfied staff is usually a caring staff, and a community of cheerful residents is always a good sign.

You just may find that in a thorough analysis of the options available to you, choosing one that’s, perhaps, less shiny and luxurious just might be more appropriate in terms of care or atmosphere for your loved one.

4. Making a Rushed Decision

While some families can quickly become overwhelmed with all of the factors that are involved in the decision-making process, others can be too hasty in their choice of RAL facility. The need for a loved one to be moved into assisted living can seem like such an immediate crisis that some families rush into the decision, choosing the first available room they find that meets even a few of their requirements. For the best results, it is recommended that families visit a number of assisted living communities before settling on the decision. This is such a foreign industry to the average person, so seeing a number of facilities in operation gives a clearer picture of what can and should be expected. And when touring an assisted living home, don’t be afraid to ask lots and lots of questions and take notes on any details that you want further understanding about. You can always come back to these notes and do research online to compare the different options available.

5. Failing to Read the Fine Print

Compared to other types of legal documents, contracts for assisted living homes are usually fairly straightforward. However, some legal jargon may be used that is confusing and there may be add-on fees that aren’t readily apparent to the average consumer who has limited experience with assisted living. Families need to protect themselves by reading all the fine print and understanding exactly what is involved, what is expected of the senior and what the senior can expect of the care staff. And as a RAL owner, what you really don’t want is to have your relationship with the resident’s family sour because they were unaware of certain fees or price increases due to confusing contract documentation.

Most assisted living communities have a number of different pricing structures involving additional services and fees. Some facilities might separate the charges for room and board with the fees for care and the varying levels of care that are available. Other facilities separate each charge individually, which could mean that some families under the impression that three meals a day would automatically be included in the monthly price of the room, might later be shocked to find that this was an add-on fee that they had not taken into account. Other additional fees to consider might be a move-in or one-time entrance fee, yearly inflation rate increases, laundry service, medical supplies, medication delivery, etc. Still, there are other assisted living facilities that offer an all-inclusive pricing model, where all residents are charged the same cost regardless of what services they desire or the level of care that they need.

The key is simply to read all the documentation and ask plenty of questions. If there is even a remote doubt about a subject, simply ask. Knowledge is power. And there is already enough of a feeling of powerlessness when it comes time for a family to move a loved one into assisted living, so arm yourself with as much knowledge as possible.

6. Forgetting to Include Others

Most of us consider ourselves intelligent and competent people who can handle things on our own. In today’s modern world it’s easy to embrace the mantra of “if you want to go fast, go alone.” However, when making a decision as significant as where to place a loved one in assisted living, it is important to have input from a number of people and perspectives. Seek feedback from as many people as possible who have experience in the process of assisted living placement. Moving a parent or grandparent into assisted living is not a sign of weakness or something to be embarrassed about. Be willing to talk to friends and family openly about the subject and seek advice from those who have experience with it.

Connect with assisted living professionals and pick their brains about any topics, processes or advice that will help you make the best decision for your loved one. There are also organizations whose sole business it is to help advise and place seniors in the appropriate care facilities. Look to the help of a senior placement advocate who is knowledgeable and can answer all your questions; someone who can show you the residential care facilities in your area and give you reasoned advice on how to pick the best one. Placement advocates can help families evaluate, not only the facilities available, but the care requirements, amenity preferences and finances of the family as well. Using a professional to help you navigate this journey will save you a great deal of time and frustration by helping you narrow your options to the care homes that most directly meet your family’s needs.

These are just a few of the many pitfalls that families can stumble into when venturing through the often unfamiliar territory of assisted living. The more information you can gather from a variety of knowledgeable sources, the better off you and your loved ones will be when making your decision.

And if you are a RAL owner, it also might be a good idea to come up with your own list or guide so that you can educate the community around you and help them understand the mistakes to avoid in choosing an assisted living home. This exercise will serve as an internal review of your RAL business to help you implement strategies that address these pitfalls.

If you would like more information about assisted living and how to choose the right place for you and your loved one, check out the resources on our YouTube channel. We want to elevate this industry so that our seniors receive the care that they deserve.

Attracting Seniors to Your Residential Assisted Living Home

As the Silver Tsunami continues to grow larger on our shores and more investors are seizing the opportunities in assisted living, owners and operators of residential assisted living homes need to find additional ways to set themselves apart from the rest. Sterile hospital-like big-box facilities are sprouting up all across the country and while this may seem to pose a greater challenge for smaller RAL owners, we know that the residential assisted living environment is a far superior service. Although, what we have to offer seniors is generally much better quality at more competitive price points, sometimes smaller RAL businesses get lost when it comes to marketing their brand.

One method to consider is for RAL owners to think of marketing their homes in a more contemporary way and adopt practices that have been incredibly successful for retailers over the years. There are number of ways that seniors find themselves in assisted living; some are place there by family members who are too busy or unavailable to help assist their loved ones with basic activities of daily living; some have experienced chronic or acute health issues that leaves them to rely on assistance from others; and some seniors have opted into assisted living for the nurturing and loving environment that these communities have to offer.

Regardless of how seniors have been brought to assisted living in the past, as RAL owners, we know that we provide an amazing service with exceptional staff who care deeply for the seniors in their homes, and we want to use that fact to bring attention to our businesses. How amazing would it be if, over the next decade, we could transition the residential assisted living industry from one where seniors are pushed into assisted living to one where we are able to pull seniors into our assisted living homes because what we have to offer is more attractive than any other option out there. By establishing higher standards in our homes and providing exceptional care services, together we can help change the mindset of American seniors and their families.

So many RAL owners and operators get started in this business because they have a heart for people, they genuinely want to provide superior care for the elderly. I would also venture that most of these people probably don’t have a significant background in marketing, if any, and so their homes, while providing a great product and service, are going overlooked by the general public because they don’t have the time, resources or know-how to generate a successful marketing plan.

Any company or organization that provides a superior product or service doesn’t always need to have a 30-person team of marketing professionals to be successful, but it is helpful to look to those large organizations that do employees these teams and adopt some of their ideas. One way to do this is to look at residential assisted living like a large mainstream retailer might. And how do big retailers like Apple or Amazon view their potential customers? It is not just the fact that we have something to offer customers, but recognizing that we have competition, and unlike our competition… we are different.

“We Are Different”

What we provide is of better quality and at a better price point. And in order to be able to market to our communities effectively we have to know our competition. Whether it is researching online or making secret shopper visits to large and successful assisted living facilities in your area, knowing what competitors are doing, the services they are providing and the costs for those services can go a long way to helping you set yourself apart and getting your brand out there as a better choice. This may not sound like a major paradigm shift, but it is a change in the current mindset of both those who are providing senior care homes and those consumers who are looking for them.

There are a number of practical ways that RAL owners can market their brand directly to seniors and the baby boomer generation with a more retail-like approach. If you’ve spent any time in the residential assisted living industry you understand that the demographics in this country are shifting dramatically and that the baby boomer generation is set to revolutionize aging and the products and services associated with aging. In the coming years the baby boomer generation will be the primary residents in assisted living and the marketing strategies that have worked in the past will not be the same that are effective for this generation.

Throughout the history of modern assisted living, most senior residents were driven to the need for assistance due to the result of health events that precluded the loss of independent function. But today, and in the coming decades, prospective residents will likely be drawn into the assisted living environment as a positive instead of a negative.

First world prosperity has brought about extraordinary levels of technology and convenience, which has led to consumers being much more driven by their wants than their needs. This shows a complete change in the decision-making process of consumers and has compelled retailers and service providers to change their inquiry of customers from “what is the matter with you and what do you need?” to “what matters to you and what you want?”

Changing our approach in marketing to baby boomers will prove to be more successful as, instead of simply aligning to their needs, we help encourage the adoption of our healthy and vibrant communities as a place they want to be… a place they feel at home.

Along with the shift to a more modern approach of marketing your RAL home to current and future seniors, don’t be afraid to embrace technology that relates to the assisted living space. As these next few decades unfold, bringing waves of new seniors to the assisted living environment, there will be more of an expectation to adopt relevant technology and getting in on the ground floor will set you apart from other assisted living facilities.

Take advantage of opportunities to modernize, like keeping track of senior’s information, personal preferences and medical history in an easily accessible digital format, which will also make it easier to monitor and communicate any issues with resident’s families. Consider digitizing and automating aspects of your recruitment process as well. This will serve to simplify the process and save you time. Plus, most people looking for assisted living for a loved one are going to be looking online and if all of your admissions processes require paperwork and face-to-face interaction, you might be missing out on a significant portion of potential residents.

Many in the assisted living industry are already embracing technology and they are helping the residents respond to it as well. Just remember to weigh the pros and cons and be selective about how you are incorporating technology. Evaluate each element of your RAL business and decide where personal touch is necessary and where you can automate things.

Tomorrow’s seniors will have spent much of their adult life embracing technology, so make sure that you and your team are catering to those opportunities as well. And while there will be some uncertainties about the preferences of the incoming baby boomer population, there are some effective practices that can be implemented now to deliver an experience or a series of experiences that today’s seniors desire.

Finally, another way to set your RAL business apart is to understand, not only the competition, but the alternatives that seniors and their families are looking at when they are making the inquiry into assisted living. It can be very easy for an individual to dismiss residential assisted living based on the sticker price, but when they look through an actual cost analysis of the alternatives, the better financial option becomes patently clear.

The following is a chart created by ‘A Place for Mom’ and illustrates the difference between a senior living at home and one who is living in an average-priced assisted living home. (These numbers are based on national averages, as specific states and areas have higher and lower relative costs)

Amenities/Services/ ExpensesMonthly Costs At HomeAssisted Living Costs
Monthly mortgage or rent$953$3,500
Property tax$149N/A
Property insurance$78N/A
Property maintenance costs$100N/A
24-hour security services$100included
Three meals a day$494included
Housekeeping services$118included
Daily health aide visitations$4,500included
Personal care$45included
Housekeeping services$118included
24-hour emergency call system$50included
Landscaping/snow removal$50included
Home maintenance$147included
Trash removal$25included
Social and entertainment$25included

There is quite a stark difference in the cost of assisted living compared to a senior staying in their own home and receiving assistance there. Also, many of you will know that there is a significant difference in the costs of a big-box assisted living facility compared to a typical residential assisted living facility. And as more people become aware of these vast differences, the marketing of our RAL homes will become even more effective, pulling seniors joyfully into our communities, as opposed to waiting for families to push them into assisted living. The reality is, like most things in life, it is all about perspective. If we can educate those around us about the opportunities and benefits we provide in our RAL homes, compared to the alternatives, we will help revolutionize the assisted living industry and the general public’s overall view of it.

If you would like to learn more about specific opportunities in the residential assisted living space, or if you are interested in other ways to market and promote your RAL business, check out our amazing training resources and let us help you get to where you want to be in this amazing industry.

And don’t forget to save the date this year for RAL NAT CON 2019. Join hundreds of others in this amazing industry who are working together to meet the needs of the growing elderly population in this country. This incredible convention provides the chance to get more plugged into the residential assisted living industry and networking with other RAL owners, investors, lenders, equipment suppliers and support service providers that can help your RAL business grow. Be a part of the solution!

*Statistics source: www.aplaceformom.com/planning-and-advice/articles/assisted-living-in-home-care-compared

Business Plans For Opening An Assisted Living Home

Gene Guarino: This is Gene from the assisted living network. Business plans for assisted living, specifically residential assisted living. I’m going to give you the two keys to having a successful business plan and the five p’s to making it happen. First of all, the two keys, number one reason I have a business plan is for you so that you have clarity of vision of where you’re going, what it is, who you are, what you’re doing, and where you’re going. You see, you can get anywhere even without a map, but the question is where is it that you’re going to end up? So the business plan, the first key is it’s for you clarity of vision. The second key is to help raise capital. If you don’t have a business plan, no bank is going to give you a loan. No private investor or a lender is going to give you the money.

Gene Guarino: You need to have a business plan to be able to show to other people, hey, I know what I’m doing and where I’m going. You need to know where it starts, where we break even, where we’re profitable, what’s my reserve and all of the details. But the two keys to a business plan or one clarity of vision for you and to the ability to raise capital, a clear vision that you can share with others so they can buy into or lend to you. Now, five p’s for successful business plan. I’m going to give this to you if you want to write it down, feel free. But number one, people, people meaning me, you, whoever is inside and operating within this business, the first thing that somebody is going to look at as an angel investor, first thing I look at a banker, first thing they look at, who are the people involved?

Gene Guarino: What experience do they have that is similar to or even related to what it is that they’re getting the money for? Raising the capital for. So that people element is very important. So one of the keys is who are you? What do you do now that relates to what it is you’re raising the capital for. And if you don’t have something, who else can you put inside Your Business Plan? Maybe on a board of advisors to be of help to you? A team of people is better than having just one person. A little side story before we get to that. I remember when I was an angel investor investing in a project and I had over a half a million dollars invested and I was on what at one time I was on one side of the table talking to the entrepreneurs are raising capital and I was writing checks to them and after 50,000 another hundred thousand other hundred and 50,000 now we’re at 500,000 I eventually ended up on the same side of the table as them and now boom, we’re here as a team and now we’re looking to somebody else who is going to be an investor with us.

Gene Guarino: So I went from, I’m investing in to now I’m a part of the team and now we’re looking to somebody else. And I remember distinctly, and here’s the lesson, they were much older than I worked 30 years older than I was and they said, you know what? I’m not sure about the business. I’m not sure about the business plan, but I like you and what he meant was not knee, knee, but all of us, that team of people, he was betting on the jockey, not the horse, and that’s a key critical point. First P is people. Second is the product. In Your Business Planning, you got to lay it out. What is it that you’re doing? What is it? Is it a product? Is it a service, is it whatever? What is your product itself? You need to explain that clearly. We’ve seen your house when we’ve got it down to a tee, we know exactly what it is.

Gene Guarino: The third p your position, when I say your position, are you the most expensive and that’s what makes you best and better than everybody else or you’re the least expensive, makes you available to everybody and everybody will use you. The government will leave and pay for it. If you can. Are you summer? What is your position now that’s important because you’re not all things to all people. You don’t want to be the cheapest one because then you’re just always battling on price. Somebody else squeeze, you can get in a little bit cheaper and to be the top of the top, the cream of the crop. There’s very few clients or customers at the top. So many times the best position is to be a high quality, not at the bottom, not at the very top, but somewhere above the middle. That’s what we call the sweet spot.

Gene Guarino: So we taught people, we talk product and we talked position. Now at some point we do have to talk about projections. Seeing a business plan, if you’re buying an existing business, there’s a past, there’s a present, and then there’s the projections into the future. But most people who are raising capital for a business, they’re going to look at, the projections were here today, ground zero, never done it before. It’s a complete startup. This is where we’re at. And then this is where we’re going. So when you’re looking at the projections, I’m always going to encourage you to be conservative, be conservative, whatever you think it is, reduced it a little bit more. If you think the vacancy rate is going to be 10% make it 15% if you think the income is going to be $4,000 per person in rent on your assisted living home, make it 3,800 or 3,600 be conservative.

Gene Guarino: Don’t go overboard, but make it more conservative to give you some breathing room to make sure that you can under promise and over deliver when it’s all said and done. Another P to take a look at is the exit plan, and I have to say this plan to exit exit plan is one of the key elements that most people miss the notice. I didn’t even talk about the profitability because I assume that you know that, that it must be profitable. That investor, that lender doesn’t want to know how much money they’re gonna make. What’s in it for them initially, they need to know their money is safe. They need to know there is a purpose. They need to know that you know what you’re doing. You’ve surrounded yourself with the right people. They need to know the you know your position, you know your projections.

Gene Guarino: The profit should be self evident. It needs to be clear and I know that you know that you have to have the financials in place in your business plan, but those projections will give you that profitability. But again, that investors looking for number one safety of capital, that is their number one concern. And that final piece, that plan to exit or exit plan is a piece that most business plans are simply missing. Think about it, when you go to a bank and say, I’m wanting to borrow money to buy a house, they give you a 30 year amortization, what’s the plan to exit? And you pay it off in 30 years. Now some banks will lend the money saying, we’ll do a 30 year amortization with a balloon in five years, which means we’re going to do the payments as if you’re paying for 30 years.

Gene Guarino: But at the end of five years it’s all do. So the exit plan is for you to reapply for a loan or go someplace else to get the money and pay them off or to sell the property and pay it off one way or the other. It’s an exit plan at five years. In a normal business plan, when you’re talking about a business startup, especially something as simple as and as straight forward as residential assisted living, somebody wants to know that their money is safe. They know what the collateral is, they know what the positioning is, they know all of that. But a two to five year exit plan is a good plan. Two years, meaning your money is committed for two years and our plan is to either sell or refinance. Once that business stabilized and within five years, meaning that’s the outside right here, we will have either sold or refinanced, but that investor, that lender wants to know that they’re going to eventually get out of that deal. So two to five years on an exit plan is that key. So we talked people positioning, we talked about the product, we talked about the profit, the projections, and we also talked about the plan to exit. There’s a lot to know on a business plan, but the two keys are clarity for you, clarity of vision for you and the ability to raise capital. This is Jean from the assisted living network saying, do good and do well. If you like what you’ve seen and heard, please subscribe.

Strategies for Retaining Your RAL Staff

Finding the right people to work in your RAL homes isn’t always the easiest task, so when you find the right people you want to do everything you can to hang onto them. Retaining quality staff is often an issue for assisted living home owners and managers, so it is important to employ as many tools and strategies as possible to make sure that you are taking care of the people who are taking care of your residents. Home owners succeed when proper staff retention strategies are in place, resulting in: caregivers who have less stress and are more productive; caregivers who are happier in their jobs and less likely to leave; and best of all, happy and satisfied caregivers have an incredibly positive impact on your residents and their families.

The goal is to create a team of caregivers that helps fulfill your vision of a care home for seniors. It has been said that each resident will impact at least 10 friends and relatives, and those people will each impact another 10 people close to them. Thus, creating an environment for caregivers to thrive and enjoy the work of providing care for seniors is the best thing you can do to satisfy your residents, generate positive reviews, and build a pipeline of referrals for your business.

There has been talk about high staff turnover in assisted living for many years. Some of these complaints focus on low unemployment numbers and the effect that has on the unreliability of employees, or “Millennial attitudes,” or other reasons that effectively translate into “It’s not my fault that we have an employee retention problem.” Practical owners and managers quickly move past these excuses because they know that they can take on the responsibility to solve the problem.

The truth is that most caregivers are in the assisted living business because they care. They feel fulfilled by helping others. They want to do a good job and be recognized for their work. And most caregivers genuinely want the best for the residents in their care. And as most of you in the assisted living industry will know, a satisfied staff directly correlates to satisfied residents. Employing strategies that address these facts will help owners and managers keep hold of quality employees that will remain effective and loyal for years.

Tools for Residential Assisted Living Staff Retention

Retaining employees requires a multi-pronged approach to challenging your staff and getting the work done while providing proper rewards and incentives.  Employers must provide a safe and comfortable work environment while also communicating to employees that their well-being and career are of importance as well.

Compensation and Other Benefits that Increase Employee Retention

All businesses face tough decisions about employee compensation. Assisted living involves more than simply renting a room to seniors, it is about providing quality care. Caregivers are arguably the single most important part of the business. Accordingly, compensation packages are important and communicate an owner’s and their manager’s view of the value of their caregivers to the business. Salary, however, is only one of the compensation tools at a manager’s disposal. Some other important elements to a successful compensation package involve the following:

Retention Bonuses

Recent surveys report that only about 25% of assisted living residences provide cash bonuses for employees who stay with them. The average tenure required to earn such a bonus is three years, and the average bonus was just over $600. Gift certificates work great here too. Another way to look at this is that only 25% of your competition values staff retention.

It doesn’t take a lot of money to acknowledge the value of your team. Sometimes recognition alone can go a long way toward communicating value. If there is not enough money in your operation to be generous once or twice a year, staff retention may not be the only major problem. Take advantage of the opportunity to acknowledge your caregivers and other staff when you can. They are the principle ambassadors for your business.

Recruitment Bonuses

These tend to be effective when both the new hire and the recruiter get a bonus, and when the bonus is staggered (i.e. not given in full until the new hire has stayed for a defined period). Recent surveys report these bonuses were approximately $570 in 2015.

Tuition Reimbursement

As few as 13% of assisted living communities offered this benefit.  Providing assistance with certification programs benefits all parties and should be encouraged by all employers.

Mentoring Programs

This approach was used in less than 4% of care homes, perhaps because of the resource-intensive nature of mentoring.  Mentorship is very important to both sides of the relationship and helps jump start the learning process and assessment of the employee’s progress.  This could simply be the manager shadowing the caregivers once a quarter to make sure they are performing and learning.  Of course, this is more important for younger people who are new to the field, but still valuable to the more experienced worker who may be asked to mentor them.

Checksheets in Training and Operations

The use of checksheets in training and operations takes the guesswork out of the caregiver’s job and helps them focus on providing care. JJ Dedmon, who owns and operates three facilities with a total of 104 beds, helps illustrate this point. Few assisted living residences have detailed checksheets, according to Ms. Dedmon.

“Checksheets have saved me so much time and headache,” she says. “It clarifies expectations, and forces the managers to think through every single aspect of the job so that every aspect of the work is clear. I come from a nursing background and check-sheets are the norm. But other businesses use checksheets as well. Mortgage businesses, lawyers, even fast food places use check sheets, but most assisted living places don’t.”

Staff Bonuses

Performance bonuses are the most common staff retention strategy. This strategy, when combined with checksheets, will give caregivers clear performance targets.

Crafting performance standards that include clear milestones and incentives, helps your team and your managers who may be involved in the reviews.

Professional Development of Current Employees

The professional development of your staff is critical to your own success as well as to their job satisfaction and growth. Businesses that support professional development are rewarded with loyalty and more effective staff.

Professional certifications are available for both managerial and caregiver positions in most states, and are often available on their Department of Health and Human Services website.  Making certifications and regular training a standard part of your goal setting will pay dividends in both staff and resident satisfaction.

The Residential Assisted Living National Academy also offers online courses for staff and owners that can help improve caregiver performance.

Effective Communications and Friendly Relationships

Caregivers are on the front lines of resident interaction and satisfaction. Management is the key to creating an environment that supports the caregivers and establishes the positive environment desired by the residents. Communication skills are key to creating that supportive and open environment.

Open and respectful communications between owners, management, and employees is also essential for staff retention. Management must go beyond giving instructions to staff to building trustworthy relationships and demonstrating interest in their employees’ careers.

Assisted living residences are very intimate environments. A positive work environment that focuses on collegiality and positive relationships among the staff is what you want to communicate to residents and their families. This is an important part of your marketing and reputation as well, therefore, it is not something that can be left to chance. Fostering positive relationships in the workplace can do wonders for both employee and resident retention.

  • A good communication plan should include at least the following items:
  • Clearly setting detailed task expectations and adhering to them.
  • Setting schedules and allowing some flexibility for personal needs.
  • Seeking feedback to optimize operations.
  • Quarterly updates to staff on both future and completed changes in operation.
  • Allowing staff to communicate with you via the manager, or directly, to voice issues and concerns.
  • Eliciting performance reviews of your caregivers and your operation by residents and their families, and sharing these openly.
  • Setting goals and measuring achievement.

This list, however, contains merely the mechanical steps and tasks associated with a communications plan. Building skillful communication among owners, managers, and staff to establish and maintain a positive environment is more difficult to capture. Accordingly, your initial steps in establishing a positive environment will depend upon hiring people with positive communication styles.

Annual Performance Reviews

It is important and a sign of good communications to adhere to a consistent performance review schedule, usually annually. Employees measure themselves on goals agreed upon and attained, and expect to be compensated for their loyalty. If you are using checksheets, there is little guesswork in performance reviews. Staff bonuses are a common acknowledgment for staff performance. Expect to do what it takes to meet their needs so you can continue to maintain a positive work environment.  Work with each individual to set goals so they can continue to grow in their careers.

Beyond the successful completion of their work by checksheets, staff evaluations can include questions around: attitude, communications, growth, dependability, productivity, initiative and creativity

It is important to develop an objective weighting system describing how important each area is to your operation and how well the employee performed. Totaling up the scores provides a quick measure of the results and allows you to easily compare progress from review to review. Naturally, additional reviews other than the regularly scheduled ones could also be conducted in the event of a promotion or change in duties and responsibilities, or at other times deemed appropriate.

These are just a handful of the tried and tested strategies for retaining the staff in your residential assisted living homes. As with any business, you don’t want to just fill positions, you want the very best employees you can find. This is even more crucial in the business of care homes where the health and well-being of senior residents is on the line.

If you need more tips on how to find the right staff for your care home, check out our previous blog post How Do I Find the Right Staff for My RAL?

Or if you’d like more information about topics like this check out the Residential Assisted Living National Association at RALNA.com. Another excellent resource for you covering all things in the Residential Assisted Living community. The Association provides support to members through collaboration, group purchasing power, advocacy, industry marketing, educational services, and certifications. The goal is to strengthen and support the excellent care being provided in residential care homes; high quality, personalized residential care.

The Residential Assisted Living National Association represents the interests of small assisted living providers. The mission is to help small assisted living homes get the resources they need, give them a voice at the national level, and improve the quality of service provided throughout the industry. With a national membership base, RALNA offers a robust set of benefits, including:

  • Training/Education – Provide even better care to your residents through education and training opportunities with nationally renowned experts.
  • Legal Services & Advocacy – Have access to legal experts that understand the assisted living business and the legal issues surrounding it.
  • Improved Industry Standards – RALNA’s certification program tells the public that your home meets rigorous national standards.
  • Save Money – Our national membership base allows RALNA to offer robust group buying power so members save money and increase profitability.
  • Market Your Home – RALNA helps to educate the general public that smaller is better when it comes to assisted living, and we provide a home locator so potential residents can learn about your services.

Also, RALNA will be developing a staff review form for its members in 2019. Although, in the meantime, various rudimentary templates can easily be found on the Internet.

To find out more about RALNA’s training programs and learn what this amazing organization can do for you:

Visit www.RALNA.com


Call 1-307-461-9331

– Do Good and Do Well, my friend.

Finding Staff for Your Assisted Living Home

The success of your Residential Assisted Living business is dependent on so much more than simply the passion you have and the great ideas you want to implement in it. There are various types of differing roles that need to be filled and so many tasks to accomplish that unless you are Superman, you’re going to need a lot of help. And since you can’t be everywhere all the time, it is of vital importance to surround yourself with staff that you can trust to carry out the tasks that need to get done with the level of excellence that you require.

Whether you are a hands-on owner and operator of a RAL or you have a more hands-off approach and are competent in delegating and evaluating your employees, your staff is the face of your business. They are the front-door representatives of your residential assisted living home, not only to the residents and their families, but to your surrounding community and the success of your business is largely dependent on them.

This is why it is so important to take proper measures in ensuring that you find and hire the right people for the right roles in your business and that you do everything you can to assist in their development so that they remain loyal to your cause and you can depend on them for years to come. In this article, we will highlight some of the key steps to finding, interviewing, hiring, developing and evaluating qualified employees for your residential assisted living business. Here at the RAL Academy, we want you to succeed and we want you to find the best people you can to help move your residential assisted living home forward so that you can provide our nation’s seniors with the most excellent care available in the assisted living industry.

Before we get into all the specifics concerning locating and hiring employees, as a residential assisted living business owner you should first know the kind of help you would be needing for your home. There are so many different ways that people have opened and run assisted living facilities in the U.S., from the hospital-like big-box facilities to the small mom-and-pop style homes, there are various systems that have shown to be effective, some more than others. But just so you know all of the different options that are out there, the following are numerous types of care workers that can be found in various types of assisted living facilities across the country. Although you will not necessarily be interested in many of these types of care workers, it is good to know the options that are available and among this broad spectrum of care workers you will undoubtedly find just the ones that suit your business and the goals of your assisted living facility.

Types of Care Workers that You Could Have on Your Payroll

Personal Care Assistants (PCAs)

The PCAs are usually not certified and can have a varying level of experience. This would be dependent on the years they have spent in the industry before coming to be of service to you. The job description of a PCA involves holding conversations with the patients, providing companionship and walking them. They can also get involved in chores and activities such as general hygiene and clean-up (bathing, using the toilet, etc.), offering transportation to appointments, helping them go shopping and so much more. Before you hire a PCA-type worker, it would be beneficial to check the provisions concerning their employment in your state. Some states require that PCAs have a training while the rules are lax in other states. Ensure you keep to all formal requirements, and you’ll be good to go. For in-home care it is worth noting that PCAs are usually not covered under insurance, and are mostly placed on wages (hourly, daily, weekly, etc.).

Home Health Aides (HHAs)

Unlike the PCAs, HHAs have to be trained and certified before they can get into this service. Like previously mentioned, it is also good to check the state laws regarding home health aides to know what to look out for before hiring. Their job description is one that also requires assisting with parts of daily living such as bathing, dressing up and using the bathroom. Besides that, though, HHAs are trained to monitor the patient’s vitals and observe their conditions to ensure they are kept in the best of health.

Licensed Nursing Assistants (LNAs or CNAs)

The certification level of a Licensed (or Certified) Nursing Assistant is much higher, and that reflects in the added importance of their job type. The personal care provided by certified nursing assistants, and personal attendants is vital to the welfare of residents of assisted living housing. CNAs help with personal care duties that can include bathing, toileting, dressing and mobility. They are tasked with critically monitoring of the patient’s vitals and signs, and are trained to watch for health changes and to report their concerns when issues arise that could compromise patent safety and welfare. For example, when an assisted living resident stops eating or refuses to get out of bed, the CNA alerts the nursing supervisor, who then can arrange for medical tests or transport to the hospital. They are also well versed in the art of setting up medical equipment, changing dressings, taking care of infections and offering more intensive, health-based care to the patient. If there is a medical procedure to be performed, it is the job of the LNA to notify and assist a Registered Nurse to get that done. Otherwise, they can go on assisting the patient in any other way necessary.

Skilled Nursing Providers (SNPs)

Like the previous category, SNPs must meet the federal standard for health and safety, then be licensed by the state they will be practicing in. After years of training and education they are able to offer care services and direct medical care that cannot be provided by any of the professionals listed above this category. Training makes them equipped to administer drugs and shots, changing wound dressings, caring for diabetes patients and providing education for the caregiver and patient, as well as many other medical intensive care tasks. Some of these professionals have added skills to buffer their trade. It is, thus, not surprising to see a SNP with extra skills in occupational, physical and/ or speech therapy.

Registered Nurses (RNs)

RNs probably don’t need much of an introduction and don’t often find themselves in assisted living facilities, but depending on the scope of the facility, they can be employed in senior care and deserve to be mentioned as well. These professionals hold a diploma or degree that allows them practice in the medical field. They have passed all of the exams and licensing requirements from the board of nursing in their state or the state where they wish to practice in. Their job involves providing direct medical care when they can or assisting doctors in more advanced procedures. They also offer guidance to family members in addition to operating intricate medical equipment and administering regulatory level medications. Smaller assisted living facilities or those that focus on cost-cutting measures often use visiting nurses or part-time RNs to oversee the nursing assistants and check on residents. Larger assisted living facilities maintain full-time nursing shifts. CNAs must work under a registered nurse’s supervision, so on-site nurses may be needed to provide more intensive oversight of skilled nursing assistant staff and orderlies. At the same time, facilities that house a range of residents with mental and physical disabilities tend to keep at least one nurse on-site at all times.

The Important Thing Is to Find the Right Staff to Fit Your Specific Needs

Although the latter few occupational health workers will probably not feature in many of your assisted living facilities, knowing the various levels of care and medical professionals that are out there can help inform you as you seek to find the right staff with the right qualifications that will meet your needs. And if you are an owner or operator of an assisted living home or facility, having a more thorough knowledge of the experience, education and training required in the various roles of these care service professionals will only show greater confidence and proficiency to prospective employees as you sit down to interview with them. Another key reason these care professionals were mentioned is that, although you may not hire them as regular employees in your assisted living homes, you may hire them occasionally as independent contractors to come in and meet with or educate your residence and their families on specific health topics, which can only serve to boost your marketability as a superior care facility to your surrounding community.

Know What You Need

Now that we have discussed the various types of care professionals in this industry, it’s time to assess your own residential assisted living operation and determine which types of care professionals will best fit your needs. Depending on the kind of care home that you want to run, you might not need many of the kinds of personnel we have listed above.

The first step you want to take is to determine what type of housing and assistance level you want to provide for your residents. There such a broad spectrum of care and assistance needed by seniors, but the beauty of residential assisted living is that as an independent owner and operator, you get to determine what types of residents you want to care for and what levels of care you want to hire staff for. Just because there are seniors in your community who may require more advanced levels of assistance, does not mean that you necessarily need to cater to that level of clientele.

When people in the general population talk about senior housing or assisted living it is usually all lumped together in one definition with the image of a large hospital-like facility in mind. But that is just not a very good explanation of what assisted living is, nor is it what we as a society should be striving for in caring for our senior population. In this industry, one of the most common ways that we classify senior housing is by the levels of assistance provided. Not all seniors are created equal and not all senior housing needs to be equal either. For example, an active 75-year-old will not need the same kind of support and daily assistance as a much less active 90-year-old with numerous health conditions might. Just as not all seniors are alike, not all who are looking for senior housing are alike either. So as someone who is running their own assisted living business, it is extremely beneficial to know the market and exactly what part of that market you are striving to cater to.

For our purposes here in this resource, there are five basic levels of care and services provided to seniors: senior apartments, independent living, traditional assisted living, memory care, and skilled nursing. All of these types of senior care have specific levels of assistance and depending on the facility in question, many of the services provided under these five levels can overlap in interchange. But for the most part, many of you reading this article will be primarily interested in focusing on the traditional assisted living and memory care models. However, understanding the less intensive and more intensive care models on either side of the spectrum can help inform you of where to market and search for new residents as well as where to refer existing residents whose assistance needs have developed beyond the scope of your assisted living home.

The ‘personal care services’ section illustrated in the image above can be understood in terms of activities of daily living, or ADLs. This is the main area that differentiates independent living from assisted living and involve such activities as:

  • Bathing: personal hygiene and grooming
  • Dressing: help with dressing and undressing
  • Eating: preparing food, feeding and clean up after
  • Transferring: assistance with movement and mobility
  • Toileting: continence-related tasks including control and hygiene

Whether you are a caregiver, a RAL manager, a RAL owner or simply an investor in the business, understanding the needs of the residents in each type of senior housing business model is important for determining your vision, evaluation and ultimately the success of your RAL home. For example, if the majority of seniors in your surrounding community require a certain level of care, but you have defined the vision of your RAL home to be set up to meet a different level of need, then you might find it hard to fill and keep your home filled. Knowing the options out there and understanding the market of your immediate community will go a long way to determining your success in this business. There are so many ways for a person to invest their time, talent and finances into senior care and is crucial to understand the basic types of facility and community in which you choose to invest yourself.

Once you’ve decided which type of senior care facility aligns with your goals in this industry and once you have determined the level of care you want your facility to provide, you can then make informed decisions about what types of employees will help you achieve those goals. You aren’t going to want to have employees on your payroll that are far more qualified than the job that you have employed them to do, because you will probably be paying far more in wages than you need to and employees who understand their value as being much greater than their current employment won’t take long before they look for a different job. On the other hand, hiring employees who are not qualified to do what you expect of them is also not a good option because it will hurt your business and it isn’t fair to expect employees to accomplish tasks beyond their training and ability. It is all about finding the right tool for the right job.

Of the five different types of care workers that we discussed previously, the average residential assisted living business owner is probably going to want to focus on the first two categories of care workers, personal care assistants and home health aides. In the level of training and expertise for these caregivers will depend on your state and local regulations so it is important to find out exactly what is required in your particular case. Some of the roles you will be hiring for demand special licensing and certifications. So to be on the safe side, check with your state laws to know what is required. Knowing these regulations will also help winnow out prospective employees so you don’t waste your time pursuing and interviewing potential candidates who don’t actually meet the requirements of your assisted living facility.

Look for Experience

Although, it is not always a bad idea to hire marginally less experienced workers, as you can train and develop them into exactly what you’re looking for, but there are many advantages to experience that you just cannot beat. Plus, depending on your residential assisted living home’s level of assistance and the state or local regulations concerning training and certification for care staff, you will probably want to error on the side of more experienced and qualified from the start. Look to see perspective care staff who has spent a few years in the assisted living industry. On the other hand, if your residential assisted living business is relatively new or funds are limited, you might not want to seek care staff with decades of experience as these employees will likely cost significantly more than similarly qualified individuals with only a handful of years in their work history. In fact, there are some states who have very little regulation in terms of what qualifications and certifications care staff possess, and in these cases if you have the desire to start from the ground up and are willing to be patient and pay for new employees to be fully trained, that is also an option to consider. There are numerous organizations that you can find online who train and educate care staff and it is only a matter of resources and time to develop a team around you that facilitates care that meets the standards you have set.

In the end it is all dependent on your goals with your assisted living homes. Here are the RAL Academy, we encourage you to seek excellence and superior standards of care and every element of your assisted living business, however, we realize that there are periods of development that take time to reach her goals. If you are able to find staff, specifically caregivers, who have 3 to 5 years of experience and are dependable, genuinely care about your residents, meet the state and local qualifications and are on board in adopting your mission and goals for your care facility, that is probably a great place to start; besides the fact that they will know what to do right out of the gate.

It is also worth remembering to look to employ more staff than you need at any one time. Having the minimum number of care staff needed to run your operation might become problematic when one or more of them is sick or unable to work, so having alternate options at your disposal is going to ensure that you don’t have any lapse in care when some staff are inevitably unable to fulfill their shifts. Another concept that is worth looking into is the idea of mentorship. When you hire alternate staff to fill in for your regular staff, it might be easier to choose less experienced individuals who, over time, can work alongside more experienced staff and learn from them on the job; almost like hiring an understudy. These less experienced individuals, who are often more plentiful and easier to find in the job market, will grow and develop with the potential to take over and keep running the business in years to come. And because you took a chance on a more inexperienced care worker, and used to resources to develop their ability and help them move forward in their career, there is a greater chance that they will repay you with years of loyalty. After all, most of us at some stage in our professional careers were very inexperienced and along the way someone took a chance on us.

Type of Employees that Work in Assisted Living

So, what types of roles are we looking to fill in our assisted living homes?

It is good to start with the assisted living home manager. Whether you are hands-off or hands-on in your assisted living homes, this is the person that is going to have the most responsibility. They are going to be overseeing day-to-day operations, interacting with residents and their families, setting and maintaining the standards that align with your goals is a RAL owner. In many cases, when the RAL owner has a more hands-off approach to the business, the manager can be responsible for finding, interviewing, hiring, evaluating and firing staff. They can also be responsible for marketing your RAL business and finding new residents when there are beds that need to be filled.

So, what quality should a manager have?

You are looking for somebody who is in control, who can take a system and implement it. Somebody who is genuinely nice to their family, to their spouse, their coworkers. If they are the manager, they need to be fair, but firm with their caregivers underneath them. The manager is responsible for managing the caregivers, doing things like hiring and firing, scheduling, giving somebody a day off when they need it or requiring them to take a day off when they need it.

Managers need to be personal. Those interpersonal relationships are the hardest thing of all to teach and train. At the RAL Academy, we actually provide a whole training course on how to hire a manager, exactly what to look for and exactly what to avoid. If the caregivers are the heart of your organization the manager is the head and overseas the caregivers, providing vision and direction. The manager needs to have experience in human resources as they are responsible for finding, training and retaining caregiving staff. they also need to have the ability to fill the home by attracting new residents, giving tours and developing relationships with prospective residents and their families. When they interact with potential residents they need to have the interpersonal skills to help the seniors and their families feel at ease and comfortable with the living situation that is provided, as well as fostering a comfortable relationship between residents and caregivers. Ultimately, the manager is continually dealing with people, whether communicating with residents, caregivers, the families of residents, outside contractors or suppliers, the ideal candidate needs to be a real people person.

In addition to the relational aspects of the job, the manager also needs to be fairly detail oriented, making sure all the i’s are dotted and the t’s are crossed. They are responsible for keeping records, keeping stock of all necessary products and supplies, contracting maintenance and other services, as well as many other important details. While it is not always easy to find someone who excels at interpersonal communication as well as being extremely detailed, these people do exist and it is just a matter of finding them. Although, it is worthy to note that if, in your search for qualified candidates, you had to error on one side or the other, the far more important skill would be to have excellent interpersonal communication skills.

In addition to the skilled help they receive from trained caregivers, senior residents appreciate all the activities available in assisted living facilities. Depending on how you choose to set up your residential assisted living home, an effective manager can also be responsible for making sure residents have plenty to do. Organizing group activities like yoga, exercise, arts and crafts, karaoke, movie nights, bingo and card games, as well as visits from volunteers to provide entertainment for residents, are also ways to stimulate your residents and add value to the marketing of your RAL home. And depending on the mobility of your residents and the availability of convenient transportation, the manager can also organize off-site trips to museums, theaters and shopping, which are activities that can really benefit your residents.

The next most important role we are looking to fill in our assisted living home is our caregivers. So what kind of qualities should these caregivers have?

It takes a special kind of person to become a caregiver. Not only does it require a compassionate heart and a temperament that is prone to patience, a caregiver must also meet specific standards and possess skills unique to the medical care industry. Caregiving requires excellent communication skills, a dedicated commitment to resident’s health and safety and the ability to be continually flexible in an unpredictable environment.

Being an effective caregiver takes training and the right mindset. The truth is most of us are not innately equipped to take up the great responsibility of caring for others in such a continuous and intimate manner, so finding people who have these important qualifications is critical to being successful in the residential assisted living space. So, if you are looking to secure qualified staff for your residential assisted living home, or if you are a manager or caregiver and are looking for tips on how to become more effective, the information we will discuss further in this article might be helpful to you.

The bottom line is the individuals or directly providing care in your assisted living home are the most important link to your overall success. Skilled, loving, certified and dependable caregivers are the key to a well-run operation. Caregivers are the heart and soul of any quality residential assisted living home. Depending on the state, there will be certain qualifications and training that caregivers must have. In some states these qualifications are minimal and in others the requirements are more rigorous, so it is important to know what regulations exist in your state. And remember, as a RAL owner you are entitled to holding your staff to a higher standard if your states regulations are minimal. After all, your reputation in this industry is critical for success. You want your RAL to be known as a place that employees the best caregivers who provide superior care to your residents. Regardless of what the state requires, we want to make sure that they are the right person for us, how they treat the resident, how they look for solutions when problems arise, how they work with and take direction from the manager.

While most people who live in a residential assisted living home need help with basic living skills, they do not need constant medical oversight. The primary difference between an assisted living facility and a more intensive nursing home is that assisted living residents do not require round-the-clock monitoring for major illnesses and disabilities. For many seniors, assisted living is the ideal option for those who have problems with mobility but cannot arrange for help in their homes, and the added bonus is that this living arrangement also benefits people who prefer to live in a social setting in their senior years.

In addition to finding quality managers and caregivers, it is also important to find good independent contractors when outside help is needed for things like maintenance or a specific service you hire to for your residents. We want contractors with the right attitude, who understand the importance of what we do. Professionals who, when they’re on the job and on our premise, whether dealing with our residents or staff, that they do it with respect, high quality, the best attitude possible. An ideal assisted living home provides a safe environment for its often vulnerable residents. It relies on adequate maintenance and a housekeeping staff to make sure the building is free of hazards, such as cracked sidewalks and burned out lighting. Having a reliable maintenance worker or handyman that you can call at any time to address issues with the property is a must. Or if you prefer, it could be a number of independent contractors and handymen who are able to fix and maintain specific areas of your assisted living home.

Keeping the home in good shape and the cleanliness of the facility is vital for ensuring the health of your residents and preventing the spread of infections. The housekeeping staff cleans rooms and hallways, keeps the facility free of food and debris to avoid attracting rodents and insects and ensures that floors and walkways are safe and dry. In a large portion of residential assisted living homes, the caregivers share many of the housekeeping duties. Although it is always beneficial if you have the financial freedom to hire an individual or a team of individuals to tackle all of the housekeeping duties so that your caregivers can focus more of their time and expertise on your residents.

There is a lot that goes into finding the right people to work in our residential assisted living homes and because they’re play such a big role in our success we want to focus on doing it right the first time. Now that we have discussed some of the general qualifications we are looking for let’s talk about the specifics of how to go about finding and hiring the right people.

Home Care Employment Agencies

While many who start residential assisted living homes do so in a more independent entrepreneurial manner, many benefits can be found by eliciting the help of large organizational employment services.  Home care employment agencies give referrals to people seeking home care nurses and health aides. Clients may contact, hire and pay caregivers directly. When you directly hire home care workers, the advantage of working with a reputable home care employment agency is that they’ve screened each person in their database. Additionally, home care employment agencies may also provide worker training and occasional on-the-job supervision. Ideally a home care agency becomes a family’s trusted partner for senior care. When you meet with the administrator, getting answers to many important questions can help you avoid choosing a mismatch or substandard care.

What is the administrator’s background? All sorts of people direct home care agencies, and some are more qualified than others. A director’s duties are important and diverse: setting the agency’s policies, managing the employees, negotiating with insurance companies, ensuring compliance with healthcare laws, and more. Many states require that two people serve as an agency’s administrators.

The most appropriate educational background for a home care agency leader is in healthcare administration or public health. Typically, an administrator has a master’s degree, but competence for the role is certainly possible with a bachelor’s degree plus work experience. Longtime healthcare professionals such as RNs and psychologists also move into administrative positions.

The best home care agencies are led by people with relevant training and a genuine commitment to human well-being. If you get the sense that money is the manager’s main motivator, then it is probably time to ease your way out of the interview.

Is the agency Medicare certified? To receive Medicare coverage for home care, a patient needs to work with a Medicare Certified Home Health Agency (CHHA).

Is the agency licensed by the state? Not all states have industry-specific licenses for home care agencies. If your state has the option, choose a state licensed home care agency for assurance that state standards are met.

Does the agency carry insurance? Choose an agency that has its caregivers bonded and insured. A well-run agency also has professional liability insurance and general liability insurance.

What services are available? Home care agencies may provide medical services, non-medical services or both. Confirm that the desired services are available. For example, not every state-licensed center has an RN on call 24/7. Some, but not all, have caregivers trained in speech therapy, physical therapy, Alzheimer’s therapy or memory care, and other healthcare specialties.

How are the caregivers trained? The best home care agencies have extensive orientations for caregivers and provide continuing education. One essential part of caregiving is effectively handling emergencies, so be sure to ask if emergency training is included in employee orientation. (Are employees trained in fire safety? Do they know the Heimlich maneuver and CPR?) Continuing education lets caregivers build their healthcare skill sets and stay up-to-date with best practices in home care.

How thorough are the agency’s background checks? Effectively vetting a potential employee involves talking with their previous employer and other references. It also involves getting a full criminal background check to be aware of any felonies, misdemeanors and driving violations.

How many caregivers are assigned to each client? The best home care agencies assign more than one caregiver to each client. Because two or three people become regular visitors, a worker familiar to the senior is available even if one person takes time off or leaves the agency.

If the senior is unhappy with a caregiver, can another worker take the shift? You might also ask the director to explain their procedure for matching clients with caregivers.

How are caregivers managed? When caregivers are treated well, their patients can benefit. Before hiring a home care agency, observe how the management interacts with staff. Ask the director how the agency motivates its workers and recognizes great work.

Also ask about employee supervision and evaluation. Directors should occasionally observe their employees in the field, preferably unannounced to help ensure quality control.

Advertise & Leverage Your Connections

There is no better way to get your first stream of applicants than putting it out there that you are actively looking for caregivers. Use all the mediums at your disposal to get the word out: social media, job websites, your personal website and your network of caregivers, if you have one. Employee recruitment and retention has been an issue in the senior housing industry for some time and the more you can do to get your brand out there, the better off you will be when it comes to finding and retaining the right staff. When using online media, just be aware that taking your ads to sources like Craigslist might generate a lot of interest from individuals who may not meet the standards that you’re hoping for. When posting your job ads, do your best to ensure they are put in the right places so they can be seen by the right eyes. Advertising at CNA schools, for example, will bring qualified and trained caregivers to your door, but these more experienced and medically trained staff will be looking for a certain level of compensation that might be beyond what you are ready to offer at the moment.

When advertising the position, don’t be afraid to get salesy, but not too much that it becomes unprofessional. Quality caregivers know their worth, so throw in descriptions of the benefits you will offer, such as:Great pay

  • Flexible working hours
  • Optimum working conditions
  • Possible health benefits
  • Potential training certification to advance their career
  • Possible bonus programs, etc.

Overall, you want to make sure the ad is kept short, sweet and straight to the point because most people who are looking for a job are going to be scouring numerous employment resources in high volumes, so having an ad that jumps out and grabs their attention will only help you find the right people faster. And an important tip for those marketing with online sources, make sure to do what you can to separate the careers pages for jobseekers from the marketing for new residents. Because as a business, you don’t want potential residents or families of residents to go to your webpage or Facebook page and immediately see that you are looking to hire 10 new care staff. It just would not set the right message.

Another potential employee source might just be right in your nose. One way to identify employees who are most likely to stay with a senior living organization for the long-term is to turn to that organization’s current staff members. Leverage all of your connections within the assisted living space. Look at the employees who have been brought into your community that have had the most success in integrating into the company’s culture, and follow the connections that led them to being recruited in the first place. It is safe to say that a large portion of those who have been employed in assisted living, at some point were referred to the job by an existing resident, employee or other individual somehow related to assisted living. So do your best to make the most of those connections and you just might find staff with even greater loyalty than you were expecting.

Residential assisted living home owners should also be aware of their public image. Pay closer attention to company review sites like Glassdoor, which is kind of like a Yelp for employers, where current and former employees can openly have their say about your business for all to see. Many smaller RAL businesses won’t really be large enough to have to deal with that, but if you are in assisted living business that has made a name in your community, it is worth knowing what perceptions the public might have about your business.

A final point about using the right resources to find the right staff… Don’t forget to consider looking outside the senior living industry for your next employees. Many assisted living owners and businesses, large and small, can be hesitant to recruit employees from other industries, but this doesn’t necessarily need to be the case. Although this is a very skill-specific industry, it is also a very inward-looking industry, and we just might be far too limiting with our options for prospective employees. We want competent and capable staff who have the training and certification to be able to do their job with excellence right out of the gate, but some of your best and most loyal employees just might come from people who aren’t already in the industry, people who were caring, eager and ready to learn what you have to teach them. In these cases, it is advised to partner with training organizations in your local area to help assist these relatively inexperienced new hires to get the training certification they need. If you are willing to invest in people, they will be much more willing to invest in your mission and vision for your business, and they will probably end up remaining with you a lot longer.

Making the Initial Connections

The key to hiring staff for your RAL is not just getting a caregiver or a manager, but finding the best ones, the right ones, attracting them, training them and retaining them. There are so many potential employees out there, and because the people that you choose will become the voice and face of your organization, sifting through the masses and finding the gems is critical for success. With most elements of society moving more toward online activity, being able to do initial interviews over Skype can save you time and increase the number of potential caregivers that you can filter through. There are numerous placement agencies and online resources to help find potentially qualified employees near you and most of your initial evaluation can be done online. You will, however, want to hold interviews in person as you near the latter stages of the interview process in order to get a better sense of the individual and how they interact with others.

During the preliminary and latter stages of employee interviews, you’ll want to be prepared with more than just standard interview questions and delve into inquiries like, “how would you handle this particular situation? What would you say to this? What do you see as your biggest strength and what do you see as your biggest weakness?” These questions should be gleaned from your experience in the residential assisted living environment and what concerns and issues you have seen in your time working with residents. What you are looking for is how they respond, as you are looking them in the eye and getting a feel for them, you don’t even need to be in the same room. Do they understand what I’m saying?  Do they really have a genuine response or are they just saying what they think I want to hear?

Interviewing Candidates

The following tips and interview questions may be helpful as you hire home care workers, and remember to clarify your needs when interviewing caregivers.

1. List the specific areas in which help is needed. Some possibilities:
Personal Care: bathing, dressing, eating, dressing, using the toilet, lifting out of bed
Homemaking: preparing meals, cleaning, washing laundry, buying groceries
Medical Care: managing medication, physical therapy, intravenous treatments, dialysis, physician’s appointments
Emotional Care: companionship, conversation, enriching activities

2. Calculate how many hours of care are needed daily or weekly. How long is each shift?

3. Decide how much you will pay per hour. Also list any special benefits of the job. For help determining your pay rate, research the wages offered by local home care agencies. Also put yourself in the worker’s shoes, paying the local norm isn’t necessarily fair to the employee, and it’s doesn’t serve your best interest as a RAL owner.

Living on market rates can be especially stressful for entry-level home care workers. If the market rate is just $10/hr in your town, then a full-time worker would take home just $1600/month before taxes. Their annual income would be so low that they would qualify for federal assistance. If home care workers our living on such fine margins, they probably won’t be able to keep up a high level of care for long. When setting a rate, put yourself in the worker’s shoes.

Employment benefits can make your job offer more attractive. Home health care agencies typically offer health care and other benefits to their employees. A few examples of benefits you might offer:

  • Meals
  • Paid vacation days
  • Paid sick days
  • Dental insurance
  • Health insurance
  • Travel opportunities
  • Tuition for healthcare education

Figure out how you’ll make payments and comply with the law. When you hire home health workers directly, you need to report the expense to the Internal Revenue Service. Reporting the work may bring tax deductions, plus it gives social security benefits to the employee. For more details, visit the IRS publications page. Finally, write an employment contract to protect yourself and your employees. It’s wise to first have a trial agreement, e.g., for 30 days.

Preliminary Interview by Phone

Before meeting a job applicant in person, interview him or her by phone or over Skype. This can be a great time saver. Covering the following topics in a preliminary interview might rule out a number of applicants and save you lots of time.

  • Work hours
  • Relevant training and work experience
  • Access to transportation
  • Why the person is interested in the job

If the preliminary interview is to your liking, then arrange to meet in person. Some employers find that it is a good idea to have the initial meeting in a public place unless you already trust the individual based on a friend’s recommendation. Ask the applicant to bring a photo ID, their job history or resume, contacts for references and any other documentation that you might find useful.

Full Interview in Person

Although there is no set list of interview questions that must be asked, below are some of the many questions that are ideal for most care worker environments. Remember that the main tasks of your interview are: presenting your needs, understanding the applicant’s skills and qualifications, explaining the compensation and deciding whether the applicant is a good match for your residents and families.

When appropriate, you can also have your seniors interact with the interviewee before or after the interview to get a better sense of how they well communicate with your residents. This is easily done if you feel comfortable having the interview at your residential assisted living home. The following questions are key to any caregiver interview. Consider amending them and adding any additional questions that you feel would be helpful to the process.

  • Why are you working in home eldercare?
  • What is your work experience as a caregiver?
  • What do you like about assisted living?
  • What are the greatest challenges of home care work?
  • Why did you leave your previous job?
  • What is your favorite part of the job?
  • What is your least favorite part of the job?
  • Do you have any other special skill that would be helpful to know about?
  • Can you provide documentation of your health status including immunizations?
  • Can you provide documentation of your relevant training?
  • Are you capable of executing these duties? (List out what you expect from them and make sure they not only understand, but are willing and capable to take on the job).
  • What do you think makes for a good work experience and environment?
  • Are you certified in CPR or willing to become certified?
  • How do you prefer to receive feedback? Would you be comfortable with a weekly or monthly check-in about progress and any problems?

It is a challenging thing to get to know someone really well in a short amount of time, but there is a lot you can glean about a person if you are observant and are equipped with the right questions and answers. After gathering all of the pertinent information you can from their background checks and credentials, it is time for a talk with your preferred candidates.

We generally recommend having three different interviews for your referred candidate. They should go on the lines of:

  • A phone interview – This is not the main thing, and should not be treated as such. The importance of a phone interview is to establish contact with the candidate, know a little about them and determine if they meet all the basic requirements you are looking for before you invite them over for an in-person interview.
  • In-person interview – At this point, only those who have passed the test above are invited for a sit-down. You get to meet them and ask all the relevant questions that will help you determine whether or not they are a good fit for your company.
  • Second in-person interview – The fact that a person impressed when you interviewed them might not mean that they will be great with the clients too, and vice versa. Thus, give everyone a benefit of the doubt and let them come back for another interview where they meet an older person they will most likely be working with. See how that pans out and you will usually be able to make your pick based on the interaction that happens before your eyes.

After the Interview

Following a positive interview, here are steps you can take to help ensure an effective home care agreement.

Call the job applicant’s references. There will always be a few bad eggs in any business who will take advantage of the employer and or the clients. That is not to say you can always weed them out, but a simple call to references will help you find the right ones most of the time. If you have someone who is unwilling to submit their references, that is a red flag that you should not ignore. No matter how good the rest of their credentials look, stay away. Previous employers and other references might confirm your impressions of the individual, or they might share other “red flags” that you missed. When you speak with other employers, ask about the worker’s punctuality and work quality. Ask why the person no longer holds that job position.

Consider paying for a criminal background check. Another service you can use to check for criminal records and past behavior is Intelius or SentryLink. If they have any dark records, you can be sure to come up with those here. Ask your local police station for guidance to get an accurate report. Many companies offer background checks via smartphone apps or the web, but their reports can be misleading. Some RAL owners might find this step a little intimidating, but it is worth remembering that these potential employees are the face of your business and are responsible for ensuring your resident’s health and safety.

Make the job offer. If the candidate accepts, then put your agreement in writing. Include a mention of a trial period before the job position is considered permanent. A contract for home care should also include: job duties, wages, payment schedule and method, start date, termination policy, time off and other benefits.

Include the Clients

Once you have established that the candidate is likely going to be the person you choose to fill your open position, it is good practice to involve the clients in the process. It can be very beneficial to have them interact with your residents to better evaluate their service of care and their rapport with your clientele and their families. This is a great way to hire someone that your seniors would be able to relate well and communicate better with, not just someone who looks good on paper. After all, this individual will be working daily with your residents. Another helpful tip is to identify common interests with the caregiver, which can be a huge boost to the success of the relationships in your business, not only between you, your manager and the caregivers but also with your residents.

Decide the Terms of Engagement

You can either decide to hire the caregiver as a full-time employee or contractor. The decision will mostly be based on the amount of money you are willing to spend to keep them with you as well as the amount of liabilities you are willing to take on. Making them an employee means you are required, under law, to take care of their taxes and other benefits (Medicare, social security, unemployment tax, etc.).  On the other hand, keeping them as a contractor means they would be paying their own taxes. However, you will still have to file appropriate documents around the terms of engagement (such as a 1099 form with the IRS).

Following the establishment of the terms of engagement above, an employment contract is important to help keep everyone in check about what is expected of them, and what they are entitled to. This would be a great reference in case any altercations come up in the future and can help alleviate any confusion when it is time for employee evaluations.

A solid employment contract should, at least, contain points like:

  • The job description
  • Expected hours of work
  • Schedule to be maintained by the caregiver
  • The rate of payment
  • Period of payments and
  • Every other element that you deem worthy of inclusion, especially everything you agreed upon during the interview process.

Provide your new employee with the proper employment forms, allow them go over it and make sure that all necessary documents are signed before having them begin working, to cover any issues of liability should something unforeseen come up.

It is worth reiterating a previous key point, that when you are going through the hiring process consider hiring backup workers. You are hiring real people, not super humans. Make sure that you are prepared to cover all the needs of your RAL home and its residents without stressing in case an employee falls ill or otherwise needs to skip a shift.

Check in during your caregiver’s work shifts. Especially when the work arrangement is new, spend time at the home to help familiarize the caregiver with your seniors’ needs. Periodically drop by unannounced during a shift to ensure that all is well. When setting up employment, schedule a regular time to meet with employees to address concerns about job duties and to evaluate the status of your residents’ health and well-being.

As you spend more time in your residential assisted living business, you will want to come up with more detailed systems and checklists to streamline your hiring processes that helps you identify and hire the right people. Until you get to that point, though, the tips and information found here will be a good starting point and get you headed in the direction that you want to go.

It is also worth mentioning that sometimes we need to adjust our expectations around staffing. Gone are the days where an employee loyally puts in 20 or 30 years of work into one company. Nowadays, it’s simply unrealistic to believe that most part-time assisted living care staff are going to stay with a RAL home for years on end. This is especially true for the community’s youngest part-time workers. To stand out from the crowd and distance yourself from other competitors, focus on creating an engaging and dynamic community and company culture. If a community can succeed in retaining an employee for one year, their chances of keeping them around long-term may increase exponentially.

Good help might be hard to find at times, but it is very possible. It might take some to get used to new processes, but if you persist in seeking excellence for your residential assisted living home, you will be interviewing a stream of highly qualified applicants in no time.

These are just a few of the numerous methods and tips that we help RAL owners adopt in their businesses to help create models of success in the residential assisted living industry. We have additional training that covers every topic you can imagine concerning RAL homes, setting up and running a successful RAL business, training and managing employees and every other assisted living topic under the sun. As valued members of our community we would like to continue to offer tips to help you find the residents that you are looking for to fill your RAL homes and create greater success in your business. You may already be familiar with some of these tips, so they might be a good reminder for you, or some of them may be new ideas that will help your business grow. And if you would like more information about additional training, visit:


The RAL Academy is here to help you succeed, so don’t put it off any longer. Come out to one of our amazing interactive 3-Day Fast Track events, where industry professionals will teach you everything you need to know to get started and excel in this amazing industry. Take control of your future and get involved in a unique market that allows you to help others while creating a sustainable business that can provide for your family for decades to come.

The Convenience of Home Study

Don’t have the time to set aside a weekend learning about the incredible opportunities in residential assisted living? We’ve got you covered. We offer a Home Study Course that will teach you what you need to know to hit the ground running in assisted living. Learn on your own time and at your own pace. Learn everything from strategies to find funding for your business to how to hire and train care staff, how to market your Residential Assisted Living home to the communities around you, and what not to do that will end up saving you thousands of dollars, and so much more. You will also have access to real-life case studies from students and associates who have taken the course and implemented it, creating countless positive cash flow success stories.

Sign Up for Our Informative Webinar

The Silver Tsunami of seniors is hitting the shores now. These seniors will be depending on a robust network of care homes, care-givers, medical professionals and the investors to support this vibrant industry. Be one of the first to respond to the fastest growing demographic shift in the U.S. today.

In the U.S., 180,375 people every month turn 85 years old. Most of these people will need assistance with daily activities and the current crop of nursing homes and care facilities are ill-equipped to give them the help and dignity that they deserve. Along with every great need comes great opportunity.

The Residential Assisted Living Academy is here to help you take advantage of the opportunity in this relatively untapped market, while also helping the most vulnerable in our society.
Our experienced professionals will show you how to start a Residential Assisted Living business that can create substantial, recurrent cash flow. Check out our Assisted Living Business Accelerator course and learn how you can convert a residential home into one for assisted housing and senior living,
while creating a stable business and income stream for life!

Along with the critical training you will receive, we will also include invaluable bonuses absolutely free. Bonuses like, 6 months of live support and group Q&A calls, handled by leading experts in the field, they will help answer all of your questions and guide through all of the important topics in the assisted living space.

These bonuses are available for a limited time. Don’t miss out on this amazing offer. Take your first steps toward financial freedom today.

Build Your Network with the Residential Assisted Living National Association

We can’t encourage you enough become member of the Residential Assistant Living National Association, which was formed to bring our industry together and to provide critical resources needed by every owner, operator or investor in Residential Assisted Living. Whether you are an owner, operator or an investor or just looking to learn all you can about the incredible opportunities in senior housing, the RAL National Association is the community for you. Get help from industry professionals and learn how Residential Assisted Living is the answer to set you on the path to financial freedom and success.

Some of the invaluable resources for our members include:

  • Group purchasing power with access to over 200 companies
  • Lobbying and legal support focused on the Fair Housing Act and Zoning
  • National Marketing for your RAL home
  • Continuing education for direct care staff
  • Strengthening and supporting the RAL community
  • Monthly newsletters addressing important issues facing RAL homes
  • Private Facebook page, building support and community
  • Access to business opportunities, investors, qualified operators and administrators
  • And much, much more

For anyone who wants to get started, expand, invest in or help support the mission of providing high quality senior housing and care in a residential setting, the RAL National Association is a must for anyone serious about their financial future in assisted living.

– Do Good and Do Well, my friends.

Nutrition & Longevity in Your Residential Assisted Living Home

Are you looking for ways to improve your Residential Assisted Living home? What if you could keep your RAL full of residents longer?

How about starting with nutrition?

There are many unique challenges that come with operating a Residential Assisted Living home, but one of the vital elements that can easily be overlooked is the nutrition we offer our residents. So many of us take food for granted. It is part of everyday life and we are all so busy that we don’t always give it the thought it deserves. Not only does nutrition provide the important fuel that we all need to enjoy healthy and balanced lives, it also equips our bodies to fight infection and stave off disease.

Seniors in our care face especially significant challenges as older bodies tend to have a more difficult time absorbing as many nutrients from food as younger bodies do. There are also other challenges facing seniors ranging from difficulty chewing to problems with digesting to special dietary needs of changing metabolism or medications. Later on in this article we will discuss strategies and solutions for helping RAL owners support their seniors in getting the nutrients they need to live healthier lives, but for now let’s dive into the issues that are creating these challenges in the first place.

Our society has long faced problems associated with diet. Unfortunately, even issues as simple as eating too much or eating too little are greatly expounded when you involve the elderly. Generally, after decades of living busy lifestyles, many Americans have developed fairly poor eating habits that easily extend into old age if they are not addressed.

For the most part, all of us reap what we have sowed throughout our lifetime. The decisions around nutrition and exercise that end up forming practices and habits play a significant role in our longevity in the physical and mental capabilities in our twilight years. Of course there are external factors that can have a huge effect as well, but generally a lifelong series of choices about what we put in our bodies will result in particular consequences. In short, the environment that we have established during the first 40–50 years sets the stage for how we will experience the aging process. Unfortunately, far too many of us become aware of time’s eventual effects on our mind and body sometime around middle age, when we start to see the actual effects of aging.

There are four main health concerns that loom large around the elderly: heart, mind, bones and the various forms of cancer. While some of these issues work in conjunction with our genetic makeup, there is mounting scientific evidence that supports the conclusion that adopting healthy nutritional and exercise habits can greatly improve the odds for a healthier period of aging. [1] And it only makes sense that these key factors would greatly affect the aging process. The human body is an amazing thing, but it isn’t magic, what you put into it will affect what you get out of it. Thankfully, we are learning more about how vital nutrients can have a profound effect on overall health and longevity.

Although the overall caloric intake of seniors is less than other adults, the surprising thing is that the nutrient requirements do not change all that significantly with age, and they are only marginally different between men and women. The nutrients chart below is the Dietary Reference Intake for older adults established by the Food and Nutrition Board of the National Academy of Sciences and details how all of the important dietary nutrients play a role in the four most significant health concerns for seniors, i.e. heart, mind, bones and cancer.

With smaller food portions and lower caloric levels consumed by seniors, the goal to hit the daily recommended intake of essential nutrients can become a bigger challenge.

Studies have shown that the dietary intake of a sizable percentage of older adults is significantly below the Recommended Daily Allowance. On average, seniors are at a major risk for consuming less than two-thirds of the recommended daily allowance.

  • Vitamin or Mineral
  • Vitamin B6 (mg)
  • Vitamin B12 (mcg)
  • Vitamin C (mg)
  • Calcium (mg)
  • Vitamin D (mcg)
  • Vitamin E (mg)
  • Folate (mcg)
  • Magnesium (mg)
  • Niacin (mg)
  • Riboflavin (mg)
  • Thiamine (mg)
  • Male
  • 1.5
  • 2.4
  • 75
  • 1200
  • 15
  • 14
  • 400
  • 320
  • 1.4
  • 1.1
  • 1.1
  • Female
  • 1.5
  • 2.4
  • 75
  • 1200
  • 20
  • 15
  • 400
  • 320
  • 1.4
  • 1.1
  • 1.1
  • Function
  • Lowers total homocysteine; nerve function; Alzheimer’s; may help prevent vascular and heart disease
  • Cell growth and division; red blood cell formation; nerve function; may help prevent heart disease
  • Antioxidant: protects against cancer, cognitive impairment, decreased function; wound healing
  • Bones and teeth; muscle contraction; nerve function; normal blood clotting; may lower blood pressure
  • Aids calcium absorption; bone mineral fracture risk; muscle strength
  • Coronary heart disease; nervous system disorders; Alzheimer’s; Parkinson’s; macular degeneration
  • Red blood cell formation; cell growth and division; may help prevent heart disease
  • Muscle contraction; nerve function; may lower blood pressure; energy utilization
  • Cell respiration; carb, fat and protein metabolism; circulation; nervous system; normal secretion of bile and stomach fluids
  • Activates B6; carbohydrate, amino acid and fatty metabolism
  • Enhances circulation; carbohydrate metabolism; blood formation; nerve function

Food Insecurity & Elderly Malnutrition

Because reduced caloric intake plays such a large role in the nutrient deficiency of seniors it is important to address the overall issue of food insecurity and how it relates to elderly malnutrition. Even in the midst of a rapidly transforming global landscape the U.S. economy continues to be the largest in the world, so it should make sense that no senior citizen in America should have to go hungry. Unfortunately, that sentiment doesn’t match reality, and hunger among our elderly population is a growing crisis. In recent years, hunger rates in the United States have more than doubled. The fact is that food insecurity among the elderly decreases resistance to infection, increases disability, exacerbates chronic health conditions and extends hospital stays. Many seniors in America are who are struggling to live on meager budgets often face the choice of skipping meals in order to have the means to purchase medication. It is important to understand the moral and financial implications of this issue so that we can provide solutions to ensure that all of our seniors have access to adequate nutrition.

This is potentially where the residential assisted living industry can step in. Owners and operators of residential assisted living homes have the opportunity to meet this growing crisis head on. We need to be at the forefront of the solutions on this issue. And throughout the rest of this article we will discuss some of the many strategies we can implement that give our elderly population the health and dignity that they deserve.

Why It Matters

As the next few decades unfold we are going to see just how much of an impact elderly nutrition and health has on society as a whole. The obvious immediate impact will be visible in the health of seniors, their longevity and the prevalence of chronic diseases influencing their quality of life. But there are other causal impacts that will end up leaving far-reaching consequences, the extent to which we are only able to predict now.

Estimates from the Center for American Progress show that senior hunger will increase the costs associated with illness each year in the United States by $130.5 billion. In 2012, over five million Americans beyond the age of 60 were food insecure, which constitutes 9 percent of all seniors.

Seniors require more consideration towards their health and medical needs, which can become compromised when there is food insecurity. Studies examining the health and nutritional status of seniors reported that food insecure seniors had significantly lower intakes of vital nutrients in their diets when compared to their food secure counterparts. Additionally, food insecure seniors are 2 to 3 times more likely to report poor health and have higher nutritional risk.

Seniors who are food insecure, on average, consume far fewer nutrients and calories compared to food secure seniors. And it is not the quantity of food that is the only issue, the quality of nutrients consumed bears an even greater effect on the health of the elderly. In an assessment of seniors and their intake of various nutrients, food insecure seniors not only consumed less calories, but much lower quantities of all 10 key nutrients than their food secure counterparts. For example, food insecure seniors had intake levels of protein that were 12 percent lower and levels of iron that were 14 percent lower than that of food secure seniors. Many of these nutrients, including protein and iron, have been well documented to be particularly important to the health of the senior population. The differences in nutrient intake between food insecure and food secure seniors persist when taking into account other known risk factors for poor health, such as income, race, and age. That is to say that, food insecurity still has a negative association with nutrient intake for all nutrients, except Vitamin A and calcium, when filtering all other known risk factors.

Food Insecurity & ADL’s

In addition to these serious conditions, food insecure seniors are 22 percent more likely to experience physical limitations that impede their Activities of Daily Living. ADLs are the fundamental activities involved with taking care of one’s self and are usually learned in early childhood; activities such as eating, walking, getting dressed, going to the bathroom and bathing. These are typically tasks that most elderly individuals can perform independently. However, when faced with food insecurity the development and exacerbation of serious chronic diseases can severely limit an individual’s ability to perform these tasks independently.

These effects can become cyclical and compound the nature of such limiting chronic conditions. A senior faces food insecurity, due to economic or other reasons, and therefore consumes less vital nutrients. This leads to the deterioration of health through chronic disease and results in limited mobility, which puts the senior at risk for even greater food insecurity, and the cycle continues.

Many of us often take food for granted, but it is worth remembering that good nutrition is the first line of defense that our bodies have to fight infection and disease. In this fact is made all the more important when it involves aging bodies which have a more difficult time absorbing and processing those nutrients.

Because there is such a close link tween food insecurity and disease, it is of vital importance for people who work with seniors to be vigilant in the observation and assessment the dietary needs and eating habits of those in their care. In a busy residential assisted living home can be easy for caregivers to miss the small signs that a resident isn’t getting their proper nutrition. In a well-run assisted living home, it might be easier to notice if a resident has skipped or is regularly skipping meals, as seniors will often eat together at regularly scheduled times. However, recognizing when a resident isn’t consuming their full meals and is shortchanging themselves of vital nutrients, might not be as easy to keep track of.

This is just another reason why it is imperative to hire and train caregiving staff who are competent and who have a great attention to detail and genuine concern for the residents. Big-box assisted living facilities across the nation regularly have issues with caregivers simply not caring. It seems far too regular an occurrence when we hear about the staff of a large assisted living facility abusing their position, taking advantage of residents or simply ignoring the warning signs that a senior’s health is in jeopardy.

We tend to believe that most people who get involved with the business of residential assisted living are doing it for the right reasons, because they want to help people. But even if that wasn’t always the primary motivation, ensuring the health, longevity and quality of life of the seniors in your care helps keep residents in your home longer, which can only be good for your business. The bottom line…healthier residents leads to a healthier business. Thankfully, we realize that if you’re reading this you probably care a great deal about the health of our seniors, and it is just a bonus when our RAL businesses benefit from the improved health of the residents in our care.

Food Insecurity & Disease

Among the elderly population, food insecurity is closely associated with an increased risk of developing specific chronic health conditions, such as diabetes, high blood pressure, asthma, coronary artery disease and congestive heart failure.

Food insecure seniors are at a significantly increased risk for chronic health conditions, even when filtering out for other contributing factors like income. Statistics show that food insecure seniors are 60 percent more likely to experience depression, 53 percent more likely to report a heart attack, 52 percent more likely to develop asthma and 40 percent more likely to report an experience of congestive heart failure.

A proper diet and a healthy life go hand in hand, and this is especially true for elderly adults. Medical research from the World Health Organization has led to the conclusion that a majority of the diseases that older people suffer are as a result of lack of proper diet.

Many of the diseases suffered by elderly people are the result of dietary factors, some of which could have been dietary habits that were practiced since infancy. These factors are then compounded by environmental factors and changes that naturally occur in the aging process.

One of the main nutritional concerns that occupies a sizable amount of attention from the medical community is the overconsumption of dietary fat, which seems to be associated with numerous diseases and chronic conditions including cancer of the colon, pancreas and prostate. Atherogenic risk factors, such as increased blood pressure, glucose intolerance and blood lipids are all significantly affected by dietary factors and play a significant role in the development of coronary heart disease.

Degenerative diseases such as diabetes, osteoporosis, cancer, cardiovascular and cerebrovascular disease are among the most common diseases affecting older persons and all are heavily affected by diet. There is increasing evidence in the study of the diet/disease relationship, that micronutrients play a significant role in promoting health and preventing incommunicable disease. Micronutrient deficiencies are incredibly common in elderly people due to a number of factors, such as their reduced food intake and a lack of variety in the foods they eat.

Another factor that leads to micronutrient deficiencies in elderly is simply the price of foods rich in micronutrients, which further discourages their consumption. Individuals who have spent a lifetime developing certain dietary habits are often more hesitant to change up their routines in light of medical evidence that suggests it would benefit their health, especially if it comes at a greater financial cost. The irony is that our bad dietary habits have a direct correlation to our eventual medical expenses. While we might fail to justify spending more money at the grocery store buying natural, healthier foods, we will end up paying even more for those decisions with our health and with our pockets, treating disease and chronic conditions that might have been avoided, or at least delayed, by spending a lifetime making healthy dietary choices.

Compounding the issue of micronutrient deficiencies is the fact that the older people often suffer from decreased immune function, which contributes to this group’s increased morbidity and mortality. Other significant age-related changes including the loss of cognitive function and deteriorating vision, are contributing factors that hinder wellness and healthy dietary habits in old age.

Elevated serum cholesterol, a risk factor for coronary heart disease in both men and women, is common in older people and this relationship persists into very old age. As with younger people, drug therapy should be considered only after serious attempts have been made to modify diet. Medical intervention trials have shown that the reduction of blood pressure by 6 mm Hg reduces the risk of stroke by 40% and of heart attack by 15%, and that a 10% reduction in blood cholesterol concentration will reduce the risk of coronary heart disease by 30%.

There is evidence to suggest that dietary changes directly affect risk-factor levels throughout life and that these changes may have an even greater impact in older people. In fact, relatively modest reductions in saturated fat and salt intake, which would reduce blood pressure and cholesterol concentrations, could have a substantial effect on reducing the burden of cardiovascular disease. Increasing consumption of fruit and vegetables by one to two servings daily could cut cardiovascular risk by as much as 30%.

Not only does food insecurity affect senior nutrition, disease and activities of daily living, but it also has a significant economic impact as well. It often costs more money to spend one day in the hospital or six days in a nursing home recovering from health complications than it does for senior to spend an entire month in the supporting environment of residential assisted living. With a robust network of residential assisted living homes filled with qualified and caring staff we could curb the incidences of acute health complications among the elderly. As the saying goes, “an ounce of prevention is worth a pound of cure.” Quality care provided by a national grid of tens of thousands of superior residential assisted living homes could eventually save billions of dollars in unnecessary Medicaid and Medicare expenses every year, tax dollars that could be spent in other ways.

While we enjoy the benefits of an overall increase in lifespan in this country, maintaining health throughout the aging process comes with its own challenges. Proper nutrition for an aging population is not just an issue for elderly Americans but is a growing global challenge that will need to be addressed. The number of elderly persons aged 60 and over is growing both the number and in proportion of the entire population in virtually all countries this trend is likely to continue for decades to come.

Rapidly Increasing Growth of the Elderly Population

The National Institute on Aging (NIA), part of the National Institutes of Health, worked with the U.S. Census Bureau to commission “An Aging World: 2015,” a report that sheds light on the details of this global aging phenomenon.  This report examines the demographic, socioeconomic and health trends accompanying the current boom of the aging population.

Overall, the general population of the world’s citizens is growing dramatically, however, the elderly section of this population growth is increasing at an unprecedented rate. In 2015, 617 million people were aged 65 and over, making up 8.5 percent of the total worldwide population and according to a new report, this percentage is projected to jump to nearly 1.6 billion, making up 17 percent of the world’s population by 2050.

“Older people are a rapidly growing proportion of the world’s population,” said NIA Director Richard J. Hodes, M.D. “People are living longer, but that does not necessarily mean that they are living healthier. The increase in our aging population presents many opportunities and also several public health challenges that we need to prepare for. NIA has partnered with Census to provide the best possible data so that we can better understand the course and implications of population aging.” [2]

“An Aging World: 2015” contains detailed information about life expectancy, gender balance, general health, disability, mortality, health care systems, labor force participation, retirement, pensions and poverty among older people around the world.

“We are seeing population aging in every country in every part of the world,” said John Haaga, Ph.D., who is the acting director of NIA’s Division of Behavioral and Social Research. “Many countries in Europe and Asia are further along in the process, or moving more rapidly, than we are in the United States. Since population aging affects so many aspects of public life — acute and long-term health care needs; pensions, work and retirement; transportation; housing — there is a lot of potential for learning from each other’s experience.” [2]

Highlights of the report include:

  • America’s 65-and-over population is projected to nearly double over the next three decades, from 48 million to 88 million by 2050.
  • By 2050, global life expectancy at birth is projected to increase by almost eight years, climbing from 68.6 years in 2015 to 76.2 years in 2050.
  • The global population of the “oldest old” — people aged 80 and older — is expected to more than triple between 2015 and 2050, growing from 126.5 million to 446.6 million. The oldest old population in some Asian and Latin American countries is predicted to quadruple by 2050.
  • Risk factors for disease — such as tobacco and alcohol use, insufficient consumption of vegetables and fruit, and low levels of physical activity — directly or indirectly contribute to the global burden of disease. Changes in risk factors have been observed, such as a decline in tobacco use in some high-income countries, with the majority of smokers worldwide now living in low- and middle-income countries.

Our Bodies Change with Age

The evidence is clear; our bodies change as we age, and seniors have slightly different nutritional needs compared to those of children, teenagers, and even middle-aged adults. These age related changes affect how the body processes food, which influences a person’s dietary needs and can greatly affect their appetite, mood and longevity. Micronutrient deficiency among the elderly can be due to many more factors then simply reduced food consumption and a lack of variety in their diet.

Some of the more noticeable changes that hinder proper nutrition are:

Slowing Metabolism. This happens naturally, but it becomes more pronounced if seniors don’t get as much exercise as they should. When metabolism slows, the body doesn’t burn as many calories, which means a person needs to eat less to stay at a healthy weight. As a result, the foods eaten should be as nutrient-rich as possible. Most senior women with average activity levels need about 1,600 calories per day, while senior men with an average activity level need about 2,000 calories each day. Fewer calories are needed if the person is relatively sedentary, more if they are very active.Change in Digestive System. Later in life, the body produces less of the fluids that it needs to process food in the digestive system. These changes can make it harder for the body to absorb important nutrients like folic acid and vitamins B6 and B12.

Change in Appetite. Many seniors take one or more medications for health conditions; these can cause side effects such as a lack of appetite or upset stomach, which can lead to poor nutrition.

Change in Digestive System. Later in life, the body produces less of the fluids that it needs to process food in the digestive system. These changes can make it harder for the body to absorb important nutrients like folic acid and vitamins B6 and B12.
Change in Appetite. Many seniors take one or more medications for health conditions; these can cause side effects such as a lack of appetite or upset stomach, which can lead to poor nutrition.Physical Difficulty. Seniors become weaker with age, especially when dealing with conditions like arthritis and disability. Pain and poor physical strength can make simple tasks appear to be challenging. Performing basic functions like standing for long while cooking, carrying groceries, or even peeling a fruit may become daunting tasks.

Decreased Sensitivity. As an individual advances in age, your senses become numbed down; it takes more energy and time to trigger a stimulus. The sense of smell and taste decreases reducing appetite. In some cases, the person may even have trouble differentiating fresh food from stale since their senses are compromised. There is no doubt that this would be detrimental to overall health.

Medication Side Effects. Some medications can cause nausea, reduced appetite, and change the perception of different food tastes. In this case, the side effects can discourage a person from eating, and then they end up skipping meals.

Poor Dental Health. Dental issues are more likely to come up as we grow older, problems like missing teeth, receding gums that cause the teeth to be shaky, mouth sores, and jaw pain. All of these factors can make chewing painful and uncomfortable, thereby reducing the likelihood of seniors consuming the proper amount of healthy foods.

Lack of Finances. Older people can also develop situations where they have limited resources and worry more about money. In order to cope they might cut back on groceries and buy cheaper food, which, in most cases, is less nutritious. This lifestyle can result in many nutritional deficiencies.

Lack of Transportation. To shop for fresh ingredients, a person often needs to drive to the store, wait through traffic, and park the car a distance from the door. If it’s raining or snowing, it’s even more challenging. Chances of slipping and falling are high. These activities may discourage older people from going to shop altogether. This is one of the many areas where residential assisted living can have a profound impact on a senior’s ability to attain healthy nutritious meals, as the RAL staff are responsible for purchasing and preparing these meals.

Memory Loss. Dementia, Alzheimer’s disease and memory loss are all fairly common among seniors and these conditions all pose a challenge to achieving good nutrition. While residing in an independent living environment, a senior may forget to follow their advised meal plan, skip a meal or even forget to buy food from the store, in the residential assisted living environment, many of these challenges can be met head-on by a diligent and proactive care staff.

Change in Emotional Health. Nutrition has a significant impact on the emotional health of an individual. Seniors who feel depressed or lonely can often lose interest in eating. On the other hand, emotional issues may cause others to eat more and gain weight, leading to a whole host of health problems. As you grow older, a lot of environmental changes take place, (children move away, friends and loved ones are lost due to death, feelings of loneliness, physical changes and loss of independence can all lead to significant changes in emotional health). All these issues can compound on one another leading to depression. Seniors may become apathetic about their health and avoid eating. If left untreated, depression can lead to much more significant health problems.

There are many simple ideas you can employ to help elderly residents in your care develop better eating habits and achieve positive nutritional results. Ideally, residents should see a physician in order to determine their exact caloric need, as individuals’ needs vary.

What Is Nutrient packing?

So with all these challenges, the question becomes how do we get seniors to eat better? They might profess to have no appetite, or can’t taste food and don’t care to eat it. Yet, there is evidence to suggest that the elderly do respond to certain food stimuli. As a group they tend to like sweet things. They also tend to prefer soups and easily digested puddings. They often drink beverages that can be made to reflect their tastes, and they respond favorably to seasoned, but not necessarily spicy foods, that overcome their reduced taste sensitivity.

What may be needed to stimulate tired and bored palates are unit servings of foods that are easy to consume, require minimum preparation and contain proper nutrients. Moreover, by delivering the nutrients in a food matrix, conditions are optimized for their absorption. Many people have experimented with numerous soups, prepared foods and a variety of baked products designed to meet specific nutritional targets for the elderly population. In all cases, the food matrix is large compared to the nutrient content, making it relatively easy to mask the offensive taste of some vitamins while maintaining the original taste.

For example, a 100g muffin can be made to deliver 1g calcium, 10-12g protein, and a number of critical micronutrients, in particular vitamins C and E and all the B vitamins. The same can be accomplished with a serving of rice or tapioca pudding. In both examples, one needs to bury 2-3g of nutrients in a 100g food matrix, a formulating challenge that can be met.

Soups are another category of favorite elder products that can attain similar results. We have yet to meet an aged person who has not responded favorably to a good soup. James Duke, MD, with the US Department of Agriculture, stated: “An old-fashioned vegetable soup, without any enhancement, is a more powerful anti-carcinogen than any known medicine.” A highly flavored Tuscan bean soup can be made to incorporate all the desired nutrients in a satisfying vehicle.

When food is used to deliver nutrients, care must be exercised during processing, as nutrients can be lost to varying degrees upon exposure to heat, light, shear forces or simple dissolution in water. The level of fortification needs to be adjusted according to the pH of the ingredient mix, or the baking or broiling process used. It is critical to have products analyzed to establish the end level of nutrient for each specific product type and then adjusted as needed.

Health conditions facing the elderly may be remedied with the creation of delicious and nutritious foods tailored to compensate for specific dietary deficiencies. These foods need to take into consideration the declining ability of the elderly to chew, digest and importantly to taste. After all, if the senior doesn’t like the food available to them they won’t need it, and it doesn’t matter how much nutrition is packed into that food, if it doesn’t get consumed it is useless.

There are many ways to address elderly nutrition in a residential assisted living home. If you have the opportunity, bring in a nutritionist that will help guide your residents toward eating a healthy and balanced diet, that would be a significant advantage for their longevity and add value to your RAL business. Or you can do some research of your own and help create nutrition plans that are more tailored to senior health.

Helpful Nutrition Ideas

Most nutrition plans involving seniors should begin with an increase in healthy calories. Many of us have become accustomed to skipping the occasional meal as we move through our busy days but as we age this deficit in nutrition can have a greater negative impact on our health. Some excellent and simple ways to boost caloric intake in seniors include:

  • Smoothies & healthy milk shakes. They pack a lot of calories, and if fortified with nutritional ingredients make great meals for seniors, especially those with problems chewing and digesting their food. Smoothie Recipes
  • Dehydrated milk. Try adding it to cereal or a creamy sauce to boost calories and much needed protein.
  • Eggnog. It’s not just for the holidays, and it also delivers lots of calories.

As you and your team make food choices to improve the nutrition of your residents, keep these helpful tips in mind:

  • Get to know H2O. Hydration is extremely important for older adults. If a senior becomes dehydrated it can lead to a whole host of issues. Sometimes people just focus on the nutrition aspect, but it is just as important to make sure your residents are well-hydrated. Drinking plenty of water is so vital for our body’s health. Help your residents stay hydrated and be sure to offer lots of water and non-caffeinated beverages as well as foods with high water content like soups, cucumbers, grapes, and melons (unless otherwise instructed by their doctor).
  • Pack in the protein. So important for optimal health, protein powers our body. It provides energy, helps cognitive function, keeps the immune system functioning properly, maintains heart and respiratory health and supports our mood, boosting the body’s resistance to stress, anxiety and depression. When protein is consumed it is broken down into amino acids which are the basic building blocks for energy and growth in our bodies. These nutrients are vital for building, maintaining and repairing cells, tissues and organs throughout the body. Lots of foods contain protein, but there is a difference between high quality low quality protein. Processed foods like lunch meats, for example, might have a significant amount of protein, but they are loaded with salt, which causes high blood pressure and leads to other health problems. Yogurt can be a great source of protein, however, most of the flavored yogurts found in your local supermarket contain astonishingly high levels of added sugar. You might also want to skip on the processed cheese, which often contains non-dairy filler ingredients. So it is better to stick with protein rich foods don’t come with unwanted ingredients that are more harm than good. Stick with lean proteins like beans, eggs, chicken and fish, lean meats, and nuts, and keep to the unprocessed foods as much as possible. *It is also worth noting that it is feasible to meet your daily requirement protein through plan-based sources alone, such as beans, vegetables, grains and nuts. But just be aware that many of these protein sources can lack one or more of the essential amino acids that our bodies need, so it is important to consume a variety of these plant-based sources every day to ensure that the body gets all of the essential amino acids that it needs.
  • Manage cholesterol and opt for healthy fats. Cholesterol is naturally produced in the body and generally doesn’t need to be supplemented by diet. But we get into trouble when we consume foods high in saturated and trans fat, which causes our bodies to produce unhealthy levels of LDL (bad) cholesterol. Saturated fats are naturally found in many foods, primarily dairy and meat products and the daily intake of these fats should be limited. Trans fats, on the other hand, are not natural. Also called partially hydrogenated oils, trans fats are created through an industrial process that adds hydrogen to vegetable oils in order to make them more solid. These fats serve no real purpose to our bodies and, if possible, should be avoided entirely. The American Heart Association advises that individuals would benefit greatly with lower LDL cholesterol by eliminating trans fats from their diet. Most of the fats we eat should be unsaturated fat, which is broken up into two categories, polyunsaturated and monounsaturated fats. These are primary found in nuts, seeds, avocados, vegetable oils and fatty fish. The healthier oils are naturally occurring unhydrogenated vegetable oils, so opt for canola, sunflower, safflower or olive oil. These foods that are low in saturated fat and trans fat and can help reduce the risk of heart disease and cardiovascular disease. Consumed in moderation, both types of unsaturated fats can help improve blood cholesterol when used in place of saturated and trans fats. How do you know which type of fat you are eating? Do yourself a favor and take a moment to read the labels on your food. Another good visual indicator is that the healthy unsaturated fats, monounsaturated and polyunsaturated fats, are typically liquid at room temperature.
  • Exercise a “rough” diet. Include a variety of high-fiber foods daily, such as raw fruits and vegetables and whole grains. These foods help cut down on constipation and help the body stay regular, as well as providing the vitamins, minerals, fiber, and nutrients that the body needs for healthy aging. Fiber can help maintain body weight, prevent type II diabetes, and reduce the risk of heart problems and cardiovascular disease. It is also important for seniors to increase their intake of fruits, vegetables, beans, nuts, and other fiber-rich food in order to boost the healthy enzymes found in a plant-rich diet. Another option if a resident isn’t sure they are getting enough fiber is to talk to a doctor about fiber supplements.
  • Choose whole grains. These nutrient and fiber rich foods will help digestion and protect the heart. Choose brown rice, whole grain cereals, and whole wheat bread instead of white bread and refined grains.
  • Calcium & Vitamin D is critical. There are certain nutrients that become especially important for good health as we age. Everyone needs calcium to protect bone health, but older adults need more calcium and vitamin D to help maintain bone health. Seniors should have three servings of calcium-rich foods and beverages each day. This includes fortified cereals and fruit juices, dark green leafy vegetables, fish, low-fat dairy products, milk and fortified plant beverages. If seniors take a calcium supplement or multivitamin, it should usually be paired with vitamin D, its partner in bone building and nutrient absorption to help provide what the body needs.
  • Supplement B12. Many people older than 60 do not get enough vitamin B12. Seniors should also consume foods, like fortified cereals, lean meat and some fish and seafood, which are great sources of vitamin B12. The aging body has a decreased ability to absorb B12, so getting more through diet and supplements will ensure that seniors meet their daily requirements. It is also worth asking a doctor or a registered dietitian nutritionist if a vitamin B12 supplement would be beneficial to the residence diet.
  • Don’t forget potassium. Increasing potassium along with reducing sodium may lower the risk of high blood pressure. Fruits, vegetables and beans are good sources of potassium. Also, select and prepare foods with little or no added salt. There are many ways to add flavor to food with herbs and spices.

These are just a few of the many ways you can help your residents get the nutrition they need for health and longevity. Not only will you be helping your residents, but establishing a real commitment to senior health is something that is likely to spread by word of mouth in your community, setting your RAL apart from the rest as a place that genuinely cares for the health of its residents.

As you look to improve the nutrition of your seniors. Remember that it is fine to start gradually, exchanging poor foods for healthier options is a good first step. But try equip your team to make changes every week that will bring your residents closer to a healthy diet and a healthy lifestyle.

Better Ingredients & Flavorful Cooking

Along with better nutrition, flavorful, healthy and satisfying food begins with fresh ingredients. It is better if the kitchen cooks from scratch and follows recipes designed to use fresh ingredients. When they do, residents eat great tasting meals that are nutritious. Sure it is easier to resort to packaged food that is nearly ready to serve, but you will be missing out on the many benefits of using fresh ingredients, such as, improved flavor, greater nutritional value, reduction in the need for additional supplements, and overall improved health and wellness.

Have you ever heard an older person complain about how food tastes? Do you know why? It’s partly in the taste buds. These change over time and affect the flavor of foods. For older adults, the same foods don’t taste the way it did years ago. As the body ages, so do the taste buds. Adults have over 6,000 taste buds, while elderly people have only 2,000 to 3,000.

This doesn’t mean that the flavor of food diminishes forever, and that they’ll never enjoy food again. On the contrary, it means that food needs more seasoning than it was previously getting. Put down the salt shaker, because there are many other things that can increase the savory nature of food. Lessen salt intake by using other ingredients such as cayenne pepper, rosemary, garlic, and more. The stronger a seasoning, the more likely seniors will be able to sense it and enjoy their food again.

The good thing about adding healthier seasoning is that many of the herbs and spices used to create savory dishes are beneficial to the body. Garlic offers anti-viral, anti-bacterial, and anti-microbial functions in the body. The traditional bulb of garlic is a high blood purifier and is chock full of strong taste that is so needed for seniors. Rosemary is also great for treating and preventing influenza. Cinnamon and cayenne pepper have properties that help both glucose levels and arthritis symptoms.

The body needs some salt for regular functioning, but salt is a restriction for many elderly people, and they often need to follow a sodium-free style of meals. If it is essential to add salt to a meal, do it carefully and avoid adding any salt at all to prepackaged food.

Seniors are just like any other demographic, they want food to taste good. For many residents in senior housing, food is one of the more important priorities, even over other amenities. The importance of quality food cannot be over-stated as it offers nourishment and nutrition that contribute significantly to a senior’s defense to chronic illness and declining health. But if it doesn’t taste good, it doesn’t get eaten. And if it doesn’t get eaten, then the health benefit isn’t there.

Assisted living homes and care agencies with strong nutritional programs may have a competitive advantage in this ever-expanding industry. Many people look for assisted living homes that have a cooking staff and chef willing to cater to the preferences of the residents, so if you are looking for another way to stand out from the rest of assisted living options in your area, consider hiring for this added feature. Look for a chef who specializes in organic and fresh produce and supports the health objectives of residents, wellness, and community involvement by creating memorable meals. This will only add to the value of your RAL home.

A dynamic and interactive chef can guide residents through cooking topics, preparation techniques, tips for exploring new types of cuisine, and nutritional benefits of healthier ingredients. And giving seniors a chance to participate in the process is a great way to create social engagement and improve their mental health as well.

Resident Participation

Prospective residents and their families are looking for amenities in the home that will offer a safe living environment, one designed for mobility and accessibility while offering expert care and comfort. For example, does the home have a spacious dining room able to serve many people and foster a sense of community? They will want to know that your staff offers well-prepared, nutritious meals tailored to the changing health and needs of the residents.

Also, consider offering opportunities for the residents to become an active part of their own healthy nutrition by allowing them to help with various elements of meal preparation. Many seniors enjoy the interaction and activity of mixing ingredients and preparing food…something that most of them will undoubtedly have many years of experience doing for themselves.

To ensure residents receive the food they like, have your team get feedback from them regularly. Of course, there are some residents who won’t always want the foods that are best for them. In these cases, your team can counsel them about healthy choices, but they can’t force them to comply. You can only educate residents who want to be educated.

And remember, when establishing a plan for balanced nutrition, the team approach is always a good place to start. One of the most effective methods is to encourage a working relationship between your team or kitchen staff and the families of the residents in order to meet the residents’ needs. Communication and a shared goal of resident satisfaction keeps everyone on the same page. If there is a breakdown in communication, it can become very apparent. Some family members might want complete control over a loved one’s diet, so it is important to establish a rapport with them, in case you need to explain, for example, why it’s alright for the resident to enjoy a slice of cake on her 85th birthday.

Mental Exercise & Effects on Longevity

In an ever-increasing digital age where access to information and the demand for it seems limitless, you can’t spend much time online or watching TV without someone talking about fitness and physical exercise. It is woven into the shows we watch, the news we read in the social media that keeps us constantly plug-in. As much as society focuses on physical fitness and beauty, there is a relatively insignificant amounts of focus and capital that goes into communicating the importance of exercising the mind. While there are plenty of benefits that come with being able to access unlimited information on our screens in a matter of seconds, this constant barrage of words and imagery can lead us to complacency when it comes to exercising our brains.

Physical exercise is clearly important for health and happiness, though many of us don’t give it the attention it deserves, there’s plenty of modern scientific evidence to suggest that exercising the brain is just as critical to overall health.

From a physiological standpoint the brain is obviously one of the most important muscles in the body and just like the other muscles, it need be exercised in order to stay healthy. This is made all the more important for the elderly population. A person’s longevity is clearly related to the body’s health and physical fitness, but mental fitness can play an equally important role in helping to ensure an individual’s life is long and that the quality of life is optimal for us long as possible.

Regardless of what age someone is, anyone and everyone can begin a daily workout that exercises the brain to the benefit of their health and there is no better time to start than now. Scientists in all sorts of fields are learning more and more about the power and potential of the brain every day. Widely held conclusions from earlier research suggested that the brain’s capacity to grow and learn halted with age, but recent studies have shown that the brain is continually able to adapt and learn with the creation of new neural pathways.

Called, neuroplasticity, this phenomenon is defined as the capacity of neurons and neural networks in the brain to change their interconnectivity and behavior in response to new information, development, sensory stimulation, damage or dysfunction. This is an exciting new field of study that bears significance for everyone’s health, but especially for the health and longevity of seniors, who, for generations have been written off when it came to mental development and the ability to change.

This discovery has completely overhauled the way that scientists think about brain function and it gives new hope for the aging population, including those who face difficulties with brain damage and brain disease. For decades, scientists had believed that the ability of the brain to grow and learn was finite and hardwired into our DNA, however, with neuroplasticity we are finding ways to proactively reorganize and create new neural pathways. Research developments have been made that suggest that the healing of brain injuries is possible as well as the probability of brains to adapt and stay sharp well past the formative years.

All of these new developments are wonderful and have potential benefits for all people at any age, but the one caveat is that in order to fully take advantage of neuroplasticity, an individual must be proactive and practice using the brain in new ways. Fortunately, there is a near limitless amount of exercises that a person can do to engage their brain to develop new neural pathways.

Now that we know the critical role that mental exercise plays in strengthening our brains, just as the same physical workouts decrease their effectiveness to our bodies over time, the same monotonous set of challenges to the brain can become less and less effective. In other words, in order to keep our brains as healthy as possible, it is essential to continually introduce new and adaptive experiences to our mental workouts.

The beauty of mental exercise is that it generally doesn’t cost a thing, it doesn’t require a gym membership or pumping iron or working up a sweat, and can involve a myriad of possible exercises that can be done by anybody at virtually any time and place. So whether you want to exercise your own brain, or you own and operate a RAL home and you want to help your residents stay healthy and happy, getting to know the various methods for mental exercise can only be a benefit.

There are many enjoyable brain exercises and activities older adults can use to help keep their minds sharp and their hearts happy. Some of these activities include word games, music, arts and crafts, puzzles, aerobic movement, gardening and many more.

What used to be primarily associated with children, word games and brain teasers are now known to have wonderful benefits for boosting brain function in adults of all ages, as well. Over the past decade and with the ubiquity of mobile devices, activities like Sudoku, crosswords, word jumbles, puzzles and brainteasers have become readily available to everyone and can usually be obtained free of charge. These mental exercises are an easy way to improve word association and recall memory and brainteasers offer a fun and effective way to promote the benefits of neuroplasticity. And if you or your senior residents don’t have easy access to mobile devices or tablets, local newspapers and periodicals tend to have at least one, if not more of these brain exercises, and generally for a very low cost. If you’re RAL home as a community computer for the residents to use, there are literally hundreds of websites and apps that offer these games and activities for free.

If you and your residents would prefer non-digital options, activities like board games, jigsaw puzzles, card games, dominoes, checkers, chess and other similar games can all be incorporated into the daily mental exercise plan. The added benefit of choosing analog activities is that they usually involve problem-solving skills in combination with manual dexterity, and when these activities are used in rotation they help further stimulate the creation of new neural pathways. Whether young or old, people are creatures of habit, and most of us have our go to activities, which is especially common with seniors in assisted care facilities. But if, instead of going back to that same card game or puzzle every day, your senior residents had a plethora of options that they could rotate between, it would have more beneficial effect on their brain’s ability to adapt continue to grow. Another great advantage of these analog activities is that they provide plenty of opportunity for social interaction and developing interpersonal relationships. And unlike digital activities, which only require the participants to solve the mental puzzles, activities which require multiple individuals also create the opportunity for cooperation and relational problem-solving. These activities can also be great in preventing feelings of isolation or loneliness, which has a negative compounding effect on mental health.

Arts and crafts are also a great way for your residents to exercise their brains and it affords the opportunity for personal creativity as well. Being creative requires much more brainpower than simple rote learning exercises, so activities that have a more artistic focus can have a greater impact on mental sharpness. Drawing, painting, poetry, sculpture, knitting, scrapbooking and other similar activities all offer seniors the opportunity to flex their mental muscles while showcasing their creativity. Most of these activities can also be very communal as they encourage cooperation with others as well as the opportunity to give and receive feedback on artistic expression.

And who knows, by turning your residents on to artistry, it just might unlock something special in them that the world is waiting to see. While most professional artists usually experience their most productive and lucrative period in young to middle adulthood, there are many cases of great artists who took up their craft very late in life. Artistic activities have become popular in recent years as a form of therapy that uses the creative process as an instrument for healing. Creatively engaging with art has the benefit of stimulating many areas of the brain to enhance physical, emotional, cognitive and social capacity.

The process of creating art provides the opportunity for an individual to integrate their life experiences through objects and imagery, and often helps to foster feelings of support, safety and well-being. Art therapy has been known to show signs of significant reduction in anxiety and depression as well as provide a platform to boost the self-esteem of those who participate in it. As RAL owners, it would be well worth your time to look into organizations or businesses in your area that provide art therapy for seniors.

Music is another great way to stimulate the brain. I am sure that most of us have experienced music’s ability to provide comfort, bring back memories of the past and evoke a whole host of emotions that have caused us to ponder the big questions of life. Many of us have benefited from music therapy without even recognizing that it was therapy. More than just the cognitive benefits, music can also be a great mood changer or stabilizer and provide benefits that address the emotional issues of people of all ages.

Music therapy has been adopted by psychologists for years and it can be its especially effective when dealing with age-related issues like chronic pain, memory impairments, depression and general stress. Listening to comforting music has been found helpful to people dealing with stress and anxiety by slowing down the heart rate, creating a feeling of ease and reducing the levels of the stress hormone cortisol. In memory care treatments music therapy is used to slow the decline of speech skills found in dementia patients. There are some cases where music therapy was effective in inspiring nonverbal individuals to communicate with humming or singing.

Music therapy may also have the benefit of improving cognitive abilities in aging adults and recent studies have found that certain rhythmic music can stimulate particular areas of the brain to increase blood flow and improve performance in cognitive tests. I don’t know about you, but I can definitely relate to this. Certain music just seems to have the ability to engage your mind like nothing else can. I can’t even count how many times I got through 4 to 10 hour long study sessions in college with relative ease because I had specific albums on loop in my headphones. Good music can inspire and motivate you to push through difficulties and it can also help mundane activities come to life.

Another great benefit of music therapy is its ability to bring people together. Music is a language that overcomes all barriers of race, creed, religion, background and every other distinction found in society. Music helps unlikely individuals communicate and connect in ways that few other mediums can, which is especially beneficial in residential assisted living, helping alleviate feelings of loneliness and isolation among seniors.

Music is a wonderful thing to experience as a passive listener, but it can be even more engaging on a cognitive level when you actively participate in its creation. As older adults find themselves with more time on their hands after retirement, it can be a great chance to try something new, like learning to play a musical instrument. Learning and playing an instrument offers endless opportunities to keep one’s mind engaged because there will never be a shortage of songs to learn or a limit to how an individual can express their creativity through the performance of each song. Playing an instrument, regardless of how simple or advanced, can provide a great sense of accomplishment, which helps in stimulating the brain’s reward system, increases the release of dopamine and triggers additional neural pathways in the brain.

Music therapy doesn’t have to be complicated. You can start by simply playing music for the seniors in your RAL home and offer them the opportunity to participate as they feel comfortable. Once they start engaging with the music, maybe you bring in some simple rhythm instruments, like egg shakers and tambourines, and encourage them to play along. As you begin to see them respond more to the music there is really no limit to ways you can inspire them to creatively immerse themselves in it. There are even companies that you can hire who will send music therapists to your residential assisted living home and work with your residents. But there are also plenty of organizations, community youth and religious groups that you can find locally to provide similar services free of charge.

Cooking and baking are another great way to help engage the minds and bodies of your assisted living residents. These culinary activities provide the opportunity to employ all five senses, each of which exercises different parts of brain. It also requires the planning of recipes, measuring and offers the chance to use one’s creativity.

Practicing the culinary arts can be a very socially stimulating thing, as food in the process of creating it tends to bring people together. For many people food is the vehicle that helps express their culture and provides a roadmap to showcase their family’s deep history and meaningful traditions. In all likelihood, your senior residents probably grew up in homes where cooking and food were common rituals that created strong family relationship bonds. Sharing family recipes and the history attached to them was just another way to pass down cultural traditions and family values.

Giving your residents the opportunity to be part of the cooking process can be very therapeutic, particularly for those who are living with dementia and other brain disorders. These experiences have been shown to relieve stress, reduce depression and improve physical function. Along with those benefits, participation in the kitchen has also been a help to stabilize the mood and behavior in seniors by allowing for more social interactions and normalized experiences to improve the overall living environment.

Cooking and baking provide the opportunity for productivity, a sense of purpose and an enhanced state of well-being. There are so many activities in the kitchen that can be accomplished by residents of varying degrees of physical mobility and mental capacity. Something as simple as setting the table for clearing away and helping to wash up after a meal could be an enjoyable activity for some seniors. Get residents involved by letting them mix batter, knead dough, roll out cookies, or ice and decorate cupcakes. Seniors with more mobility might find it relaxing to peel and chop vegetables or cut up fruit to help make nutritious smoothies. Assisting caregivers or cooks in the house might be something that many residents would really enjoy, but you may never know that if they aren’t given the opportunity to try.

When selecting flavors for various dishes, the myriad scents and tastes of herbs provide a great opportunity for exploration. These sensory experiences can be even more beneficial for individuals who suffer from Alzheimer’s and dementia, especially since for most seniors with conditions like these, the opportunity to participate in the kitchen is often very limited. Being able to cook and bake can also encourage seniors to feel more self-sufficient and less dependent on others around them. This helps to boost confidence and can dramatically improve a resident’s state of mind and quality of life.

While cooking and helping out in the kitchen might not be everyone’s cup of tea, another great activity that can stimulate the mind while exercising the body is gardening. Obviously, many seniors in assisted living homes may not have the strength and mobility to practice gardening like most, but their ways that you can make this wonderful activity more accessible to your residents. Raised planters at waist height filled with smaller plants like herbs can be a great way to help your residents spend some quality time outdoors while doing something productive that they can be proud of.

There are so many physiological benefits from being physically active and being outdoors. Gardening gives seniors a reason to spend time in the sun, a great source of vitamin D, and it also helps stimulate the brain by requiring focus and a plan as to how residents will create and tend the garden. Older adults, especially those in assisted living facilities, tend to spend a lot of time indoors, which can lead to vitamin D deficiency.

Vitamin D is such an important nutrient especially for the senior population, and recent studies have led scientists to conclude that vitamin D deficiency is quickly becoming a pandemic. One of the major factors causing vitamin D deficiency is the lack of appreciation that daily sun exposure in moderation is the major source of vitamin D for most people. Very few food sources naturally contain vitamin D and most foods that have been fortified with vitamin D often contain inadequate amounts that would not satisfy the body’s daily requirement.

According to the National Center for Biotechnology Information “Vitamin D deficiency precipitates and exacerbates osteopenia, osteoporosis, and fractures in adults. Vitamin D deficiency has been associated with increased risk of common cancers, autoimmune diseases, hypertension, and infectious diseases.” [3] Studies have also shown that low levels of vitamin D can impair the neurological and cardiovascular systems, not to mention the impact taken person’s mood.

So whether indoors or outdoors, staying active helps the longevity of your residents. It increases the flow of blood and oxygen throughout the body, and a healthy body leads to a healthy brain. And whatever exercises or activities you introduce to the seniors in your RAL home, be sure to start with low-impact activities and take it easy at the beginning.

Be Part of the Solution

Solving the problems of elderly nutrition in America is a daunting task that will require collaboration across sectors of government, business and private organizations. The AL Network and the RAL National Association have been founded to offer RAL owners a myriad of resources to, not only navigate the world of Residential Assisted Living, but also to equip them with the resources and training needed to offer superior care to seniors across the country.

We need to work together as a community to provide the necessary support for our seniors. There’s no reason that we can’t come together and pool the nation’s resources and the talents of those in the medical, organizational, governmental and assisted-living fields to address the needs of an aging America.

The Silver Tsunami of Seniors is coming; it cannot be avoided. The question is, how committed are we to addressing the needs of a growing senior population how much are we willing to help in order to help the elderly live healthier and happier lives.

And to Wrap It All Up…

The truth is there are a lot of challenges that we face as our bodies and minds grow older and just about every single one of us will end up interacting with the assisted living community in one way or another. Whether we encounter the likelihood that we need to find a home for our parents and grandparents or maybe one day we ourselves need a home that provides us care in our twilight years, assisted living is here to stay. With population growth outpacing previous predictions and lifespans extending the time people spend in their senior years, the need for quality assisted care in a safe and comfortable environment is only going to increase.

Nursing homes across the nation are not prepared for the growth that is on the horizon, and as plenty of evidence has shown, these big box facilities often aren’t the places that you would want to depend on to care for your loved ones. Residential Assisted Living it is the logical answer to this crisis and we hear at the Residential Assisted Living Academy we are proud to provide a roadmap to doing assisted living a better way. A better way to care for our seniors, with respect and dignity. A better way for you to invest your time and your capital. A better way to get out of the rat race and get into the industry that offers freedom and financial independence. A better way to secure your family’s future, all while helping others during one of the most vulnerable times in their lives. This is why everything we do revolves around our motto “To Do Good and Do Well.” First to do good, then to do well.

Gene, the founder of this organization, has dedicated tens of thousands of hours to researching and developing strategies for investing in the senior living market. He has a passion for helping people just like you learn how to create, build, improve and excel in a residential assisted living business. He has surrounded himself with professionals in the fields of business investing, real estate and medicine to amass a treasure trove of information and strategies on how to succeed in the assisted living market. Do yourself a favor and take advantage of his hard work and learn the systems and methods that will improve your RAL homes and help you take the next step in this rewarding industry. We are here to help you so you can go out and help others.

How to Get Involved

Would you like to know how Residential Assisted Living holds the key to your future? There are number of ways you can begin to get involved in this amazing and rewarding industry. If you haven’t yet had the opportunity, come out to one of our monthly 3-Day Fast Track training courses and see why residential assisted living is an unmissable investment opportunity. This immersive 3-day training is for anyone who wants to get started, expand, invest in or help support the mission of providing high quality senior housing and care in a residential setting. These seminars are taught by leaders in the industry and owners and operators of numerous successful residential assisted living homes and businesses across the country. Come hear from industry professionals and learn how Residential Assisted Living is the answer to set you on the path to financial freedom and success.

The Convenient Home Study Course

Don’t have the time to set aside a weekend learning about the incredible opportunities in residential assisted living? We’ve got you covered. We offer a Home Study Course that will teach you what you need to know to hit the ground running in assisted living. Learn on your own time and at your own pace. Learn everything from strategies to find funding for your business to how to hire and train care staff, how to market your Residential Assisted Living home to the communities around you, and what not to do that will end up saving you thousands of dollars, and so much more. You will also have access to real-life case studies from students and associates who have taken the course and implemented it, creating countless positive cash flow success stories.

As valued members of our community we would like to continue to offer tips to help you find the residents that you are looking for to fill your RAL homes and create greater success in your business. You may already be familiar with some of these tips, so they might be a good reminder for you, or some of them may be new ideas that will help your business grow. Either way, we want to see you succeed.

The Silver Tsunami of seniors is hitting the shores now. These seniors will be depending on a robust network of care homes, care-givers, medical professionals and the investors to support this vibrant industry. Be one of the first to respond to the fastest growing demographic shift in the U.S. today.

Get Plugged in with the Residential Assisted Living National Association

Lastly, we can’t encourage you enough become member of the Residential Assistant Living National Association, which was formed to bring our industry together and to provide critical resources needed by every owner, operator or investor in Residential Assisted Living. Whether you are an owner, operator or an investor or just looking to learn all you can about the incredible opportunities in senior housing, the RAL National Association is the community for you. Get help from industry professionals and learn how Residential Assisted Living is the answer to set you on the path to financial freedom and success.

Some of the invaluable resources for our members include:

  • Group purchasing power with access to over 200 companies
  • Lobbying and legal support focused on the Fair Housing Act and Zoning
  • National Marketing for your RAL home
  • Continuing education for direct care staff
  • Strengthening and supporting the RAL community
  • Monthly newsletters addressing important issues facing RAL homes
  • Private Facebook page, building support and community
  • Access to business opportunities, investors, qualified operators and administrators
  • And much, much more

For anyone who wants to get started, expand, invest in or help support the mission of providing high quality senior housing and care in a residential setting, the RAL National Association is a must for anyone serious about their financial future in assisted living.

Don’t Miss Out On This Incredible Investment Opportunity

In the U.S., 180,375 people every month turn 85 years old. Most of these people will need assistance with daily activities and the current crop of nursing homes and care facilities are ill-equipped to give them the help and dignity that they deserve. Along with every great need comes great opportunity.

The Residential Assisted Living Academy is here to help you take advantage of the opportunity in this relatively untapped market, while also helping the most vulnerable in our society.
Our experienced professionals will show you how to start a Residential Assisted Living business that can create substantial, recurrent cash flow. Check out our Assisted Living Business Accelerator course and learn how you can convert a residential home into one for assisted housing and senior living,
while creating a stable business and income stream for life!

Take your first steps toward financial freedom today.

If you liked this resource and are interested in finding out more, check out our YouTube channel, filled with tons of content to answer all your questions and help you navigate the exciting opportunities in Residential Assisted Living.


[1] https://www.ncbi.nlm.nih.gov/pubmed/1590263?dopt=Abstract

[2] (The “An Aging World: 2015” report was prepared by Wan He, Ph.D., and Daniel Goodkind. Ph.D., of the International Programs Center in the Population Division of the Census Bureau, and Paul Kowal, Ph.D., of the World Health Organization’s Study on Global Aging and Adult Health. Research for and production of the report were supported under an interagency agreement with NIA’s Division of Behavioral and Social Research.)

The National Institute on Aging: The NIA leads the federal government effort conducting and supporting research on aging and the health and well-being of older people. The Institute’s broad scientific program seeks to understand the nature of aging and to extend the healthy, active years of life. For more information on research, aging, and health, go to www.nia.nih.gov.

The National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visitwww.nih.gov.

[3] https://www.ncbi.nlm.nih.gov/pubmed/18400738

Insider’s Guide to Investing In Senior Housing

The Insider’s Guide to Investing in Senior Housing, “America’s Best Financial Opportunity for the Next 25 Years!” is an exciting new book that you will definitely want to pick up. This text is the definitive handbook for those wanting to discover how to best capitalize on the massive demographic shift called “The Silver Tsunami.”

Written by seasoned business and investment experts, brothers Gene and Jim Guarino share how to participate as an active or passive investor in the exciting new real estate investment opportunity of senior housing.

Read about their journey and what led them to shift their entire professional focus toward educating and equipping others to invest in this relatively untapped opportunity.

Drawing on decades of experience in business and investing, Gene and Jim show you step-by-step how to take advantage of the opportunity in senior housing, while helping others in the process.

There are so many real estate and investment plays out there, but there are few opportunities with such a concrete foundation. In this case, the foundation is based, not on market fluctuations, but on verifiable numbers regarding population demographics in this country.

“The number of seniors in our country is expected to double to more than 72 million by 2030. And by 2050? That number will hit 83 million. However, the senior housing story isn’t just about numbers. It’s about understanding how powerful demographics translate into meaningful trends and changes in our society, our culture and the economy. As you know, we’re living longer, families are working more, and the number of loved ones available to care for our aging population is dropping at a record pace. But the real message here is that this demographic shift is creating both tremendous wants and needs-and unparalleled opportunity.”

What is the cause of this demographic shift?

With the explosion of birthrates in the 50’s and 60’s, the Baby Boomers are now entering into the ages where they will need assistance, and so far, this country has not sufficiently accounted for that dramatic shift in senior population. People are going to continue to age and as they do, society will need to find ways to care for them.

“The Silver Tsunami isn’t just a storm, it’s a multi-decade, record-busting gale.”

This excellent book not only details all the facts and figures pertaining to the untapped potential in senior housing, but it also explains why Residential Assisted Living is the best way to make the most of that potential.

You may not know this but, senior housing has outperformed all other real estate asset classes over the past ten years, including hotel, industrial, office, retail and apartments. “Senior housing has the potential to stabilize your portfolio while keeping it safe as well. In other words, it has a proven track record of weathering the down times.”

Pick up this book and learn how Residential Assisted Living has the potential to give you and your family financial security for years to come.

Gene and Jim’s motto is Do Good and Do Well. Residential Assisted Living is not only a real estate or investment play, but a call to action. Our parents and grandparents are depending on us to create a network of care homes and facilities, staffed with compassionate caregivers to provide for them as they enjoy their twilight years with dignity and grace.

Many are familiar with the concept of a nursing home, and it rarely calls to mind a place that we would feel comfortable sending our own loved ones. Gene and Jim recognized that there is a better way to care for our seniors and they want to show you how.

So don’t hesitate.  Your future awaits.


I hope you enjoy reading it. So, don’t wait any longer, click the link and get your copy today.

Do good and do well!
-Gene Guarino

P.S. Don’t forget to review the book once you’ve finished reading it, and feel free to share this link with anyone else you think might be interested.

What Does A Residential Assisted Living Home Look and Feel Like?

So you are interested in starting your journey in the Residential Assisted Living industry, but you don’t have a clear picture of what it should look like?

The RAL Academy is here to help.

A Residential Assisted Living home, first and foremost, should look like, well, a home. There are so many options available to people who find themselves needing to locate a residence for their aging parents. Unfortunately, many of those options at the moment are the big box facilities, which feel cold and unaccommodating. These facilities are very common and often what comes to mind when most people think of assisted living.

We want to encourage you to offer another way. Our aging parents or grandparents grew up in a house that they made into a home. That is what is comfortable to them and what they are used to. So whether you are starting with a single-family house or a commercial building that is being converted into a residential facility, the look and feel to aim for is one of a home.

Consider the image to the right. With the open floor plan and comfortable furniture, doesn’t it feel more like a regular home full of warmth, rather than an assisted living facility?

There should also be a sense of convenience and accessibility to every area of the home, including the outside. Driveways, paths and walkways should all be easy to navigate for people of any mobility. Inside, consider adopting an open floor plan with less clutter and strategically placed furniture to allow freedom of movement for all residents. Consider space not only for residents, but also those who will be visiting them.

Remember, while accessibility for the residents is paramount, it is also necessary to consider accommodating for families of the residents. Do you have a large dining area or living room to entertain family members comfortably all in one area? Is there ample room for parking near the residence for visiting family members?

Consider offering amenities that create a comfortable and cozy environment. Like any business, you want your brand to stand out from the rest, and one of the often chosen options in the U.S. is the big-box facility, most of which feel sterile and cold. So, to set yourself apart and establish an identity that is attractive to prospective residents and their families, try to create a sense of warmth and care in your RAL home. Chose furniture that looks and feels comfortable. Most homes don’t have bare walls, so think about adding personal touches like art on the walls.

Think About All Five Senses

Consider what a home looks like, feels like, and even smells like. The home should look and smell clean. If you were looking for a place for your aging parents, would you even consider one where the staff didn’t appear to keep the residence clean? Of course not. If we can’t keep the home clean, that will communicate to prospective residents and their families that we are unable to sufficiently care for their loved ones.

Aside from keeping the home clean, another way to create a great smelling home is to use an air purifier, which can also be a benefit to the health of the residents. Delicious home cooked meals create a wonderful aroma, so think about when you will be hosting visitors at the home and plan on being aromatically prepared. Try something as simple as fresh baked cookies, or have freshly cut flowers in a vase. When your guests walk through the door they will be immediately greeted with the feel of warmth and comfort.

There are so many elements that need to be considered when starting your Residential Assisted Living Home and so many ways that you can create a space that will attract residents and keep your home full.

If you are interested in finding out more, check out our YouTube channel, filled with tons of content to answer all your questions and help you navigate this exciting opportunity with confidence.

A Day In the Life of An Assisted Living Caregiver

Have you ever wondered what a day in the life of a caregiver entails? Whether you are already involved in Residential Assisted Living or just curious about this rewarding and fulfilling industry, surely it is something that most of us have thought about. These wonderful professionals who take care of the most vulnerable in our society are a vital part of any RAL business. And while it is difficult to truly depict a caregiver’s day as each varies based on the resident’s needs, the following is an example of a typical day for these busy and caring saints.

The Average Morning of A Residential Assisted Living Caregiver

7:00 am: Time to rise and shine. The caregiver wakes up, getting ready for the day, and if necessary wakes up any residents who many need assistance getting up. The caregiver gives special attention to any personal care or help with hygiene that residents might require after waking.

8:30 am: The caregiver and residents usually enjoy breakfast together, which is often prepared by the caregiver. This is also usually the time that many residents take their medication.

10:00 am: Fitness time. The caregiver may lead or assist a paid fitness trainer in leading exercises for any residents who are capable of exercise. Moderate daily physical activity is so important for the health of all residents. This may involve light aerobics, senior yoga, calisthenics or the caregiver might go on a walk with residents to get their blood flowing and keep their bodies moving.

11:00 am: The caregiver may organize or personally help their residents get to and from any appointments to doctors, dentists or other obligations scheduled for the day. They might also run errands for the RAL home and may be accompanied by a resident or two.

The Average Afternoon of A Residential Assisted Living Caregiver

12:00 pm: After completing various chores, the caregiver will prepare lunch. Lunch is a great time for friends and family to stop by for a visit. Lunch can also be a good time for any prospective residents and their families to come tour, so the caregiver will be busy assisting residents while helping on the tour and answering any questions that the families may have.

1:30 pm: Nap time! Depending on the health and energy levels of the residents, they may like to take a rest while the caregiver finishes up tasks around the house. This time is often productive for the caregiver, and can be used for tasks like scheduling doctor’s appointments, washing dishes or preparing for dinner.

3:00 pm: Often after a rest it is a good time to re-engage and exercise the mind. We know how crucial it is for seniors to get mental exercise and keep their minds active, so caregivers will usually lead or assist in activities that engage the resident’s mentally. Some activities may include playing cards, puzzles, board games, crosswords or other interactive elements rather than simply turning on a T.V. and vegging out.

5:00 pm: Depending on the weather or surrounding environment, the caregiver and residents may take a walk or spend some time outside doing a bit of light gardening or other light outdoor activities that stimulate their bodies and minds. Getting sunlight, fresh air and change of scenery is a welcome activity and a pleasant conclusion to the day.

The Average Evening of A Residential Assisted Living Caregiver

6:00 pm: Dinnertime! In many RAL homes, the caregiver is often the one who prepares dinner and they usually share the evening meal together with the residents. Engaging them in conversation and reviewing the day’s activities or challenges is a great way to exercise the mind and memory of the seniors. This is also another key time that may require the caregiver to dispense medications or tend to the other health needs of their seniors.

7:00 pm: Time to unwind and relax. The twilight period of the day might consist of reading books, watching a television show or participating in a hobby together. The evening is often a challenging time for those suffering from dementia and Alzheimer’s, so caregivers are often focused during this time on helping residents manage fleeting memories, confusion and anxiety.

9:00 pm: Bedtime. The caregiver assists with additional personal care needs before helping their residents get into bed. Depending on the needs of the seniors and the house schedule, the caregiver may stay overtime to hand off responsibilities to the caregiver who works from evening till morning, making sure there is someone on hand should assistance be needed throughout the night.

This is just a small, abbreviated glimpse into the regular life of a caregiver. While there are many similar elements, caregivers rarely have the exact same day, and are often faced with numerous unexpected challenges. All of these depend on the needs of their residents and the level of care and options that each individual RAL home offers.  For example, some many hire independent contractors who specialize in memory care or fitness, while some RAL homes may offer a personal chef, allowing the caregivers to focus more on the constant needs of those in their care. Every caregiver will probably tell you that there is no “typical day,” but they continue to invest their time and their lives into helping our dear and beautiful parents and grandparents, and for this we love and appreciate them.

If you have the pleasure of knowing any caregivers, we encourage you to thank them for their hard work and if you are able, offer to give them a hand. And if you, yourself are a caregiver, we here at the RAL Academy want to thank you for your service and for the amazing work you do from morning to night.

If you want to know more about the life of a caregiver, listen to Gene describe how his caregivers operate.  Also, check out many more informative videos at our YouTube channel, and don’t forget to subscribe.

The Valuation of a Residential Assisted Living – The Real Estate and the Business.

This valuation has two parts. Think real estate on one side and the business on the other. You have a home which is the real estate with value. Let’s talk about that first. The home is a residential property. It’s a residential home in a residential neighborhood. Notice I keep stressing “residential” because as much as you think it’s commercial because it’s a business, it’s not. It’s residential.

The home is valued based on the comparable market analysis, based on the other homes in the area. If the garage was converted to a living space, that’s a plus and a minus because now you have extra living space, extra square footage which is good, but you no longer have a garage which is bad. If the home is twice the size of every other home in that neighborhood, it’s not worth twice as much.

It’s going to be worth more, but not twice as much. The additional space that is created which is very common in residential assisted living is not worth per square foot the exact same as every other square foot for every other home in the area. Additional space is good for the business, but it’s not worth the same on every single level.

When you take out a bathtub and you put in a shower, that’s a plus and a minus as well. When you add grab bars, a plus and a minus as well. All those different things you add, they add to the valuation. Realistically, a lot of times specifically for a residential property, an appraiser is going to have a hard time getting that appraisal correct.

I’ve had appraisers come to the home and look at it and go, “You know, it looks like a duck and it quacks like a duck, but this duck is a little bit different. It’s in a residential neighborhood, but it’s got business inside. There’s a license on the wall, there are grab bars on the wall; there are different things going on.” They have a bit of a hard time getting the correct appraisal.

What about appraising for an SBA loan? The appraiser understands that there’s a business involved, it is residential real estate and it’s a guaranteed loan by the government, so even though there’s the bank involved, the government guarantees. The appraiser has a different level of experience. I’d have to say that the appraisers that come in when there’s an SBA loan involved tend to have a little higher level of experience.

Let’s talk about the business.

I’m going to give you a couple of ways to value this business. – Tweet this!

First, if it were a big box like a Brookdale, Sunrise, Atrium, it’s all about the cost per bed. They’ll have 100 beds and they’ll say it’s worth $100,000 per bed, $200,000 per bed. Keep in mind, they have an infrastructure that includes parking lots, boiler rooms and commercial kitchens, and everything else relevant to a huge facility.

We can’t look at it the same way for a residential facility. As a business is worth one thing and then per bed is worth something else. Let’s assume the business is worth 50,000 (just giving you a number). Then per bed, depending on the revenue each bed generates, the gross revenue might be worth $10,000 per bed to $25,000 per bed.

If it’s $10,000 per bed (10 beds), $50,000 for the business and $10,000 a bed, 10 beds, that’s an extra $100,000; that business is worth $150,000. Let’s check the cash flow. If you have $50,000 a month coming in, and your expenses are $30,000 a month, you have $20,000/month of net income. Each year, $240,000 in profit. If I have a multiple of two, that would be $480,000.

That would be one way to value that business. I could go 1x that multiple, 2x or 3x. Bear in mind that this is not a technology company. It’s not going to be worth 10x, or 100x that. Unfortunately, a lot of people do not understand this business the way I do. They will value the business on something like 5x, or 10x the cash flow of the business.

If you valuate on the gross and not the net income; the numbers will really skew. – Tweet this

You really need to know this business the way I do.Frankly there’s just not a lot of people out there that do it. At the Residential Assisted Living Academy, this is all I do. It’s what I teach, it’s what I know. I do this business myself, that’s why people call me to ask me what do I think, and how do I do it.

There are two parts on the valuation. One is the real estate. Pretty cut and dry. What is it worth compared to what other properties are worth? What alterations have been done to the property? Just because you made it twice as big, it doesn’t mean it’s worth twice as much.

On the business side, we can go per bed

plus something for the business, but I would rather you do it on a profitable basis. How much is the profit, let’s have a multiple, and is it worth 1x the annual profit, or2x? Maybe 3x?

If I’m buying it, let’s call it 1x. If I’m selling it, let’s call it 3x. – Tweet this!

This is the valuation of residential assisted living. If you’d like to learn more, and I bet you do, This is a great industry where you can learn how to make money and help people do good and do well. Continue to explore our resources and check out the amazing training that we have to offer: residentialassistedlivingacademy.com

Watch this short video: https://flipnerd.com/show/valuation-residential-assisted-living/

Do Good and Do Well!

Gene Guarino

Founder of the Residential Assisted Living Academy.

PS: The right time to do the right thing? It’s always right now. Don’t let another day be lost or wasted not creating the freedom you want in your life. Call us (480)-704-3065 or just click here and let’s get started.