The Standard of Quality in Assisted Living

“Where did you eat breakfast?” Derean Thornley asked. “Did you get a Bloody Mary while you were at it? I hear their Bloody Marys are really great.”

This wasn’t a conversation between two young adults on a lazy Sunday afternoon. It took place at Warm Valley Lodge, the assisted living community in Dubois, where Derean was working her shift as a certified nurse assistant (CNA). Her friend had just returned from breakfast in town with some visitors, and they were chatting in his apartment. While there, she took his blood pressure.

Some nurses would “just go in and out,” she observed later. “They do what they have to do and then leave.” But for Derean, hanging out and conversing is one of the best parts of the job.

There is a name for this kind of nursing practice: Person-centered care (PCC).

The Center for Excellence in Assisted Living describes PCC as a pivot away from the traditional mentality of the health-care industry, which is focused on the providers’ tasks and efficiency, and toward a custom based on the dignity and self-determination of the individuals in the community. The emphasis is on the individual residents’ preferences and needs–not those of the staff or the organization.

It’s not just a set of rules or a practice standard. For some senior living communities, it’s culture shift, a change of paradigm.

For some others, like Warm Valley Lodge, this philosophy has been embedded in the community from the outset. The term person-centered care was new to Warm Valley Lodge staff members last spring, when they heard about it at a conference–but not the concept. Talking afterwards, Marcy Leseberg and Melissa Miller agreed, “we already do that.”

What does PCC mean in practical terms?

  • There’s usually no need to invade another resident’s personal space, for instance, just to collect a sample for urinalysis. A CNA can simply hand a resident a sterile plastic cup with a lid, and pick up the urine sample later. Most people at Warm Valley Lodge are perfectly able to complete that small task for themselves.
  • An aging man wants to take care of his own clean laundry, but that’s too cumbersome with his walker, and all that moving about would tire him out. To make him feel less needy, the nurses ask him to tell them where everything goes, and they chat while putting his clothes away.
  • To refill a prescription for medication, staff members never drive to the pharmacy for the man who needs it. He has his own car, and he picks it up for himself. The object is not efficiency for the staff; it’s one of many ways to reinforce his autonomy.
  • A woman with early-onset Alzheimer’s disease was constantly fretting about the disorder in her apartment (far too many clothing choices and “books flung from hell to breakfast,” as Darean put it). So after asking permission, the staff worked to help the woman organize her belongings. The task isn’t ordinarily in a CNA’s job description, but they knew she no longer had the resources to de-clutter for herself.  The result was reduced distress and an increased ability to care for herself.

This kind of effort can have a significant benefit for dementia patients, according to an analysis published in the journal “Clinical Interventions in Aging,” which combined the results of 17 studies. PCC reduces the prevalence of depression particularly for individuals in the early stages of dementia, the authors wrote, probably because they are fully aware of their situation and are grateful to be given choices and opportunities that affirm their individuality.

How can you recognize a senior living community that embraces these practices?

There’s no official checklist, but research shows the features of assisted living that are most important to residents’ quality of life: their level of control, how much they feel themselves to be at home, what they do all day, and their relationships with staff and other residents.

To optimize these, a residence must offer as much privacy and autonomy as possible, learn what each resident enjoys doing and provide those opportunities, and do everything possible to enable close friendships.

An assisted living residence may fulfill all of the regulatory requirements, ensuring proper hygiene, nutrition, and housekeeping, while missing out on opportunities for person-centered care. However clean, bright, and inviting the physical facility may look, the daily routines and schedules that go on behind the scenes could be revealing.

If someone needs help with a shower, for instance, does the schedule require staff to assist in the morning when the resident prefers to have a shower at bedtime? Does housekeeping staff routinely vacuum at night when there’s no traffic in the corridor, although that may disturb someone’s sleep? Is there only one set of options at meals, because that’s simpler for the kitchen staff

The nature and environment of the facility may also be a factor, judging from experience with nursing homes (not assisted living facilities) in Ohio. After that state began to mandate steps toward providing PCC in skilled-nursing facilities in 2015, studies showed that the ones most likely to fulfill the requirements were those located either in large cities or in rural areas, not in mid-sized cities.

Contrary to previous research, they were also more likely to be for-profit entities, rather than nonprofit. The researchers speculated that the for-profit facilities in the study had more resources and a greater ability to change practices quickly in the face of a government mandate. Perhaps nonprofit facilities, being more “mission-oriented,” have been doing this all along, they wrote, and were simply less motivated to spend time documenting their results.

“Most large businesses do not want to run a place like this because it’s too small. There’s not enough profit margin in it,” said Warm Valley Lodge resident Dick Hodge, “But I think it ends up with some very positive aspects because of the personalized relationships between the people that work here and the residents.

“It’s a very powerful thing,” he went on. “You’ve got to talk to each resident and find out what each resident is like,-wise, health-wise, all of the different aspects of a human being, and try to adjust to that. You can watch the people working here and they will treat people differently. But that’s what they need.”

So CNA Chandra Baughn measures vital signs, serves meals, and helps people change clothes if they need it, but she said most of her job is “just to sit and listen to their concerns. A lot of these people don’t have family nearby, so I feel like I’m their family.”

Ultimately that kind of person-centered care works in more than one direction. “The residents embrace each other,” she went on. “They’re concerned for each other. It’s just a big family.”

Cost of Living at Home vs. Assisted Living

Most people assume that staying at home is more cost effective but in reality, it can become more expensive as you begin paying for home health services, assistive devices and home modifications.

Figures from SoFi show that the cost of living in Wyoming with all expenses included would come to $47,832 per year or $3,986 per month. This is a general estimate of the entire state of Wyoming and does not include the additional cost of living in some places.


The cost of homemaker and/or home health services is estimated to be upwards of $6,000 per month in 2024 in Wyoming as reported by Genworth. This would be in addition to all the other expenses associated with keeping a home. Those can include: cost of the property (if any), property taxes and insurance, food, transportation, utilities (electric, gas, internet, etc.), maintenance, housekeeping, general supplies and possible renovations for additional safety features.


For those using low income housing or unable to afford additional services, Many level 1 assisted living communities accept the LT-101 waiver that will pay for the majority of your stay. The remainder will be dependent upon your personal income and how much you can afford. Most long term care insurance will cover the charges of assisted living but you will need to check with your insurance provider.

In conclusion, assisted living is affordable to anyone in need.


Payment Sources

Transitioning to an assisted living community can help maintain independence for a longer period than those who wait. One can build a foundation and become familiar with their environment while remaining safe, healthy, and independent.

Warm Valley Lodge accepts private funds, long-term care insurance, and the Medicaid LT101 Waiver funds. Low-income individuals may be able to utilize Medicaid to help cover the cost of services at assisted living. Applying for Medicaid can begin by contacting your county public health office. Medicaid rooms are currently available at Warm Valley Lodge!

Fremont County Offices:

Riverton: 307-856-6979

Lander: 307-332-1073

More information can be found on the Wyoming Department of Health’s website

Still not sure how to start? This checklist may be helpful Check List of Prospective Residents

Crowd-Sourcing Information about Long-Term Care Facilities

How do you find a good motel? You check reviews on TripAdvisor. How would you check out whether a rental cabin is really a dream or just a dump? You’d look it up on VRBO, of course, and learn the facts from people who stayed there.

What if you’re thinking of a long-term care residence for yourself or a family member? You might read some reviews online – although how many people take the trouble to write reviews if a place is just OK, but not wonderful? Many places don’t get lots of reviews, and how many residents would know how or where to post a review anyway?

In Wyoming, high-quality information of this kind actually is available. Searchable information about complaints and inspection reports for Wyoming facilities for the aging are available online here.

The state also requires all long-term care facilities to carry out annual satisfaction surveys of residents and their families, and to keep this data on file for review. The Wyoming Department of Health doesn’t tell facilities which questions to ask on these satisfaction surveys, doesn’t post the results online, and doesn’t require these residences to share them with the public, prospective residents, or their relatives.

But the survey results do exist and are worth requesting–if only for the opportunity to judge how a long-term care facility responds when it receives the request.

Administrator Margaret Chantry says anyone is welcome to look at the results of the 34-question survey distributed every year to residents of Warm Valley Lodge, the assisted living facility in Dubois, and their relatives. The answers exist even for residents who find it too daunting to complete the survey themselves.

Most often when high school volunteer Mia Chandler stops by, she spends her time playing cribbage with one resident. (“He always wins,” she said.) But one day last fall, the staff asked her to help with the survey, rephrasing questions and recording the responses for four others who were unable to complete the task.

Sometimes she had to speak more loudly than usual, Mia said, which was a challenge because she’s a “bit of an introvert” and “not a loud person.” But recording the responses was fun.

On the scale of 1 to 4, she said, “most people were all in the 4s. There was nothing below a 3. They really love Warm Valley Lodge. Nobody wanted to change anything.”

That’s not entirely true: There was the snack problem. One question, about the availability of snacks, scored a very low mean of 2.2. Chantry explained the issue with a chuckle: Snacks began to disappear when they were left out on the food-service counter, and housekeeping staff later discovered that a few residents had been hoarding them.

Now the nurses distribute them every afternoon when they refill the water jugs. (In any case, residents are able to buy their own snacks on regular trips to the center of town in the Lodge’s van.)

The state requires long-term care facilities to maintain several other kinds of quality-assurance procedures, in addition to the surveys. Beyond fire drills and specified kinds of staff meetings, it mandates calendars of activities and regular resident council meetings where people can raise concerns.

Facilities are required to keep notes from regular residents’ meetings, which also might be useful reading for someone considering a residence. Besides reminders to be kind to each other and the staff, and compliments about the menu, people at Warm Valley Lodge have had issues to raise. In January 2022, they had cabin fever and wanted to visit a virtual museum or play shuffleboard. Two months later, someone complained that the dining room was noisy. Last September, someone said that the shrubbery beds could be landscaped better.

Visitors are welcome to attend resident council meetings in person, said Administrator Chantry, as long as they just listen and don’t speak. “It really is their meeting,” she explained.

Understanding Levels of Care Facilities in Wyoming

Level I Assisted Living

– Provides limited nursing care, personal care, and boarding home care but no Habilitative Care.

– Assisted Living Prices +

– ALF Core Services

– Does not require a secured unit.

Level II Assisted Living

– Provides limited nursing care, personal care, and boarding home care but not Habilitative Care.

– Memory Care and/or Nursing Home Prices +

– ALF Core Services

– Requires a secured unit with special staffing and staff education in dementia.

– Additional activities, services, and slightly higher level of core services.

Skilled Nursing / Nursing Home

– Provides extensive 24-hour nursing care

– Nursing Home Prices +

– May be used as a transitional point from hospital to a lower level of care.

– Provides total care for all activities of daily living around the clock.

Assisted Living Core Services 

Assistance with transportation, assistance with obtaining medical, dental, and optometric care, and social services; assistance in adjusting to group living activities; provision of appropriate recreational activities in and out of the facility.

Partial assistance with personal care; limited assistance with dressing; minor sterile dressing changes; Stage I skin care; infrequent assistance with mobility; cuing guidance with activities of daily living for visually impaired persons, or the intermittently confused and/or agitated residents requiring occasional reminders of time, place, and person.

Limited care to residents who can independently manage catheter or ostomy care and incontinence; and 24 hour monitoring of each resident.

For more information about levels of care, please visit: Wyoming Department of Health