Care Types

Assisted Living

When your aging family member can no longer live completely independently, you and your loved one have some difficult decisions to make. Many older adults don’t want to live with their children or grandchildren; they might feel that they won’t have enough independence or that they will become a burden on their younger relatives. At the same time, those who have been independent don’t want or need to relinquish all of their autonomy. For these independent seniors who require care a bit of extra help, an assisted living facility (ALF) can be the perfect solution.

What is Assisted Living?

Assisted living care is a form of senior living in between independent living in a private home and a skilled nursing facility, where residents are cared for by nurses and other medical professionals 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”.

What are Activities of Daily Living (ADLs)?

ADLs include bathing, dressing, transferring, eating and toileting, and typically senior care is required when a person needs help 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 facilities provide these 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.

The People Who Benefit From Assisted Living

Assisted living is for senior citizens who have been living independently that may need more help with their day-to-day living activies. 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 for assisted living 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.

The Requirements for Assisted Living

Assisted living is not right for everyone. Someone who is very independent and who wishes to take care of his or her own personal, 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 an alzheimer and dementia patient, might not have his or her 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 alzheimer care, you will also need to make sure the facility provides memory care or else they may need to move as their condition declies.

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 important to be honest and conscientious when helping your relative explain his or her 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 alzheimer or dementia care for patients that typically would need to go to 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.

Different Types of Long-Term Care Facilities

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 activites of daily living, such as showering and getting dressed. Assisted living residents have their 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 (SNF)

If your loved one requires a higher level of care or an increased amount of long-term care services than can be provided in an assisted living community, a skilled nursing facility (also called a nursing home or SNF) 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 a SNF there is a good chance that your relative will have a roommate as many residents stay in 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.

  • Licensing: States handle this differently. Some states, such as Connecticut and Minnesota, license the care providers themselves, so the facility is not necessarily licensed. Instead, it is handled the same way any other landlord/tenant relationship is handled. Other states license the facility itself.
  • Resident contracts: Most states require some sort of resident contract that might specify when the resident is moving in, how much it will cost, the services that are provided, which type of staff will provide which services, sources of payment accepted, discharge criteria, and other information. Again, this varies widely by state.
  • Admission criteria: Most states have specific criteria that qualify or disqualify a potential resident for living in the facility. There might be certain health conditions, some cognitive behaviors, and some special needs that disqualify someone for residency in any assisted living facility in that state.
  • Assessments: Some states require that health and functional assessments be completed periodically within a specific timeframe. This is so it’s clear when a resident is no longer healthy or able enough to live in an assisted living facility.
  • Hospice and other third-party providers: Some states have rules and regulations concerning the services of hospice and other third-party providers within the assisted living facility. These providers might include home-health aides or in-facility private nursing staff to care for someone with a terminal illness.

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:

  • Medication management: If your relative needs help remembering to take his or her medication, a nurse can dispense meds each time they’re needed.
  • Personal care assistance: A nurse’s aide or health assistant can help your loved one with his or her personal care activities such as bathing, getting dressed, brushing teeth, combing hair, and taking care of fingernails and toenails.
  • Housekeeping and laundry: Many assisted living facilities offer housekeeping and laundry services.
  • Food services: Your loved one will be able to eat meals and snacks provided by the facility. Many will cater to special diets (such as vegetarian diets, Kosher diets, or diets appropriate for diabetics).
  • Unit maintenance: Your loved one’s apartment or room will be maintained by the maintenance staff. In addition, on-site recreational facilities and common areas will be maintained.
  • Transportation: Many assisted living facilities will transport residents to doctor’s appointments, shopping venues, libraries, churches, and other locations.
  • On-site resident activities: Most assisted living facilities offer some on-site resident activities. Some offer a wide array each day. Examples include a swimming pool, bingo, exercise or yoga classes, painting classes, game nights, and afternoon movies.
  • Off-site resident activities: Some facilities will take interested residents to the park, to cultural events, to the movie theater, and to other places in the community. Some might even take residents on longer day trips to nearby cities.
  • Physical and occupational therapy: Many facilities will help coordinate physical and occupational therapies for residents. In many cases, these services can be provided by the facility itself or by private practitioners who go to the facility.
  • Counseling: Social workers or therapists might be on staff to provide counseling services to residents. In some cases, support is given to family members who are having a hard time adjusting to their loved ones’ needs.

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:

  • Private funds: The first source of funds should be your loved one’s retirement account, if any. Depending on how much he or she has saved and invested over the years, it’s possible that they will have enough to cover several years or more in the assisted living facility.
  • Reverse mortgage: If your family member is not going to be selling his or her house (because, for example, their independent spouse or a grown child lives there), they could take out a reverse mortgage. This is an equity loan that does not have to be paid back until the house is sold or after the owner dies.
  • Long-term care insurance: While you can’t buy long-term care insurance for a relative who is already in their 80s, your loved one might have purchased a long-term care insurance policy decades ago. In this case, check the policy to see if it covers part or all of an assisted living facility.
  • House sale: If your parent no longer needs his or her house and is planning to sell it, the proceeds could be used to pay for the assisted living facility. If funds are needed before the house is sold, a bridge loan could be a potential solution.
  • Medicaid: Depending on your state, Medicaid might be an option for covering an assisted living facility. One major caveat: Medicaid coverage is generally reserved for people who do not have any savings left and there is very limited funding available, meaning long wait lists. Check out our Home and Community-Based Services State Medicaid Waivers to learn if you may be eligible.

How to Select 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.

How Far Away Is the Location From Loved Ones and Doctors?

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.

Checklist of Questions 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:

  • How many residents live at this facility? What is the ratio of staff to residents?
  • Is there a nurse present at all times? If not, what is the plan for residents who have health issues when there is no nurse present?
  • Can we see the different floor plans available? What is the price of each floor plan?
  • Are all housekeeping and laundry services provided? How often are the units cleaned? How often is laundry done?
  • What are the activities available to residents on-site and off-site?
  • How do their monthly fees compare to the cost of assisted living in the area
  • What type of special care is offered to residents with ______? (Ask about any special needs that your loved one has.)
  • What if my loved one needs more care than the facility can provide in the future? Where will they go to live?
  • Can my loved one choose his or her own doctors, therapists, pharmacies, and other health care providers?
  • What are grounds for discharge from the facility?
  • Can we have a list of the rules and regulations?
  • What is the plan to get all residents out safely in the event of an emergency or fire?
  • Is there a backup power source in the event of a power outage?
  • What services or utilities are available that are not included in the regular monthly fee?
  • Do they provide person-centered care?
  • Do they provide memory care or alzheimer’s care?
  • Do patients often move out to nursing homes? If so which ones?

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:

  • What was my loved one’s gut feeling? Did they feel welcomed and comfortable?
  • Did the facility look and smell clean?
  • Were the bathrooms clean and in good repair? Were there handrails?
  • What about the kitchens and the common areas? Were they clean and in good repair?
  • Did the staff that you encountered greet you, even with just a smile? Did you see them treating the residents with respect? Did you see anything disrespectful or anything that made you uneasy?
  • Did the residents look clean and well-groomed?
  • What was the decor like? Would your loved one feel that the surroundings were attractive and welcoming?
  • Were the common areas, hallways, and stairways well-lit? Were there any safety issues that you noticed?
  • Did every room or apartment have a security lock on the door?
  • Were there emergency buttons in each resident unit and bathroom?

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 his or her home clean, isn’t taking good care of his or her hygiene, or isn’t able to remember to take necessary medication, then they might not be safe living alone. 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 the 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.