Independent Living Evaluation Checklist

Community Name: __________________________________________________ Contact Name: _____________________________________________________ Address: _________________________________________________________ Telephone: _____________________ Email: ______________________________ Date Visited: _______________ Circle: First Visit Second Visit Third Visit

Day of the Week:____________ Circle: Morning Afternoon Evening

Is the floor plan logical and easy to follow? Is the property compliant with the Americans with Disabilities Act? What different sizes and types of living units are available? Are the available units an appropriate size for the resident’s needs? What is the square footage? Do living units have kitchens or kitchenettes? Are all living units private? Does the bathroom have grab bars and emergency call buttons? Circle the utilities that are included: Electric Gas Water Trash/Sewer Other Circle the in-home amenities that are available. Is there an extra cost? Phone TV Cable Internet Other

Are living units furnished or unfurnished?

Is there a parking fee for residents or visitors? Does the community have parking options such as carports or garages? Is there an extra cost?

What kind of security is provided? Key or code access, gated entry, security patrols, etc.?

Is smoking allowed? Where? Does the community provide EMSA/TotalCare ambulance service membership or a medical alarm service? Is there an extra cost?

Is there an emergency generator or alternative power source?

What special amenities are available (e.g., on-site beauty salon, exercise facilities, library, game room, etc.)? Is there an extra cost? What kind of laundry facilities are available? What special services are available (e.g., housekeeping, linen/laundry services, etc.)? Is there an extra cost? Are a variety of planned activities available? Ask for the monthly activity calendar. Are transportation services available? Is there an extra cost or any restrictions? Circle meals that are served daily. Is there an extra cost? Can special dietary needs be accommodated? Breakfast Lunch Dinner Snacks Can residents have pets? Are there any restrictions? Is there an extra cost? Does the community offer worship services? How often? Which religions and denominations are served?

Are the common areas clean? Does it smell clean? Is there a resident notification area? Is there an up-to-date activity and meals calendar posted? Do the activities and meals sound appealing? Are the grounds and landscaping well groomed and free from debris? Are the grounds accessible and secure? Does the property offer other levels of care (e.g., assisted living) if a resident’s needs change? Do residents appear happy and engaged in life? How do staff and residents greet each other and interact? If residents are around, ask for their opinions about the community and staff.

Is a contract available that details all leasing fees and services? Is the contract easy to read? Do you understand it? Is there a buy-in fee? How much is the monthly rent? How much is the security deposit? Which deposits are refundable? What is the total move in cost? How are services and utilities billed? How are rate increases and late payments handled? Under what conditions would a resident be asked to leave the community? How much notice is given?