Compassionate Heights in West Bend, WI
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1937 N Main St, West Bend, WI 53090
For more information about senior living options: (844) 490-3973
Compassionate Heights offers competitive pricing for its accommodations, particularly in comparison to both Washington County and the broader state of Wisconsin. For a one-bedroom unit, residents can expect to pay $2,200 per month, which is significantly lower than the county average of $3,451 and the state average of $3,412. However, the cost of a studio at Compassionate Heights stands at $6,600 per month, notably higher than the county's $4,386 and the state's average of $3,999. This pricing strategy suggests that while Compassionate Heights may provide more specialized or luxurious amenities in its studio offerings, it remains an attractive option for those seeking one-bedroom units in a more affordable range compared to other local providers.
| Floor plans | Compassionate Heights | Washington County | Wisconsin |
|---|---|---|---|
| 1 Bedroom | $2,200 | $3,451 | $3,412 |
| Studio | $6,600 | $4,386 | $3,999 |
The facility is beautiful, clean, well-maintained, and thoughtfully designed with comfort and safety in mind. The facility feels like home, and its common areas foster a real sense of community and connection. The caregivers treat residents like family, always listening, engaging, and tailoring care to each person's needs. Communication with families is excellent, leaving them informed, involved, and reassured. Meals are nutritious, delicious, and served with care. Compassionate Heights brings peace of mind, safety, dignity, and happiness to loved ones. The community is highly recommended for loved ones to be valued and cared for. The facility is outstanding, with amazing staff and top-tier owners. Residents are treated as a top priority and are well taken care of; everyone becomes family the moment they walk through the doors. Danielle and Keri are described as going above and beyond to keep the facility well maintained and up to date.
There is no LPN or RN on staff or on call. The owners are not onsite. There is a challenge with consistent follow-through. A large barking dog is onsite. The portions of food are small.Compassionate Heights in West Bend, Wisconsin is best suited for families seeking a warm, home-like assisted living where caregivers deliver genuinely personal attention, the environment feels safe and comfortable, and open, proactive communication with families is a core strength. This community rewards residents who value connection, routine, and a sense of belonging, with common areas designed to foster conversation and community. For loved ones who thrive on daily warmth from staff and a setting that feels like an extension of home, Compassionate Heights delivers a compelling fit.
However, it is important to weigh certain realities. The facility does not staff on-site LPNs or RNs, and the administrator is not consistently on site, which can translate into variable medical oversight and follow-through. For residents who require regular nursing supervision, routine medication administration, or high-acuity medical attention, this arrangement often points to alternatives that guarantee on-site licensed nursing support and more predictable care coordination.
The strongest positives - an immaculate, well-maintained setting; a home-like atmosphere; staff who listen, engage, and tailor care; and excellent family communication - offer meaningful offset to the downsides. Families consistently praise the cleanliness and safety of the environment, the way staff treat residents with dignity, and the tangible sense that residents are valued. The dining experience is considered nutritious and thoughtfully served, and the overall culture emphasizes safety, happiness, and belonging, with owners and caregivers going above and beyond to create a sense of family.
Still, the notable drawbacks deserve careful consideration. The absence of on-site nursing oversight can be a significant gap for those whose loved one requires ongoing medical management, and the reported challenge with consistent follow-through suggests that care planning and execution may vary day to day. A larger barking dog on site can also affect comfort for residents with noise sensitivity or anxiety around animals. Additionally, even though some caregivers are described as highly attentive, there is evidence of inconsistency across staff, which can complicate expectations for 24/7 reliability.
For families weighing decisions, decisive next steps center on clarity around care coordination and leadership presence. Prospective movers should seek detailed answers on nurse availability and after-hours coverage, the process for care conferences, and how the team ensures consistent follow-through when administrators are not on site. Inquire about the dog policy, address any dietary needs beyond standard menus, and request concrete examples of how communications with families are maintained - frequency, formats, and points of contact.
Overall, Compassionate Heights offers a compelling blend of warmth, dignity, and a well-kept, community-forward setting that resonates with families seeking meaningful interaction and transparent communication. It is a strong fit for residents who prize human connection, comfort, and a lively, caring milieu, and for families who can operate with a care model that relies on a high-touch, family-centric approach rather than around-the-clock licensed medical supervision. For those who require daily nursing oversight, or who prioritize unwavering administrative on-site presence, exploring alternatives is prudent. When the match is right, this community delivers peace of mind and a sense of happiness for both residents and their families.
22 resident community capacity
Assisted LivingAssisted living facilities provide crucial support and care for seniors who may need help with daily tasks such as medication management, bathing, and meal preparation. These communities offer a safe and comfortable environment where seniors can maintain their independence while receiving the assistance they need to thrive in their golden years.
Memory CareMemory care is crucial for seniors as it provides specialized support and services for individuals with dementia or Alzheimer's disease. These programs offer a safe and secure environment where residents receive personalized care, cognitive stimulation, and help with daily activities. Memory care helps seniors maintain their independence, quality of life, and dignity while also providing peace of mind for their families.
Respite CareRespite care provides temporary relief for caregivers, allowing them to recharge and attend to their own needs. It also gives seniors the opportunity to socialize, receive professional care, and experience a change of scenery, promoting overall well-being and reducing feelings of isolation.
Cats allowed"Pet friendly" senior living communities are important for seniors because pets provide companionship, reduce feelings of loneliness and depression, promote physical activity and mental stimulation, and offer a sense of purpose and responsibility. Pets can improve overall well-being and quality of life for seniors in many ways.
Dogs allowed"Pet friendly" senior living communities are important for seniors because pets provide companionship, reduce feelings of loneliness and depression, promote physical activity and mental stimulation, and offer a sense of purpose and responsibility. Pets can improve overall well-being and quality of life for seniors in many ways.
Activities on-siteActivities on-site are important for seniors because they provide opportunities for socialization, mental stimulation, physical activity, and overall well-being. Engaging in activities can help seniors stay active, maintain their independence, and improve their quality of life.
Air-conditioningAir conditioning is important for seniors as they are more vulnerable to heat-related illnesses and may have underlying health conditions that make it difficult for them to regulate their body temperature. It helps to keep them comfortable, safe, and healthy in hot weather.
Beauty salonBeauty salons are important for seniors because they provide a space for them to feel pampered, socialize, and maintain their personal grooming and hygiene. Regular visits to a beauty salon can help boost seniors' self-esteem and overall well-being.
Cable or satellite TVCable or satellite TV is important for seniors because it provides entertainment, news, and companionship, helping to combat loneliness and boredom. It also offers a wide range of programming options tailored to different interests and preferences.
Devotional services off-siteDevotional services off-site are important for seniors as they provide spiritual nourishment, social engagement, and a sense of community outside of the senior living facility. This can enhance overall well-being and help combat feelings of isolation and loneliness often experienced by older adults.
Dining roomDining rooms are important for seniors as they provide a space for socialization, connection, and nutritious meals. They offer opportunities for residents to bond over shared meals, foster a sense of community, and promote healthy eating habits. Dining rooms also ensure that seniors have access to well-balanced meals tailored to their dietary needs and preferences. Family private dining roomsFamily private dining rooms are important for seniors as they provide a space for quality time with loved ones, encourage social interaction, and allow for a sense of normalcy and comfort in their living environment. This can greatly improve their overall well-being and quality of life.
Fully furnishedFully furnished senior living communities are important for seniors because they provide convenience, comfort, and a hassle-free moving experience. Seniors can easily settle into their new living space without the stress of having to buy and move furniture. This allows them to focus on enjoying their new home and community.
GardenGardens are important for seniors as they provide a peaceful and therapeutic environment for relaxation, physical activity, and socialization. Being in nature has been shown to reduce stress, improve mood, and promote overall well-being. Gardens also offer opportunities for seniors to engage in gardening activities, which can improve mobility, flexibility, and cognitive function. Additionally, gardens create a sense of community and connection with others who share a passion for plants and outdoor spaces.
Housekeeping servicesHousekeeping services are important for seniors because they help maintain a clean and safe living environment, promote independence, and reduce the risk of accidents or illnesses. Additionally, having assistance with household chores can alleviate physical strain and allow seniors to focus on other aspects of their well-being.
Indoor common areasIndoor common areas are crucial for seniors as they provide a space for socialization, recreation, and community engagement, promoting overall well-being and reducing feelings of isolation and loneliness.
Located close to restaurantsBeing located close to restaurants is important for seniors because it offers convenience, social opportunities, and the ability to maintain a healthy and varied diet. Easy access to dining options allows seniors to enjoy meals with friends or family, try new cuisines, and support their overall well-being.
Located close to shopping centersBeing located close to shopping centers is important for seniors because it provides easy access to daily necessities, social interaction, and recreational activities. This convenience can enhance their quality of life and independence, making it a desirable feature for senior living communities.
Meal preparation and serviceMeal preparation and service are crucial for seniors as they may have limited mobility or energy to cook nutritious meals. Having access to healthy and convenient food options can ensure they are getting the proper nutrition needed to maintain their overall health and well-being.
Move-in coordinationMove-in coordination is important for seniors because it helps ease the transition into their new living environment. It ensures that all logistics, such as packing, organizing movers, and setting up utilities are taken care of, allowing seniors to focus on settling in and adjusting to their new home. Having a smooth move-in process can alleviate stress and anxiety, making the transition smoother and more enjoyable for seniors.
Outdoor patioOutdoor patios are essential for seniors as they provide a safe and peaceful space for them to enjoy the outdoors, socialize with friends and family, engage in physical activity, and soak up natural sunlight which promotes overall well-being and mental health.
Outdoor spaceOutdoor spaces are important for seniors as they provide opportunities for physical activity, social interaction, exposure to natural light and fresh air, and a sense of connection to nature. Having access to outdoor spaces can improve overall well-being and quality of life for older adults living in senior communities.
Private bathroomsPrivate bathrooms are important for seniors in senior living communities because they provide independence, dignity, and comfort. Having a private bathroom allows seniors to maintain their personal hygiene routines without the need for assistance, promoting a sense of autonomy and privacy. Additionally, private bathrooms help prevent the spread of infections and provide a safe and clean environment for seniors to navigate safely.
Small librarySmall libraries are important for seniors as they provide access to a variety of reading materials, including books, newspapers, and magazines. This can help stimulate their minds, keep them engaged, and provide a sense of community through book clubs and other social activities. Additionally, reading has been shown to improve cognitive function and overall mental well-being in older adults.
TelephoneTelephones are important for seniors as they provide a lifeline for communication with loved ones, emergency services, and healthcare providers. They offer a sense of security and independence, enabling seniors to stay connected and access assistance when needed.
Wi-Fi/high-speed internet availableWi-Fi/high-speed internet is important for seniors to stay connected with loved ones, access online resources, and participate in virtual activities to combat feelings of loneliness and isolation. It also allows them to easily manage healthcare needs, access entertainment, and engage in lifelong learning opportunities.
Transportation arrangementTransportation arrangements are crucial for seniors as they may face challenges with driving, mobility, or access to public transportation. Having reliable transportation services ensures that seniors can easily attend appointments, social activities, and maintain their independence and quality of life. Transportation arrangement (non-medical)Transportation arrangements are essential for seniors as they provide access to essential services, activities, and social interactions outside the home. This service helps maintain independence, mobility, and overall well-being for seniors who may have limited transportation options.
24-hour call system24-hour call systems are important for seniors because they provide peace of mind and immediate assistance in case of emergencies. This technology ensures that help is always available, promoting safety and security for elderly individuals living alone or in assisted living facilities.
24-hour nursing24-hour nursing is important for seniors because it provides round-the-clock medical care and support, ensuring their health and safety are consistently monitored and attended to. This level of care can help prevent emergencies, manage chronic conditions, and provide peace of mind for both seniors and their families. 24-hour supervision24-hour supervision is important for seniors to ensure their safety, well-being, and access to immediate assistance in case of emergencies or health issues. This constant support provides peace of mind for both seniors and their loved ones, allowing them to age in place with dignity and security.
Accept incoming residents on hospiceAccepting incoming residents on hospice is important for seniors because it allows them to receive specialized end-of-life care in a comfortable and supportive environment. This ensures that they can maintain their dignity and quality of life during their final days, surrounded by compassionate staff who are trained to provide the necessary medical and emotional support. Activities of daily living assistanceActivities of daily living assistance are important for seniors because they provide essential support with tasks such as eating, bathing, dressing, and mobility. This assistance helps seniors maintain their independence, dignity, and overall quality of life as they age.
Administer insulin injectionsAdministering insulin injections is important for seniors with diabetes to help regulate their blood sugar levels and prevent complications such as heart disease, nerve damage, and blindness. Proper insulin management can also improve overall health and quality of life for older adults.
Ambulatory care"Ambulatory care services provide essential medical support and treatment to seniors without requiring hospitalization, allowing them to maintain their independence and quality of life while managing chronic conditions or receiving routine medical care."
Assistance with bathingAssistance with bathing is crucial for seniors as it helps maintain personal hygiene, prevents infections, and ensures their overall well-being and comfort. It also provides a sense of dignity and independence for seniors who may struggle with this task on their own.
Assistance with dressingAssistance with dressing is important for seniors because it helps maintain their independence, promotes personal hygiene, prevents accidents and injuries, and improves overall quality of life. This service ensures that seniors can continue to dress comfortably and confidently, despite any physical limitations they may have.
Assistance with transfersAssistance with transfers is crucial for seniors as it helps prevent falls and injuries, maintains their independence, and ensures they can safely navigate their living environment. It also provides peace of mind for both seniors and their loved ones.
Care with behavioral issuesCare with behavioral issues is important for seniors because it ensures they receive the specialized support and attention they need to manage their unique challenges and maintain their quality of life. This type of care helps address issues such as dementia, aggression, anxiety, depression or mood swings, allowing seniors to live comfortably and safely in a senior living community. Coordination with health care providersCoordination with health care providers is crucial for seniors to ensure proper medical care, medication management, and overall well-being. This collaboration helps prevent overlapping treatments, track progress more effectively, and provide comprehensive support tailored to individual needs.
Diabetes dietA diabetes diet is crucial for seniors as it helps manage blood sugar levels, reduce risks of complications, and improve overall health and well-being. By following a balanced and nutritious diet tailored to their specific needs, seniors can better control their diabetes and enhance their quality of life. Diabetic careDiabetic care is crucial for seniors as they are more susceptible to developing diabetes due to aging and other health conditions. Proper management of diabetes can help prevent complications such as heart disease, vision loss, and nerve damage, improving the overall quality of life for seniors in senior living communities. Meal preparation and serviceMeal preparation and service are crucial for seniors as they may have limited mobility or energy to cook nutritious meals. Having access to healthy and convenient food options can ensure they are getting the proper nutrition needed to maintain their overall health and well-being.
Medication managementMedication management is crucial for seniors to ensure they are taking the right medications at the correct dosages and times. This helps prevent adverse drug interactions, reduces the risk of medication errors, and promotes overall health and well-being. Proactive management also allows for adjustments as needed based on changing health conditions or new prescriptions.
Mental wellness programMental wellness programs are essential for seniors as they promote cognitive stimulation, emotional support, and social engagement. These programs help prevent isolation, depression, and cognitive decline, ultimately enhancing the overall quality of life for older adults. Mild cognitive impairment"Mild cognitive impairment" is important for seniors because it is an early stage of cognitive decline that can potentially progress to more severe conditions such as dementia. Recognizing and addressing mild cognitive impairment can help seniors receive appropriate care and support to maintain their quality of life and independence for as long as possible.
Physical therapyPhysical therapy is essential for seniors to maintain and improve their mobility, strength, and overall quality of life. It helps reduce pain, prevent falls, and enhance independence in daily activities. By promoting movement and function, physical therapy can help seniors stay active, healthy, and engaged in their communities.
Preventative health screeningsPreventative health screenings are crucial for seniors as they can help identify potential health issues early on, allowing for prompt treatment and prevention of more serious conditions. Regular screenings can help maintain overall health and quality of life in older adults. Rehabilitation programRehabilitation programs are vital for seniors as they provide specialized care and therapies to help them regain independence, mobility, and overall quality of life after an injury or illness. These programs offer individualized support and services to promote recovery and prevent further decline in physical and mental health. Respite programRespite programs provide short-term relief for family caregivers and allow seniors to receive temporary care in a safe and supportive environment. These programs help prevent burnout among caregivers, promote socialization for seniors, and offer a break from the challenges of daily caregiving responsibilities.
Same day assessmentsSame day assessments are crucial for seniors because they provide immediate insight into their needs and abilities, allowing for more timely and effective care planning. This can help address any urgent concerns or issues that may arise, ensuring seniors receive the appropriate support as quickly as possible.
Special dietary restrictionsSpecial dietary restrictions are important for seniors because age-related changes in metabolism and health conditions can make it difficult for their bodies to process certain foods. By following a diet tailored to their specific needs, seniors can maintain their overall health and well-being, manage chronic conditions, and reduce the risk of complications such as malnutrition or food interactions with medications. Specialized memory care programmingSpecialized memory care programming is crucial for seniors with cognitive impairments such as dementia or Alzheimer's disease. These programs provide a safe and supportive environment tailored to the unique needs of individuals with memory loss, helping them maintain their independence, dignity, and quality of life. Transportation to doctors appointmentsTransportation to doctors' appointments is crucial for seniors as it ensures they have access to necessary medical care and support for their health needs. Without reliable transportation, seniors may struggle to attend important appointments, leading to potential delays in treatment and health complications. Providing transportation services helps seniors maintain their overall well-being and quality of life. Diabetes dietA diabetes diet is crucial for seniors as it helps manage blood sugar levels, reduce risks of complications, and improve overall health and well-being. By following a balanced and nutritious diet tailored to their specific needs, seniors can better control their diabetes and enhance their quality of life. Meals provided"Meals provided" are crucial for seniors in assisted living communities as it ensures they have access to nutritious, balanced meals without the stress of meal planning and preparation. This can help promote overall health and well-being for seniors who may have limited mobility or cognitive abilities. Special dietary restrictionsSpecial dietary restrictions are important for seniors because age-related changes in metabolism and health conditions can make it difficult for their bodies to process certain foods. By following a diet tailored to their specific needs, seniors can maintain their overall health and well-being, manage chronic conditions, and reduce the risk of complications such as malnutrition or food interactions with medications. Activities on-siteActivities on-site are important for seniors because they provide opportunities for socialization, mental stimulation, physical activity, and overall well-being. Engaging in activities can help seniors stay active, maintain their independence, and improve their quality of life. Community-sponsored activitiesCommunity-sponsored activities are important for seniors as they provide opportunities for social interaction, mental stimulation, and physical activity. These activities can help improve overall well-being, combat loneliness and isolation, and promote a sense of belonging and purpose among older adults. Devotional activities offsiteDevotional activities offsite are important for seniors because they provide social engagement, spiritual growth, and a sense of community outside of their living environment. This can improve overall well-being, mental health, and combat feelings of isolation or loneliness.
Planned day tripsPlanned day trips are important for seniors because they offer opportunities for socialization, mental stimulation, and physical activity. They provide a change of scenery and help seniors stay engaged and connected to their community, promoting overall well-being and quality of life. Resident-run activitiesResident-run activities are important for seniors as they encourage social interaction, creativity, and a sense of autonomy. These activities empower seniors to stay engaged and active in their community while fostering meaningful connections with their peers. Scheduled daily activitiesScheduled daily activities are important for seniors because they provide structure, socialization, mental stimulation, and physical activity. Engaging in regular activities can improve overall well-being and quality of life for seniors living in a community setting.Compassionate Heights is an assisted living community located in the serene city of West Bend, WI. With a focus on providing specialized care for individuals with memory impairment, our dedicated staff ensures a safe and nurturing environment for our residents.
Our community offers various amenities to enhance the quality of life for our residents. Devotional services off-site provide spiritual support and opportunities for worship outside of the community. Indoor common areas encourage socialization and foster a sense of community among residents.
At Compassionate Heights, we prioritize the health and well-being of our residents. We provide diabetic care services to ensure proper management and monitoring for individuals with diabetes. Our trained staff is equipped to handle the unique needs associated with this condition.
We believe in keeping our residents engaged and active, which is why we offer devotional activities offsite. These activities provide opportunities for spiritual growth and personal fulfillment.
In addition to our compassionate care and engaging programing, our community also benefits from its convenient location. There are 2 cafes nearby, allowing residents to enjoy a cup of coffee or a meal outside of the community. For those who enjoy outdoor activities, there are 9 parks nearby where residents can take leisurely walks or participate in recreational activities.
Access to healthcare is crucial for seniors, and at Compassionate Heights, we ensure that it is easily available. With 6 pharmacies located nearby, getting necessary medications is hassle-free. In addition, there are 11 physicians in close proximity who cater to various medical needs.
For dining options beyond what is offered within our community, there are 20 restaurants nearby where residents can explore different cuisines and dining experiences. We understand that transportation can be a concern for seniors; however, we have 2 transportation options available to conveniently take residents wherever they need to go.
Maintaining one's faith and participating in religious services is important to many individuals. Our community has 2 places of worship nearby that allow residents to practice their religion and engage with fellow worshippers.
Lastly, ensuring access to quality healthcare facilities is of utmost importance. With 3 hospitals in close proximity, residents can receive prompt medical attention whenever necessary.
At Compassionate Heights, we strive to create a supportive and enriching environment for individuals requiring memory care. Our community's amenities, care services, engaging activities, and convenient location make it an ideal place for seniors to live happily and comfortably.
This part of West Bend, Wisconsin, offers a variety of amenities and services that cater to seniors looking for a comfortable and convenient living environment. With a range of restaurants nearby such as M & R Bar and Toucan Food & Custard, seniors can enjoy delicious meals without having to travel far. The proximity to parks like Regner Park and Lac Lawrann Conservancy allows for outdoor activities and leisurely strolls in nature. There are also pharmacies like Walgreens and healthcare facilities such as St Joseph's Community Hospital and Froedtert West Bend Health Center nearby, ensuring easy access to medical care. Places of worship like Immanuel United Church of Christ provide spiritual fulfillment, while cafes like Panera Bread offer a cozy spot for socializing or enjoying a cup of coffee. Overall, this area provides a peaceful and supportive community for seniors considering senior living in West Bend.
Compassionate Heights offers competitive pricing for its accommodations, particularly in comparison to both Washington County and the broader state of Wisconsin. For a one-bedroom unit, residents can expect to pay $2,200 per month, which is significantly lower than the county average of $3,451 and the state average of $3,412. However, the cost of a studio at Compassionate Heights stands at $6,600 per month, notably higher than the county's $4,386 and the state's average of $3,999. This pricing strategy suggests that while Compassionate Heights may provide more specialized or luxurious amenities in its studio offerings, it remains an attractive option for those seeking one-bedroom units in a more affordable range compared to other local providers.
Compassionate Heights is located at 1937 N Main St, West Bend, WI 53090 in Washington County, Wisconsin
Compassionate Heights offers a comprehensive suite of features tailored to enhance the quality of life for residents with dementia or Alzheimer's disease. The 24-hour supervision ensures that residents receive constant support and safety, while assistance with activities of daily living, including bathing, dressing, and transfers, promotes dignity and independence. Addressing behavioral issues is crucial for creating a calm environment, and coordination with health care providers facilitates seamless medical care. Thoughtfully prepared meals cater to specific dietary needs, fostering proper nutrition which is essential for cognitive health. Medication management further ensures adherence to treatment plans, while programs focusing on mental wellness and physical therapy support both cognitive engagement and physical mobility. Additionally, specialized memory care programming provides targeted activities that stimulate memory retention and social interaction, ultimately enhancing overall well-being for residents at various stages of cognitive decline.
Yes, Compassionate Heights allows both dogs and cats.
Compassionate Heights on seniors.fyi includes 13 photos including images showing interior, windows, bedroom, decor, bathroom, wall art, landscaping, waiting area, and more.
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The transition from assisted living to skilled nursing care is often prompted by complex medical needs that assisted living cannot meet, with key indicators including frequent health declines, increased falls, severe memory issues, and caregiver burnout. Families should recognize these signs early to discuss options with healthcare providers and prepare for the emotional and logistical aspects of moving to a facility that offers comprehensive medical support.
Nourishing the Mind: Essential Dietary Approaches for Dementia
Dementia is characterized by cognitive decline, with nutrition playing a vital role in brain health; while no specific diet can prevent or reverse it, a nutrient-dense diet rich in antioxidants and healthy fats may support cognitive function. The MIND diet, which emphasizes beneficial foods and limits processed items, along with proper hydration and individualized meal strategies, can enhance the well-being of dementia patients.
Understanding Dementia Behaviors: Practical Insights and Strategies for Caregivers
Dementia affects memory and cognitive function in older adults, presenting challenges for caregivers due to behavioral changes such as confusion and mood swings. Compassionate, person-centered care that considers individual history and preferences, along with effective communication and environmental modifications, is essential for supporting both patients and their caregivers.
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8 Key Indicators That Suggest It May Be Time to Transition from Assisted Living to Skilled Nursing Care