Assisted Living

When an aging loved one can no longer lead a full life without daily help, it might be time to consider an assisted living facility (ALF). Many seniors choose assisted living in order to maintain a sense of independence, stay socially active, and prevent family members from the responsibility of 24/7 caregiving. For independent seniors who need only a little help with daily activities and minimal oversight from medical staff, assisted living can be the perfect solution.

Assisted living care is a form of senior living in between independent living in a private home and a nursing homes, where residents have access to medical care most or all of the time. Assisted living communities are all a bit different, but they all give provide senior housing with some privacy and independence while also providing assistance when it comes to taking medication and some of the other tasks of daily life known as “activities of daily living”.

Activities of daily living (ADLs)

Activities of daily living (often shortened to ADLs) include bathing, dressing, transferring, eating, and toileting. Senior care is required when a person needs help with one or more of these.

If your loved one isn’t able to keep up with his or her grocery shopping, meal preparation, housekeeping and laundry, an assisted living facility might be the right place for him or her to live. Most assisted living facilitiesprovidethese services, so elderly residents don’t have to worry about chores like dusting, carrying heavy laundry baskets to the laundry room, chopping vegetables, and other activities that might have gotten too difficult in recent months or years.

Who needs assisted living?

Assisted living is for senior citizens who have been living independently that may need more help with their day-to-day living activities. They might have noticed that they forget to take their medications or that they have a hard time making appointments to go to the doctor for refills. Maybe they have difficulty driving and no longer have a car. Often, they aren’t able to grocery shop easily, and they might not have the dexterity, desire, or energy for household chores anymore. Many people who are ready forassistedliving feel lonely and bored because socializing with others is something that they don’t have the ability to do anymore. In short, the people who most benefit from assisted living are those who aren’t able to take good care of themselves all on their own.

If your relative’s spouse or partner has died and they are living alone, you might feel uneasy about them living on their own. If they agree that they would be more comfortable in a facility that allows them to socialize with their peers, have their cooking and cleaning needs met, and have healthcare personnel within easy reach, then an assisted living facility might be the right choice.

For caregivers that take care of a senior relative at home, an assisted living facility can be a great option for respite care. Respite care is short-term, temporary care that allows a caregiver to take a break. Many assisted living communities will provide senior care for a short period of time if they have beds available. If local facilities cannot take a senior for a short period of time, hiring an in-home care company is another option for respite care.

Assisted living assessments

Assisted living is not right for everyone. Someone who is very independent and who wishes to take care of their own cooking and transportation needs would likely feel stifled in an assisted living facility and may be better off moving into a retirement community. On the other hand, someone who requires in-depth health care, such as a patient with Alzheimer's, might not have their needs met appropriately in this type of setting. Before your aging relative is accepted into an assisted living facility, they will need to undergo a screening to be sure that it’s the right environment for them. If your relative needs care for dementia, you will also need to make sure the facility provides memory care or else they may need to move as their condition declines.

Health assessment

A healthcare professional will conduct a health assessment to see if your loved one is healthy enough to thrive in an assisted living facility. Many seniors have some health problems, so the staff will want to know if there is a history of cancer, high blood pressure, past surgeries, heart problems, lung conditions, and so on. It’s importanttobe honest and conscientious when helping your relative explain their health history. Compile a list of medications that your loved one is taking to provide a comprehensive health assessment.

Cognitive function assessment

While some people with cognitive declines can live successfully in an assisted living facility, others will need more specialized care. Therefore, a cognitive function assessment will be done by a medical or mental health professional. This might be done prior to the screening assessment; you can certainly request that your loved one’s own physician do it. The assisted living facility staff will need to know if your elderly relative can follow instructions, suffers from severe memory loss, is prone to wandering off, or has any other issues that could compromise his or her safety. If the facility has a memory care unit, they may be able to provide the kind of high-quality dementia care that would typically be found in a nursing home.

Personal care abilities assessment

The staff will also need to know how much care your loved one needs when it comes to taking care of personal needs like showering, getting dressed, toileting, and caring for his or her fingernails and toenails. Again, it’s important to be comprehensive and honest when answering questions. Assisted living facilities are good solutions for people who need some assistance, but if your parent or other relative has high needs in this regard, the staff might recommend a skilled nursing facility.

Types of long-term care

When it comes to choosing a senior living facility with the help of your aging loved one, there are several options available. Here are some of them:

Active adult communities

If your parent or other loved one is ready to downsize but is perfectly capable of living independently, an active adult community might be the right choice. These can be single-family homes, condominiums, or mobile homes. Each individual or couple has their own residence within the community. They cook for themselves, drive themselves around, and do everything else that they’ve been doing in their previous homes.

The main difference between an active adult community and a private home is that everyone in the community is age 55 or over. There are typically rules about how long younger relatives, including children, can stay for a visit. While grandparents might have their grandchildren visit for a week or two, these communities typically don’t allow minors to move in (to be raised by their grandparents, for example).

Independent living communities

For those who still want to live independently but don’t want to worry about cooking meals or driving, an independent living community might be a good option. In these retirement communities, residents live on their own in apartments or condos but are able to have meals in a communal setting with other residents. Transportation is often provided within the community and to doctors’ offices, shopping plazas, and leisure activities. Sometimes housekeeping is included, too.

Assisted living facilities

An assisted living facility is great for seniors who are still active but who need medication management or to help them with the activities of daily living, such as showering and getting dressed. Assisted living residentshavetheir own studio or one-bedroom apartment, though this can vary; some assisted living facilities offer single rooms or two-bedroom apartments, as well.

Residents go to a common area for meals or they can have meals delivered to their rooms. There are nurses and other healthcare professionals available for medical care and general assistance. In most cases, laundry and housekeeping services are provided. Residents often have several recreation options to choose from each day; for example, there might be swimming, aerobics classes, a chess tournament, afternoon movies, or other activities to pick from on a regular basis.

Skilled nursing facilities 

If your loved one requires a higher level of care or an increased amount of long-term care servicesthancan be provided in an assisted living community, a skilled nursing facility is an option to consider. These long-term care facilities provide round-the-clock nursing care. Nurses will help residents shower, dress, brush their teeth, and attend to their personal needs. They will also dispense medication and check vital signs as needed. In addition, residents enjoy meals prepared for their dietary needs; in most cases, a nutritionist will oversee what each resident is eating.

In some cases, a resident of an assisted living facility or someone who lives in a more independent living situation will stay in a skilled nursing facility temporarily and then will go home. For example, if an elderly person breaks a hip or is recovering from knee surgery, they might stay at one of these homes until they are able to be more independent once again.

If you are relying on Medicaid to provide financial assistance for an SNF there is a good chance that your relative will have a roommate as many residents stay in a semi-private room.

When care needs increase

Many elderly adults choose to live in a continuing care community (CCRC). These are communities with a variety of living situations available. A person might go from the independent living section to the assisted living facility, then in a few years might go into the skilled nursing facility.

Since many senior citizens experience a decline in abilities as they go through their 80s, 90s and beyond, a continuing care community provides them with a consistent place to call home even as their needs increase. They are often reassured by being surrounded by familiar people, policies, and surroundings during their acclimation to the new setting.

If a senior is in an assisted living facility that is not part of a CCRC and their level of care needs increase, they may be able to hire an in-home care private duty company to provide care in the ALF. These home care companies can be expensive when paired with the cost of the facility which makes affordable care more likely at a nursing home.

Regulations and assisted living facilities

Assisted living facilities, like most types of residential care, are regulated by the states that they’re in. Therefore, the regulations of the facilities you are considering might differ from those in neighboring states.

There are many other regulations that might apply to your state. The U.S. Department of Health and Human Services offers a publication that might help you learn more about the regulations in your state.

Assisted living services

Each assisted living community is a bit different and will offer slightly different services. With that being said, assisted living, in general, is seen as a continuum of care that is more intensive than independent living and less intensive than what residents get at a skilled nursing facility. Some of the services that would likely be provided at your chosen assisted living facility include:

Assisted living costs

When determining which type of care is best for your loved one, it’s important to consider the financial costs. While it’s best not to make a decision based solely on cost, it is a real concern for most people whose elderly relatives need care beyond what family members can provide.

How much does an assisted living facility cost?

The median cost per month for a resident to live in a one-bedroom apartment in an assisted living facility was $3,500 per month (or $42,000 per year) in 2014. The average cost per year is now about $48,000 per year. It’s likely that prices will continue to rise each year. This cost can vary substantially depending on the services available and the cost of living in the area.

Options for paying for an assisted living facility

Since most people do not have an income that can support a $48,000 (or higher) expenditure each year, they are understandably concerned about how they can cover the cost of an assisted living facility. Medicare does not cover this type of long-term care. Some of the options available might include:

Selecting a facility

Once you and your loved one decide that an assisted living facility is the right choice, your next step will be to select a facility. Depending on where you live, there might be many choices available. Here are some of the considerations you should keep in mind when making your decision.

What services are needed?

Not all assisted living facilities offer the same services. Make a list with your relative of the services that are essential, and only consider the facilities that offer them. For example, if it’s important to your loved one that they have the opportunity to go on off-site trips on a weekly or biweekly basis, be sure to ask whether that is offered when you call to make an appointment for a tour.

What amenities are important?

Does your relative love to swim or play tennis? Those are amenities that might be offered by one or more of the facilities in your area. Your loved one might have a strong preference when it comes to the type of residence they will live in (one-bedroom vs. studio, for example). Maybe it’s important to you that there is an attractive, welcoming place for visiting outside of your loved one’s unit. Think about what amenities are most important as you begin the decision-making process.

Facility location

Your loved one will likely want to be close to family members and friends, if possible. If he or she has been living many miles away from you and now would like to live closer, this is a consideration. Think about how easily you will be able to visit when you are leaving your home and/or your workplace. Also, if your relative wants to keep the same physician, you will need to choose a facility that is within an easy driving distance of the office and also to a hospital where that doctor has privileges. It’s even better if the facility provides transportation to the building where the doctor practices.

What to ask on a scheduled tour

When you go to tour assisted living residences, you might feel a bit overwhelmed. It’s best to have a list of questions written out ahead of time so you won’t forget to ask something important. Take some time a few days ahead of the appointment to compile a list, if possible. Here are some questions to get you started:

Once you leave the facility, there are some questions you should ask yourself and your loved one. Write down the answers so you don’t forget. It’s easy to mix up the features of each facility if you are looking at more than one or two. Here are some questions you might consider asking yourself after each tour:

Assisted living FAQs

There are some questions that are asked by many people who are considering long-term care for their parents or other elderly relatives. Here are some of them:

Is my loved one ready for long-term care?

This is something that needs to be decided by each family. If your loved one is having trouble keeping the house clean, managing personal hygiene, or has trouble remembering to take medication, then living alone might not be safe. Whether the solution is living with a family member, hiring an in-home nurse, or going to a long-term care facility is something that each family needs to address on an individual basis.

How can I talk to my loved one about the need for assisted care?

The topic of assisted living can be a sensitive one for your loved one. While some senior citizens realize that they are unable to care for themselves independently, others don’t see the changes in themselves. It might help to gather a few family members together to broach the subject. Keep in mind that aging and giving up independence is scary for many people. If your loved one doesn’t want to talk about it and it’s not an emergent situation, let the topic go and bring it up another day.

What if my loved one refuses to discuss going into assisted care?

Consider all of the options. It’s possible that your loved one might prefer having a nurse come to the house each day. If feasible, they might rather live with a family member instead of going to a care facility.

If your loved one does not want to admit that they cannot live independently anymore, you might need to bring in reinforcements. Advice from a trusted medical professional might carry more weight when it comes to your relative accepting the inevitable. Make an appointment with his or her family doctor to discuss whether they believe your loved one can continue to live independently. This trusted doctor can also explain the options available. You can also look on Eldercare Locator to see what’s available in your area.

If it is an urgent situation, you might have no choice but to get a social worker who specializes in elder care involved. This can be hurtful to your loved one, but his or her physical safety needs to come first.

Making the decision to place your family member in an assisted living facility can be difficult. By understanding your options in terms of care available and touring several different facilities, you and your loved one can feel comfortable that it’s the best choice for your family.

Proximity of care is very important when considering options

Research care options that are nearby when thinking about the next step for your loved ones.

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