Assisted Living Facilities – An Overview
As many seniors age, they begin to need assistance with everyday activities such as getting dressed, using the restroom, and preparing and eating meals. This is true even for seniors who are fairly healthy and mentally sharp. According to a CDC survey from 2017, 7% of all people age 65 and older need someone to help them with personal care tasks. The need for help with these activities increases rather quickly with age, with 21.7% of those age 85 and older needing assistance.
In the past, when seniors could no longer safely live at home by themselves, many were forced to turn to nursing homes, which provide 24-hour skilled nursing services in a clinical setting. The unforeseen consequence of moving seniors who are still fairly healthy to such clinical environments is that they lost their sense of independence, privacy, and control over their own lives. Such a loss, often quite premature, contributes to physical and mental decline. Additionally, nursing homes are prohibitively expensive to live in on a long-term basis. According to Genworth Financial, the median monthly cost of nursing home care is $8,500 for a private room or $7,513 a month for a shared room.
Assisted living facilities provide seniors with access to daily assistance with personal care tasks while still living as independently as possible in a social setting. Assisted living is also far less expensive than nursing homes, with the national median cost being about $4,050 per month. That’s less than half of the $8,500 a month that’s common for nursing homes. Over the years, assisted living communities have grown more and more popular, replacing the role of nursing homes in many seniors’ lives. A 2016 study by the CDC found that there were about 28,900 residential care facilities that provided assisted living or a similar level of care in the United States. In other words, there are about 13,300 more assisted living facilities available than there are nursing homes.
What is Assisted Living?
Assisted living is a form of senior housing in which residents receive regular help with activities of daily living (ADLs) such as dressing, bathing, toileting, grooming, and more. Help with transportation, shopping, medication management, and other activities that seniors find difficult to do on their own is also quite common. Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
Quality assisted living facilities can feel like a home thanks to their friendly staff, nutritious meals, and regular opportunities for socialization with other residents. They can also often look like an upscale hotel, with nicely furnished dining rooms and indoor and outdoor gathering places as well as well-kept private rooms. Of course, the appearance of ALFs varies quite a bit, so seniors should shop around for a location that meets their desired standard of living.
Assisted Living Compared to Other Forms of Senior Living
One of the challenging aspects of researching assisted living options is that it’s easy to confuse it with other forms of senior housing. The table below can help you understand the most important distinctions between common housing and care types. In some cases, one facility may offer more than one form of care on the same property.
|Comparison of Assisted Living to Other Forms of Senior Living|
|ESTIMATED MONTHLY COSTS*||ADL/IADL ASSISTANCE||SKILLED NURSING CARE||24/7 SUPERVISION||HOUSING ATMOSPHERE|
|INDEPENDENT LIVING||Approximately $2,500-$3,500||Not available||Not available||Not available||Homelike atmosphere but often structured like an apartment complex or hotel|
|ASSISTED LIVING||$3,300- $7,000, with a national median of about $4,050||Available||Limited availability||Sometimes available||Homelike atmosphere but often structured like an apartment complex or hotel|
|MEMORY CARE||Approximately $4,300-$11,000||Available||Limited availability||Always included||Similar to assisted living but more secure to reduce wandering and confusion|
|NURSING HOMES||$7,900-$13,400, with a national median of $8,500||Available||24/7 availability||Always included||Often similar to a hospital|
*These figures are estimates only and can vary significantly by area and facility. The Genworth Financial 2019 Long-Term Care Survey provides greater state-level cost data on most forms of care. Memory care often costs between $1,000-$4,000 more than assisted living each month, but state-specific data can be difficult to find.
Independent Living Communities
In independent living communities, seniors live with almost complete independence in their own apartments, bungalows, or other styles of homes. Seniors often sell their houses and move into these communities so that they can be free of home maintenance tasks and enjoy their retirement more fully in a social setting. Other benefits of living in these communities include optional access to the cafeteria, pet-friendly amenities, help with laundry and other light housework, and even transportation. These communities are suitable for both couples and single seniors.
Independent living can cost roughly $2,500-$3,500 monthly, though pricing does vary widely based on local real estate markets. Typically, independent living costs far less than other forms of senior living since these facilities do not offer personal assistance with tasks other than cooking, chores, and transportation.
Assisted Living Communities
Assisted living communities often look like and have the same basic atmosphere as quality independent living communities. However, in an assisted living community seniors can get help with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). This means that, if they need it, they can get daily assistance with numerous tasks including toileting, bathing, dressing, medication management, and more. However, assisted living communities are not equipped to provide anything more than minimal medical care. Those who use ventilators or feeding tubes or those who otherwise need continuous supervision, whether medical or behavioral, cannot live in an assisted living environment.
Assisted living typically costs several thousand more dollars each year than an independent living community does. But it also includes a much more comprehensive set of services than independent living. According to Genworth Financial, the national median monthly cost of assisted living is $4,051. This number can be much higher or much lower depending on location and amenities.
Memory Care Communities
Memory care communities may be located in self-contained buildings or they may be located within other facilities that offer other levels of care. Regardless of location, security is paramount. Patients with Alzheimer’s disease and other forms of dementia are prone to wandering, getting lost, and becoming agitated or bored. So these centers typically incorporate secure perimeters, alarms, and other safety features. Patients who live in these centers benefit from 24/7 supervision, a home-like environment, activities designed to be fulfilling and stimulating, and staff who specialize in helping seniors with memory impairment. In addition to services specifically intended for those with memory impairment, residents of memory care facilities can receive help with all ADL and IADLs. Just like in assisted living, seniors in these communities may be able to get minimal medical care.
Memory care facilities require specialized staff training, more experienced staff members, and more security than ALFs. So they tend to be more expensive. As a general rule, expect memory care to cost between $1,000 and $4,000 more per month than assisted living in the same area. This translates to a cost anywhere from $4,300-$11,000 monthly.
Nursing homes represent the highest level of medical care that a senior can receive in a residential setting. They used to be the favored care solution for seniors who needed almost any form of help with ADLs and IADLs as well as for those who had any form of dementia. Now, medical professionals have recognized that nursing homes, which are often more like hospitals than anything else, are best reserved for those who need constant medical supervision.
Due to the operating costs associated with keeping an around-the-clock staff of medically trained personnel such as RNs and physicians, nursing homes are the most costly form of residential senior care. Staying in a nursing home for a month costs anywhere from about $7,900- $13,400, with $8,500 being the national median. It can easily be over twice the cost of assisted living in many cases.
What Types of Care Are Provided in Assisted Living
Assisted living meets the needs of seniors who need some help with daily tasks but do not need constant supervision or extensive, daily medical care. Assisted living facilities are able to provide that “middle ground” option that so many seniors need. These communities primarily serve their residents by helping them with ADLs and IADLs. Most also provide meals and scheduled activities for residents. And some offer extra services such as transportation, laundry, and housekeeping.
Assistance with ADLs
ADLs include basic tasks that one must perform every day, such as bathing, eating, dressing, and using the toilet (usually referred to as toileting). Staff can also help seniors move from room to room or transfer from one surface to another, such as from a bed to a chair. Services can be tailored to each resident’s individual needs, so they will receive assistance with any ADLs they need while still having the freedom to complete other tasks independently and spend time alone as they wish. Many seniors who enter an assisted living facility will not need help with all ADLs. Note that seniors who no longer walk at all may not always be able to stay in assisted living; this can vary by facility.
Assistance with IADLs
IADLs are skills that involve more complexity and advanced abilities than the ADLs covered above. While an ADL like eating or using the restroom can be performed by many children, an IADL is a skill typically first acquired by teenagers or older individuals. Seniors who are still fairly independent may be more likely to need help with IADLs than with ADLs. Note that while assistance with ADLs is a standard feature of all assisted living communities, not all ALFs provide assistance with IADLs.
Examples of IADLs:
- Medication management
- Transportation and shopping
- Meal preparation
- Cleaning and maintenance
- Money management
Some of these skills will be important every single day as with ADLs, while others will only be necessary on a weekly basis or even less frequently. The amount of help one receives with IADLs can be tailored to their specific needs.
The key IADL that residents of an assisted living community will get help with is meal preparation. Most ALFs have a dining room where meals are served three times a day, and many communities will also provide snacks. Residents who are able can also perform some of their own meal preparation, as apartments in assisted living facilities can include refrigerators, and less commonly, hot plates, microwaves, or even ovens. However, by and large, seniors will have most of their nutritional needs met in a group dining setting.
Other Services Often Provided
Assisted living facilities can and frequently do provide services to residents beyond assistance with ADLs or IADLs. These services can be varied, but below we’ve listed two categories of services commonly offered by ALFs.
- Skilled Nursing: Often, assisted living facilities can provide a certain level of skilled nursing care. For example, seniors may be given the option of getting wound care, medication management, periodic monitoring of blood pressure or blood sugar, and other relatively minor but important forms of routine care on-site. However, skilled nursing in assisted living is never provided 24/7.
- Social Activities: Seniors, like all people, need social interaction on a regular basis to maintain mental health and an overall sense of wellbeing. Virtually all assisted living communities have an activities director that plans all kinds of social activities, including craft classes, game nights, outings, fitness classes, parties, and much more. Some activities may cost extra.
Is Assisted Living Right for Me?
Assisted living isn’t a one-size-fits-all solution. It won’t work with everyone’s financial circumstances, and it also won’t meet everyone’s needs. However, assisted living is a great option for many seniors, providing a blend of assistance and independence that promotes health and wellbeing. Below you can learn about who is and isn’t likely to benefit from a move to one of these communities.
Who Should Consider Assisted Living?
Those Who Need Assistance with Daily Tasks
As we age, certain tasks that we must perform on a daily basis become more difficult. Seniors who live alone or who only have part-time caregivers may struggle to procure necessities and maintain their hygiene, health, and the cleanliness of their home. These seniors may, voluntarily or not, stretch out the time between bathing or continue wearing clothes longer than is sanitary because the amount of effort involved is so draining. Forgetfulness or exhaustion can lead to a decline in lifestyle. In situations like this, a move to an assisted living facility can help the senior be happier and healthier. ALF staff who can efficiently and kindly help with these tasks makes completing them all regularly much more manageable. Moreover, CNAs, RNs, and other assistants at these facilities are trained to help with ADLs in the safest ways possible, minimizing the chances of injuries and other problems that can occur with well-meaning but untrained family caregivers.
Those Who Want To Increase Their Social Interactions
Some seniors who need assistance may be getting it at home from paid or unpaid caregivers. But they may be suffering from isolation even though their needs are being met. For seniors in this situation, a move to an assisted living facility that has a thriving community of other seniors can provide an invaluable boost to the senior’s social wellbeing. Many seniors love to live in a community with people like them. Many may also benefit from meeting new people there, particularly if they have recently lost other elderly friends.
Those Who Anticipate Gradually Increasing Needs
Many seniors will notice a gradual decline in some of their abilities to care for themselves. Gradual declines in self-care skills can cause worry as seniors wonder at what point their existing support system won’t be able to offer them enough help in their homes. For seniors who fully expect some tasks to become too difficult but who know that their current caregiver is unlikely to be able to help with these tasks, looking into assisted living now may be a wise move. Because residents of ALFs can live as independently as they wish, seniors can remain independent while they can and add on more assistance over time as needed.
Who Should Consider Other Options?
Those Who Prefer Smaller Group Settings
Large assisted living facilities are not the only residential setting in which a senior can get help with ADLs and IADLs. One common alternative is called a care home. In care homes, 6-10 seniors live together with full-time caregivers in a licensed home setting. These homes can provide more robust supervision. And their intimate setting may make some seniors feel more comfortable. Additionally, these kinds of homes may be more plentiful in some locations. They can be a great alternative for those who are far away from the nearest assisted living facility but who don’t want to move far from family. The cost of living in these homes is often comparable to that of assisted living.
Those Who Are Fully Independent
Assisted living is not the ideal setting for seniors who are still fully independent. Seniors who are just looking for more socialization and fewer responsibilities but who do not require help with ADLs should look into independent living locations instead. Though daily assistance is unavailable in these communities, independent living facilities can provide transportation, help with shopping and meals, and, in some cases, indoor and outdoor home maintenance. Independent living is also less expensive than assisted living. So seniors who are fully independent and expect to remain so for years to come would ultimately be spending extra money unnecessarily. Keep in mind that if and when a resident of independent living does require more assistance, they will most likely need to move to a different facility that provides more care services.
Those Who Need Frequent Medical Care
If you need very frequent medical care, with a nurse or doctor repeatedly checking on you throughout the day, then your needs will not be met in an assisted living facility. Registered nurses and other medically trained staff are sometimes present at assisted living facilities, but they are not present 24/7. Medically trained employees are staffed in assisted living communities to focus on minor medical needs rather than full-time, intensive medical needs. Those who have a chronic condition or otherwise need around-the-clock care to be available will not receive enough attention in an assisted living setting and are better suited for a nursing home.
How Much Does Assisted Living Cost?
Undoubtedly, assisted living is expensive, with a national monthly median cost of $4,051 and the possibility of even higher costs in some locations. However, assisted living includes not just a room but also regular meals, activities, and personal assistance with many aspects of life. Therefore, the cost of assisted living cannot be compared to the cost of living in a home or apartment. The value of the meals, assistance, and community can make the cost well worth it.
Payment Structures in Assisted Living Communities
There are two basic forms of billing for assisted living. Most facilities will give the resident an all-inclusive bill. This bill will stay the same month after month, regardless of how many or how few services the patient uses on a regular basis. The only time the bill will change is if the facility enacts a price increase. Many seniors will need assistance with between one and three activities of daily living in an assisted living facility. However, if they end up needing more assistance, their cost will stay the same.
In rare cases, facilities may choose to itemize their billing process, charging separately for different services. This option may be called “fee-for-service.” This form of billing tends to be more expensive, not to mention more complicated, for residents and their families. Some facilities may give you a choice between an itemized bill and an all-inclusive bill. All-inclusive may be a better deal, though if a senior has fewer than average needs an itemized bill could be a good choice. Note that most communities bill monthly, but you may also have the option of paying on another schedule if you inquire.
How Do I Pay for Assisted Living?
When seniors need help with ADLs and IADLs but are otherwise in good health, they often find themselves in a tough financial position. Since they don’t need a nursing home level of care, their housing costs cannot be covered by most private health insurance, Medicare, or Medicare Advantage. However, the cost of assisted living is often far higher than what they have been accustomed to spending on their housing, food, and other daily needs. To help you understand the financial assistance options available to seniors in need of assisted living services, we’ve covered some common personal assets, forms of insurance, and publicly-offered programs that can all be used to pay for assisted living.
Paying for Assisted Living With Available Assets and Private Insurance
Even if you do not have an especially high income, you may have some resources that you can tap into to meet your assisted living needs. Oftentimes funding a stay in assisted living will require the use of more than one of the assets listed below.
Home Equity and Home Sales
Usually, real estate is one of the largest assets that a person has. If you are no longer able to stay in your home, it can make sense to sell and use the money to augment your retirement funds. The sale of a valuable home or vacation property can enable you to enjoy a long stay in assisted living. Of course, the decision to sell can be a difficult one, particularly if you had intended to one day pass this home to a child. Additionally, the process of selling a home, particularly if the housing market has slowed, can be a long one.
Some seniors opt to leverage their home equity in ways that stop short of an outright sale. Popular options for this include a Home Equity Line of Credit (HELOC) or a reverse mortgage. In both cases, the senior is borrowing against the value of the home. And when the “borrowing” phase of their HELOC or reverse mortgage is over, they will need to begin paying that money back. A HELOC may provide more flexibility for paying back over time, whereas a reverse mortgage may require a lump sum payment. In either case, it’s possible and even probable that the family will need to forfeit the home after the senior’s death to pay for what has been borrowed. There are many restrictions for both HELOCs and reverse mortgages, and you can read more about each here.
Life insurance policies should, ideally, benefit our relatives once we are gone. However, sometimes when seniors are lacking in funding for their immediate care it can make sense to take what you can from a life insurance policy now. Some policies have a cash value, also known as the “surrender” value that the insurance company will give you if you forfeit the right to the death benefit. This amount can sometimes be quite low. Some policies also allow you to add an “accelerated death benefit” to your policy. This allows you to use a portion of the future death benefit without forfeiting the whole, but it usually means higher than normal premiums.
Another option for getting the most out of life insurance before death is to sell the policy to a third party company. This kind of deal can be called a life settlement or a life insurance conversion. In this transaction, a senior sells the policy to another company. That company continues making the payments and will get the full death benefit when the senior passes. In exchange, the company gives the senior approximately 35%-50% of what the death benefit would be. The amount you receive depends on the original value of the policy as well as many other factors. This lump sum is taxable and can disqualify a senior from receiving Medicaid.
Long-Term Care Insurance
Some seniors may have long-term care (LTC) insurance, a form of insurance that’s more directly relevant to assisted living than life insurance is. The number of companies that sell this insurance has shrunk dramatically in recent years. Moreover, getting this insurance tends to be very expensive, and you generally can’t buy it if you already have a need for help with ADLs. Those who are just thinking ahead now and are still relatively young and in good health may wish to look into their options for buying a policy now. Those who already have one of these insurance policies should try to determine how much of their assisted living costs will be covered.
Long-term care policies offer a daily amount of money ($150 per day, for example) to pay for care once the senior needs help with a predetermined number of ADLs. They may only pay out up to a certain dollar amount in a lifetime, for a certain number of years, or after a certain benefit waiting period has been completed. In other words, there will always be some form of restrictions imposed on payments. You can read “What is Long Term Care Insurance”, an article published by the US Department of Health and Human Services, to learn more about this increasingly rare but often valuable form of assistance.
Often, the children of a senior who needs to make a move to assisted living will agree to split the costs of their parent’s care. This can be particularly workable when there are numerous siblings to share the cost. However, splitting the cost between family members will often be a delicate topic, both for the children and for the parent(s). It’s important that everyone be upfront about their other financial obligations. Even within the same family, there may exist numerous spending and saving philosophies. So each family member needs to approach discussions without judgment and without insisting that anyone give more than they say they can afford.
It’s also important that the parent(s) know that receiving help does not equal being a burden. Seniors may be afraid to ask for help in many cases because they don’t want to hurt their children’s or grandchildren’s financial prospects.
Public Funding For Assisted Living
In addition to the assets and insurance mentioned above that can be used to fund assisted living, you may be eligible to benefit from a few different forms of public assistance. Some of these are provided through federal or state agencies on the basis of financial need, while others have more to do with an entitlement based on medical status and other factors.
|PUBLIC ASSISTANCE FOR ASSISTED LIVING EXPENSES|
|FUNDED THROUGH||AVAILABLE IN ALL STATES||LIMITED NUMBER OF BENEFICIARIES PER YEAR?||ELIGIBILITY STANDARDS||BENEFIT AMOUNT|
|MEDICAID WAIVERS||Medicaid and State Governments||No||Yes||-Eligible for Medicaid -Need ADL assistance -Additional restrictions may apply||Full or partial payments for assistance with ADLs (amount varies)|
|STATE PLAN PERSONAL CARE||Medicaid and State Governments||No||No||-Eligible for Medicaid -Need ADL assistance -Additional restrictions may apply||Full or partial payments for assistance with ADLs (amount varies)|
|AID AND ATTENDANCE||U.S. Department of Veterans Affairs||Yes||Yes||-Receiving a VA pension -Needing help with ADLs||$9,000+ each year in addition to standard VA pension ($13,752+)|
|SOCIAL SECURITY OPTIONAL STATE SUPPLEMENTS (OSS)||State Governments Cooperating with Social Security||No||No||-Be eligible for SSI (most cases) -Live in assisted living or adult care home -Other income restrictions may apply||Covers or partially covers room and board with monthly benefit amounts often between $300-$1,200|
Medicaid is a joint program run by both the federal government and state governments. The federal government can require some minimum coverage levels. But the state can supply more comprehensive care if they choose to. One of the ways that states provide extra care, including funding for assisted living services, is through Medicaid waivers. These waivers can have a variety of names, including Home and Community Based Services (HCBS) Waivers, 1915(b) Managed Care Waivers, 1115 Demonstration Waivers, and numerous other names that have to do with age, disability, assisted living, and more.
Waiver programs do not usually cover the cost of rent or food, but they can cover the cost of hiring someone to meet your needs for assistance with ADLs. For seniors who live in ALFs, this means the benefit can essentially pay a portion of the assisted living bill. Eligibility for these waivers depends on income and on the extent of the individual’s needs for help. Each state sets its own standards. You’ll need to, at minimum, be eligible for Medicaid in that state, but you may need to have an even lower income than what’s required for Medicaid. Seniors who apply need to understand that eligibility doesn’t always equal a benefit. States cap how many waivers they give out each year, so in some states, seniors face waitlists to get this form of help. A complete list of waivers, organized by state, can be found here.
State Plan Personal Care
In addition to or instead of offering waiver programs, states may choose to include “personal care services” (help with ADLs/IADLs) within their regular Medicaid state health plan. The main difference between waivers and state plan personal care is that state plan personal care is considered an entitlement, whereas a waiver is not. When a Medicaid benefit is an entitlement, every applicant who qualifies gets the benefit. Waivers are not entitlements because they can have long waitlists and yearly caps on the number of waivers that will be offered to applicants each year.
State plans that include personal care vary widely, just as waivers can. Many states offer state plan personal care services only for those who are aging in place in their own homes or a relative’s’ home. In some cases, residents of assisted living facilities and other residential settings may be explicitly prohibited from receiving funding under the program. However, some states do pay for care within assisted living facilities that are licensed by Medicaid. If you want to find out whether your state’s Medicaid plan offers personal care as an entitlement, find your state’s Medicaid contact information here. Or you may be able to contact your local Area Agency on Aging for more information
Aid and Attendance (A&A)
Aid and Attendance is a financial benefit available to veterans who qualify for the regular Veterans Affairs (VA) pension and who also need help with ADLs. Not all veterans are eligible for a VA pension, but if you are a veteran you should check your eligibility. Generally, to get a pension, you must be over 65 and must have served in active duty for ninety days or more with at least one day of service occurring during a war. Additionally, those who had dishonorable discharges are not eligible. More regulations and exceptions may also apply, so it’s a good idea to visit the VA website for more details.
If you already are receiving the regular VA pension, you may be eligible for the Aid and Attendance benefit. This is an addition to the pension that can increase your annual pension amount by $9,000 or more. Unlike Medicaid benefits discussed above, this VA pension benefit comes to the senior directly as a monthly payment. This means that the veteran can spend it as he or she sees fit, even at assisted living communities that do not accept Medicaid funding. A VA pension with the Aid and Attendance benefit added won’t total more than about $22,000 annually, maximum, so it won’t fully cover a stay in assisted living. However, it can be combined with other forms of assistance. For example, if you have VA Healthcare, that insurance may pay for some of the services you receive in an assisted living facility even though it won’t pay for room and board.
Optional State Supplements (OSS) and Social Security Benefits
Most seniors are familiar with Social Security as a source of retirement benefits that are based on previously paid taxes. However, the Social Security Administration can also provide a benefit that’s not directly tied to previous contributions. This benefit, called Supplemental Security Income (SSI), is available to many low-income seniors. State governments can choose to further increase these benefits for seniors in assisted living through a program called Optional State Supplements (OSS).
The additional benefit amount of OSS varies widely by state. Some states don’t offer it at all, while other states offer a modest augmentation of around $100 per month, an amount that will only cover a fraction of the senior’s yearly costs of living. Other states offer large OSS benefits that will completely cover the cost of assisted living for the resident. Some state’s OSS programs are combined with special regulations of assisted living facilities that cap how much those facilities can charge low-income residents. The qualifications for receiving OSS are usually but not always tied to the qualifications for SSI. The eligibility standards for SSI are quite complex. But using the Benefits Eligibility Screening Tool or reading these Income Guidelines can help you determine if you could be receiving SSI. Monthly, SSI may provide up to $783 for an individual or $1,175 for a couple in 2020, depending on income. If you already are or if you find that you could be receiving SSI, then you should look into whether your state provides the OSS benefit discussed above. Your state’s Department of Human Services (DHS) office may be your best source of information on whether you personally can get OSS. For more specifics on OSS and on which states are most likely to offer it, read “Social Security & Assisted Living: SSI, OSS and How It All Works.”
How to Choose the Right Assisted Living Community for You or Your Loved One
Becoming educated on what’s typically available in an assisted living facility can help you avoid a premature move to a facility that has low costs but that doesn’t truly meet your needs. Below you can learn more about a variety of factors that you should consider when choosing a facility. You’ll also find helpful tips on how these factors affect costs.
Health and Safety Considerations for Assisted Living
Diet and Nutrition
All assisted living facilities provide three meals a day, usually in a restaurant-style dining room, and many also provide snacks. When considering an ALF’s nutritional program, enquire whether the facility consults with or has a registered dietitian on staff. Ask about meal times and whether residents may choose to take their meals in their apartments. Consider whether the food being offered looks nutritious and appetizing enough to eat regularly. If you have allergies or follow a specific diet, make sure to enquire if and how the facility can accommodate your needs.
It’s likely that facilities that cost more will have more appealing, varied, and customizable dining options than their less costly counterparts. When evaluating pricing, keep in mind that diet can have an enormous impact on health over time. You don’t necessarily need to choose the place with the fanciest menu. But you’ll want to carefully consider how the fare will affect you if you eat it on a daily basis. Having appetizing options will be especially important if you tend to be a light eater or struggle with appetite.
In assisted living, you can often choose between studio, one-bedroom, and two-bedroom apartments. You’ll usually be able to move in with a spouse even if the spouse does not need assistance with ADLs. Most assisted living apartments have their own bathrooms and many will also have a kitchenette that allows for food warming, refrigeration, and the preparation of hot drinks, if not actual cooking. If you’re looking for ways to save money, consider renting either a studio apartment or a “semi-private” shared room rather than a fully private one. Choosing either of these options can save you several thousand dollars each year.
When considering private rooms, remember to look critically at the design of the room to determine if it will be safe for you. Are there tight spaces or uneven flooring that will be difficult for you to navigate? Does the room have sprinklers, smoke detectors, and other fire safety features required in your area? Does the bathroom setup have any fall risks? Is the room equipped with a call button so that you can summon help? A room designed to prevent falls and other emergencies is crucial for most assisted living residents.
Group Spaces and Amenities
Assisted living facilities are known for maintaining nice community spaces for their residents to enjoy. Community spaces include dining halls, party rooms that can be reserved by residents, libraries, gardens, sitting rooms, and activity rooms with televisions, games, and more. Some facilities may also have on-site nail and hair salons. Just as with private rooms, consider the design of public spaces with safety in mind. Look for grab bars, anti-slip surfaces, and other safety features. You’ll want to know that you can navigate social spaces with confidence, avoiding injury. Don’t forget to look at elevators and stairs if the facility has multiple levels.
All assisted living facilities offer some form of assistance with ADLs and IADLs. And many also offer minimal assistance with medical care like medication assistance, diabetes management, and other more intermittent or relatively easily managed medical needs. Additionally, some facilities can bring additional nurses in for a higher level of care on a case-by-case basis. Or some may offer physical therapy on-site. It’s crucial to find out exactly what assistance can and cannot be provided on-site at each facility you visit. It’s also important to ask if there are different prices for different care levels or if there is an all-inclusive fee. Compare the pricing structure and fees of multiple communities, and try to compare these prices to the costs of similar in-home care in your area to get an idea of what’s reasonable.
Transportation and Shopping
Having access to transportation and/or help with shopping for essentials is crucial to maintaining your health and standard of living. Make sure you’re clear on how you will get to doctors’ appointments and other essential services once you move. Most locations will facilitate some safe form of transportation for you. Ask how the cost of transportation is calculated in your bill. Make sure that the transportation provided is truly accessible to you, with low steps up into vehicles and any other features that you need. Find out if someone will be available to assist you with shopping or if you and/or your family will be expected to accomplish this independently.
Quality of Life and Happiness Considerations for Assisted Living
In addition to analyzing factors that directly affect health and safety, it’s important for seniors to evaluate facilities based on the way they may affect social well being and overall happiness. What constitutes a happy life varies significantly from person to person. But thinking critically about the location, culture, and recreational activities available at a facility can help you decide which place is right for you.
Some seniors wish to find a home that’s close to where they used to live, while others are less concerned about proximity to their old neighborhood. When you consider your options, take into account how your new location will impact the ability of your relatives to visit you. You may also wish to consider whether a move will require you to switch to different medical providers.
Some seniors choose to move quite far away from their current homes for the sake of benefiting from a lower cost of living. This makes sense since the cost of assisted living can vary by tens of thousands of dollars annually from state-to-state. A major move to an inexpensive area that you have family near can make the cost of assisted living more manageable without compromising your ability to connect with loved ones.
As you search for your new home, you may find that some assisted living communities have a large population of people with whom you identify. For example, you may find that some places have a thriving religious group that you’re part of, a large percentage of people who speak your first language, or numerous veterans. If staying connected to a specific cultural group is important to you, consider trying to find a home that already has a significant population of people belonging to that group. Some facilities may be intended specifically for a certain population, such as ALFs associated with a religion, while others may merely have a strong presence of that population.
Seniors, like all people, need to enjoy meaningful activities and interactions with others. Most facilities will have an activities director, designated recreation areas, and a program of activities planned far in advance. Art, dance, music, and cooking classes may be offered, community gardening areas may be available, and outdoor areas may be designed for walking or another form of exercise. Some facilities also allow pets. Teas, brunches, and other social events celebrating holidays may be planned as a joint celebration for residents and their family members. The activity director may also plan outings to local attractions that are accessible to seniors. When looking at facilities, enquire whether there are separate fees for activities and consider how many activities you are likely to be able to enjoy.
Visit Facilities in Person
You can learn quite a bit about a facility from phone calls, brochures, and websites, but nothing beats visiting a location in person. A place that seems like a great deal may quickly be eliminated from your list of options once you interact with its staff or look at its rooms. Visiting in person, getting an accurate price breakdown brochure, and asking questions on all of the health, safety, and happiness topics discussed above will help you to understand which places are truly options for you versus which ones are not.
Visiting facilities may be difficult for you and your loved ones because the process can feel rushed and tiring. It will help if you frankly discuss possible costs, needs, and preferences beforehand so that you have a clear idea of what to look for. Knowing what you want ahead of time makes evaluating costs and benefits much easier.
Frequently Asked Questions
What do top-rated assisted living facilities have in common?
Top-rated assisted living facilities are clean and well-maintained, offer meals that are varied, nutritious, and interesting, and offer a broad range of activities for seniors. Their environments are friendly and professional, and they have enough staff to allow for prompt responses to senior’s requests for assistance with toileting, dressing, and other needs. Top-rated facilities are also upfront about what they can and cannot help seniors with, making their capabilities and limitations clear for all.
Who licenses assisted living facilities?
State Departments of Health and Human Services/Social Services license and regulate assisted living facilities. The fact that regulation occurs on the state level instead of the federal level means that each state defines assisted living a little differently. Though assisted living in any state will still be recognizable as such. To find out more about your state’s regulations, you’ll want to visit your state’s government website. Many states provide a searchable tool for finding the license numbers of assisted living facilities. Using these sites can help you verify whether or not the facility has had major problems, too. If you’re having trouble understanding where to find information on licensing and regulations in your state, consider reaching out to your local Area Agency on Aging for state-specific information.
Does Medicare ever cover room and board in an assisted living facility?
Many seniors are used to relying on Medicare for medical and care needs, including limited nursing home care. It can be shocking to learn that Medicare cannot cover assisted living, especially not the costs associated with room and board. Medicare can still cover healthcare for seniors in assisted living. But this healthcare typically won’t include medical services rendered on-site at the assisted living facility. Some exceptions to this may include limited use of telehealth (video and phone doctor consultations). Seniors who are disappointed to learn that Medicare cannot cover assisted living room and board can explore other assistance options such as Medicaid and income/needs-based Social Security benefits.
What kinds of buildings and neighborhoods are common for assisted living?
A typical assisted living facility will have private resident rooms/apartments within a large, often multistory building. The environment can frequently feel like an upscale hotel, especially since restaurant-style dining is available. Assisted living facilities can be located in all kinds of neighborhoods, including residential, downtown areas, rural areas, and more. They are sometimes rarer in sparsely populated regions.
Who benefits from assisted living?
Seniors who have needs for assistance but not for constant supervision or medical care are the ideal candidates for life in assisted living. This includes those who need help with ADLs (Activities of Daily Living) such as bathing, dressing, toileting, and eating. If you need help only with IADLs (Instrumental Activities of Daily Living) such as transportation, home maintenance, and cooking but not with ADLs, then an independent living community may be a better and less costly option for you. On the other hand, if you have complex medical conditions, are bedridden, have dementia, or are severely disabled in some way, a nursing home is more likely to meet your needs.