This is the 39th in a series of articles intended to demystify retirement living options.

If you feel that the care your relative is receiving in assisted living or nursing/skilled nursing isn't acceptable, what can you do? First, talk with a nurse or the individual identified as responsible for your loved one's care. If you aren't satisfied with the results of that conversation, speak with the individual in charge of the assisted living or long-term care unit.

It almost always works best to remain polite and cordial. Explain the gap you have observed, for example, "My aunt is supposed to be getting food that is very easy to chew. But the last two times I visited, I saw food on her tray such as a chicken breast, an apple, and a hard roll. She didn't eat any of them. She has lost weight."

Then explain the change you are looking for, for example, "How can we ensure that she is served food she can chew at every meal, starting with the next meal?"

Often, issues can be resolved immediately. Most facilities are staffed with people who genuinely want to do the right thing.

If issues persist, you might send a cordial letter to the person in charge of the unit, documenting your concerns and efforts to get resolution, including specific details, dates, times, and employees' names if known. Explain the result you are looking for and ask what changes will be made to achieve it and when. Ask for a reply by a specific date, based on the urgency of the issue.

To learn what it is reasonable to expect of care facilities, consider crawling through the requirements spelled out in Arizona state law. While not light reading, the law covers everything from the minimum size for a bedroom to how far ahead of time menus need to be posted.

Go to www.azsos.gov/public_services/Title_09/9-10.htm. Article 7 addresses assisted living, and Article 9 covers nursing facilities (nursing/skilled nursing/long-term care). Clicking on the title of an article calls up its detail. Ignore all the legalese about the history of the section and enactment of the rules.

Assisted-living facilities are required to provide a copy of resident rights when an individual is admitted, along with phone numbers for the Arizona Department of Health Services' Office of Assisted Living Licensure, which sets standards for assisted living, performs inspections, and investigates complaints; Arizona Adult Protective Services, which investigates claims of abuse, neglect, or exploitation; Arizona Long-Term Care Ombudsman, which can help residents and families understand their rights and help address complaints; and several other agencies.

Nursing (long-term care) facilities are required to post information about their license and their quality rating from the Arizona Department of Health Services, as well as contact information for the Department's Office of Long-Term Care Licensing, which licenses, inspects, and investigates complaints about such facilities; and the state's Long-Term Care Ombudsman and Adult Protective Services, which address issues in long-term care as well as in assisted living as noted above.

Facilities are required to have written procedures for addressing resident complaints, and they are not permitted to retaliate when complaints are raised.

What if you are in independent living, so all those health care rules don't apply, but you are 60 or older and feel that you are being mistreated by your landlord? The Elder Rights Program, run by the Area Agency on Aging of the Northern Arizona Council of Governments, may be able to help.

They give first priority to low-income and otherwise disadvantaged seniors, and can help address landlord-tenant disputes and other housing issues.  They can also help with legal documents such as living wills and with government benefit programs such as Social Security. The Legal Advocacy Program can be reached at (928) 775-9993 x4271.  Alternatively, search online for Northern Arizona Elder Rights Program.

What's the bottom line? If something is going wrong with your or a relative's senior housing, or with care in an assisted living or nursing/skilled nursing facility, you don't have to suffer in silence. Many, many protections are built into the law, and many helping hands are willing to assist you if problems remain unresolved. You don't have to put up with substandard conditions or care.

-- Next -- 120. The Future of Retirement Care: The Green House Model