Ask Eloise

Eloise Tweeten answers questions about navigating eldercare.

“This was a very emotional experience from our family as Dad was refusing to leave his home. Eloise helped diffuse the emotions. She let us take our time and go at our own pace. We had never done this before and Eloise walked us through every step of the way.”

—Cynthia L., Santa Rosa, CA  

Phone: (707)570-2589.   Or click here to get started online.

Can’t I just do the assisted living research on my own? Absolutely!  But why would you, when there’s a free service to help you make the most informed decision?  For example, most people (like me when I went through this process) are unaware that there are so many options available, the wide range of prices and facilities, the requirements to become licensed, and even what differentiates a residential care facility from a skilled nursing facility or in-home services. There are also unlicensed facilities out there which are not monitored unless a complaint is filed (and then they run the risk of being closed down).  When it comes to assisted living, people need to be able to make informed decisions about either their own care or that of a loved one.  I help them do that, free of charge.

You've pre-screened over 200 licensed RCFEs throughout the North Bay. What did you find out? First, I discovered that residential care facilities come in all shapes and sizes from 3-6 bed private homes up to large assisted living facilities with 50-100+ private apartments. I also confirmed that one size doesn’t fit all!  One person might need very close supervision either because of dementia or frailness. Someone else may need to feel as independent as possible and would do better in an apartment-like setting.  In general, I can also say that I was impressed with the facilities in Sonoma County.  I visited most homes without notice, was almost always greeted warmly by the staff, and found most facilities to be clean and organized.   Available activities tended to vary based on the current residents (level of interest and cognitive functioning), facility size, and staffing.  Higher end facilities which charge over $4k/month generally offer more services and visual appeal, but I also found facilities at a much lower price that were warm and inviting.  As with real estate in general, location also influences price.

Do you help locate a facility for a client who’s out of state? Yes!  Based on my own experience with family members in other states, I recognize that families are increasingly being faced with geographic location choices and challenges when placing loved ones in assisted living.   I’m helping families by developing a network of elder care placement professionals in various housing markets who offer similar client-oriented services, and am learning more about different states and their licensing guidelines every day.  For placement in other locations, I act as a resource guide—helping families access the services they need, when they need them, while retaining expertise regarding the choices closer to home in the North Bay.  That is the way I feel I can best serve families both locally and nationally.

If you’re paid by the facilities, don’t you really work for them? That’s a great question, and the answer is no.  I develop good working relationships with facilities, but my client is the elder first and foremost, and my job is to identify the best facilities available given the needs, desires and constraints of the elder and his/her family.  Because most facilities will pay me a placement fee, the service is free to families.  Even if I don’t have a contract with a particular facility, I will share information about the facility if it has an opening and appears to be a good match for a client.  To me, it’s a matter of integrity. In doing my own research in Tucson, I discovered this service works much like the real estate business, including the payment method and fee which have become standardized.  I do not accept ‘bonuses’ or other incentives to fill facility openings.  Because people understandably prefer to stay in their own homes as long as possible, most clients don’t contact me until they have an imminent placement need, in which case I’m almost always paid by the facility.  With that said, I can also work on a fee for service basis or net of commissions depending on the particular situation and level of advice a family needs, or if a family prefers to pay me directly.   Over time, I envision working with more families on a consulting basis before a placement is imminent, which will allow us more time to explore the fullest range of options possible.

When is it time to start talking about long term care? The sooner the better! Start having a conversation about long term care at home (and with family members) to identify long term care preferences, needs and restrictions now, just like the discussion about a living will. I can serve as a resource, whether or not assisted living is being considered as an option in the near future. There are also some great free community resources available, depending on where you are in the long term care planning process.

What is the process a family would need to go through to find the right setting for a loved one? The first step is to determine what a loved one wants, needs in terms of care and what they can afford.  Can they stay safely at home with home modifications and in home services?  If not, how much care do they need?  What kind of environment would be the best fit in terms of their daily activities, interests, and needs?  Part of my service is to explore these and other questions with the person needing assistance and/or family members, depending on the situation.

Is there a difference between “assisted living” and “board and care” facilities for the elderly? All facilities, both large and small, are licensed in California as Residential Care Facilities for the Elderly (RCFEs), and are considered non-medical facilities. With that said, the name “assisted living” is often associated with the larger facilities owned by corporations such as Sunrise or Brookdale.  Some of these facilities offer a continuum of care, including independent living and skilled nursing.   The smaller facilities, on the other hand, are generally owner-operated and are frequently referred to as “board and care” facilities.  Both large and small facilities provide assistance with activities of daily living as needed, including bathing, dressing, eating, toileting, transferring, and continence care.  Some, but not all, also offer memory care (dementia, Alzheimers), and some have more limitations on the level of care available than others.

Are all assisted living facilities monitored by the State? Only licensed Residential Care Facilities for the Elderly (RCFEs) are regularly monitored by the State of California, and have strict licensing requirements.  Requirements and governing bodies vary from state to state.  Because of the monitoring involved, I only work with licensed facilities and strongly urge you to only consider licensed facilities.  To learn more, click here to go to the State of California Web site, Community Care Licensing Division.

What are the signs to look for that suggest the need for a higher level of care? While not all-inclusive, some of the signals to look for include:

  • Isolation or changes in sleeping, eating, or activity levels
  • Difficulty walking, dressing, or eating
  • Increased susceptibility to falling and/or bruising
  • Decreased mental reasoning which may put one’s own safety and/or that of others at risk
  • Increased medical care needs
  • Caregiver burnout
  • Medication errors with self-administration or missing medical appointments
  • Decreased ability to manage the household (e.g. bill-paying, cleaning


“We moved Mom…and as soon as her ‘stuff’ started getting put into place, she was a new woman, my former mommy. Next day she was participating in movies, meals… so, it seems like the perfect fit for now…I so appreciate all your help with getting her settled. We would have never found the place without you.”

—Carol C., Healdsburg. CA