About Senior Assisted Living
If your loved one is in need of help performing some of his or her daily activities, then assisted living might be the right choice for their needs. Some help that might be provided to an individual in an assisted living community includes meal preparation, bathing, hygiene, incontinence care, dressing, and more. Assisted living communities typically have semi-private and private room options with common spaces for socializing, shared dining, transportation services, beauty shops, and more. In some instances, specialized care may be provided for seniors with special conditions such as dementia or Alzheimer's disease, as well as other common medical conditions.
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More About Assisted Living
Does your loved one need help performing some of his or her daily living activities? If so, assisted living might be the right choice. These communities promote independence while offering a helping hand and life-enriching services.
What is Assisted Living?
Assisted living facilities are residences offering personal assistance and hospitality services to seniors who are still able to live independently. Assisted living is usually the next step for individuals who need slightly more support to be safe and maintain a high quality of life. Depending on the needs of the resident, they provide services such as meal preparation, bathing, hygiene, incontinence care, and dressing.
Since there is no nationwide definition for assisted living (it's regulated state by state), each assisted living community can offer different levels of care. They provide a cost effective, residential approach to care by employing home health agencies or personal care staff. Considered a long-term care option, assisted living facilities must be certified, registered or licensed depending on the state.
These facilities are designed as private communities, much like an apartment complex. Living arrangements may be furnished or unfurnished rooms, private or shared studios or one-bedrooms, and sometimes dormitory-style bedrooms. There are also common spaces for socializing, shared dining, transportation services, beauty shops, and other amenities.
Who Lives in Assisted Living Communities?
According to a 2013-2014 report by the Centers for Disease Control (CDC) there are more than 835,000 Americans residing in these types of facilities, a majority of which are white females over age 85. The average length of stay for assisted living residents is just over two years according to research conducted in 2009 with oversight by several national senior housing organizations. The next step after assisted living is typically nursing home care as individuals require more assistance and care as they age.
What Services Does Assisted Living Include?
The basic services offered in assisted living facilities can vary. Generally, these services can include:
- Transportation services
- Social, educational, recreational, or religious activities
- Assistance with medications
- Housekeeping and laundry
- Daily living activities (bathing, dressing, grooming, and other personal care)
- Dining and meal preparation
- Health, wellness, and exercise programs
- Supervision and 24-hour emergency response
There are several services provided in conjunction with an assisted living facility that go beyond those listed above, such as skilled nursing care. Some assisted living facilities specialize in Alzheimer's, Diabetes, depression, or cardiovascular programs and have designated wings for residents with these conditions. The services offered at facilities can vary based on location or state, so it is important to discuss the extent of care needed during the initial consultation.
Assisted Living vs. Independent Living
Independent living is ideal for individuals who can still live independently but enjoy having access to assistance when needed. These communities provide their residents with convenient access to dining, medical care, entertainment, and the camaraderie of other seniors. Hospitality services such as housekeeping, meals, and laundry may or may not be included in the monthly rental but are typically available. Often, independent and assisted living facilities are co-located, so that seniors can shift to assisted living when their needs increase over time.
Assisted Living vs. Residential Care Homes
These terms are often used interchangeably, but the National Institute on Aging notes that the difference is often based on the size of the facility. Board and care homes, also called residential care facilities or group homes, are small private facilities, usually with 20 or fewer residents. Rooms may be private or shared. Residents receive personal care and meals and have staff available around the clock. However, nursing and medical care usually are not provided on site.
Assisted Living vs. Home Care
Preference, abilities, and cost are determining factors when choosing the right care. Without the ability to maintain everyday tasks, individuals may benefit from the 24-7 access to support that an assisted living facility provides. That said, home care allows the individual to stay functioning at home while a home health aide or nurse makes daily visits. Home care can surpass assisted living costs if a lot of specialized services are needed in the home. An individual with more care needs can often pay less monthly when choosing an assisted living facility.
Assisted Living vs. Nursing Home Care
To have access to a wide range of personal, medical and health services, nursing homes are a good choice for those requiring more care than an assisted living facility provides. A nursing home offers medical staff, physicians and physical therapy in addition to meals and assistance with daily living. These services typically include nursing care, 24-hour supervision, three meals a day, and assistance with everyday activities.
As an example, if a resident requires intravenous medications, wound care, or occupational, physical, speech or respiratory therapy or treatments, they would most likely require a level of care beyond assisted living and be better suited for a nursing home with a skilled nursing unit. The length of stay at a nursing home can vary from a few days to a few months or longer depending on the resident's needs.
What Is the Cost?
According to a survey conducted by CareScout in June 2017, the national average cost per month for a private one-bedroom in an assisted living facility was $3,750. This figure is expected to rise to over $5,000 in the next ten years.
Seniors may want to consider creative ways to reduce the cost. For example, renting a studio instead of a one-bedroom apartment can reduce monthly payments by 15 – 20 percent. Since most facilities have plenty of public spaces, it may not be an issue. Residents may also be able to share a two-bedroom with a friend to reduce costs for both parties.
Another option is to find an assisted living community that is just opening. Usually communities have around 10% vacancy, so a new community will have to fill 100% of its rooms. Therefore, in addition to being in new condition, the management may be willing to negotiate.
The most important way to keep costs down is to review the level of care. The service contract specifically lists the services required by the resident and the cost of those services. Some communities offer both an all-inclusive package and care on an as-needed basis. Choosing the correct right level of care can save a significant amount of money over time.
How Do I Pay?
Considered a long-term care option, assisted living expenses are most frequently paid for out-of-pocket or by a combination of other methods such as Social Security, pensions, Veterans benefits, insurance, home equity, and various savings.
Long-Term Care Insurance
Long-term care insurance is a policy that is purchased through a private insurance company. Similar to health insurance policies, the price varies greatly depending on age, general health and amount of coverage. Coverage could be denied for people with pre-existing conditions such as Alzheimer's disease or Parkinson's disease. Not all insurance will deny based on these conditions, so it is important to explore different insurance companies.
Medicaid is a Federal and State health insurance program for those with low income and limited assets. Administration of the program varies by state, according to the Centers for Medicare and Medicaid Services (CMS). Medicaid does not cover the costs of assisted living but may pay for services used in conjunction with a facility such as visits from a home health aide to help provide care and to delay the need to move to a more specialized facility such as a nursing home. Unlike Medicare, Medicaid has strict eligibility requirements.
Medicare is a federal government program for those 65 or older with low income and limited assets. It generally does not pay for assisted living, but it will cover skilled nursing or home health services that may be used while living at an assisted living facility.
Aid and Attendance Benefit for Veterans
According to the VA website, the Aid and Attendance benefit (A&A) benefit is a special benefit for war era veterans and their surviving spouses. It is a tax-free benefit designed to provide financial assistance to help cover the cost of long-term care in the home, in an assisted living facility or in a nursing home. This benefit is for those who live in a nursing home or are mentally or physically incapacitated or require the regular attendance of another person or caregiver in at least two of the daily activities of living. To learn more about the eligibility requirements and to apply for these veteran benefits visit VeteransAid.org online.
Some life insurance policies may provide options to help pay for assisted living. These options greatly depend on the type of life insurance policy so it's best to discuss with an insurance broker or financial advisor.
- Life Settlement - You can sell your life insurance policy to a third party for market value and use the proceeds to fund a long-term care benefit plan.
- Surrender Policy – You give up ownership and the death benefit. If the policy has accumulated cash, the insurance company writes you a check for the full amount of cash value, which is often taxed.
- Policy Loan – You can take a loan from your life insurance policy, which means you won't pay taxes. However, you can't take it all or the policy will lapse.
- 1035 transaction – This allows you to exchange cash value from an existing life insurance policy into a new life insurance policy with long-term care insurance benefits tax-free.
Reverse Mortgage Loans
The Home Equity Conversion Mortgage (HECM) is a reverse mortgage that seniors take against their home's equity. Insured by the federal government, it is only accessible via lenders approved by the Federal Housing Administration (FHA). Once finalized, the lender makes payments in a single lump sum, monthly installments, or as a line of credit. The loan does not have to be paid back until the last borrower passes away or moves from the home for one full year. The home is usually sold, and the lender is paid back the full loan amount plus interest. If you want to use a reverse mortgage to pay for assisted living, know that one of the co-borrowers must remain living in the home to qualify for a reverse mortgage loan. Once the surviving homeowner permanently moves out or passes away, the loan is due.
In situations when costs aren't covered through other means, paying via private funds is an option. Sources of private funds for assisted living include retirement accounts and 401Ks, savings accounts, annuities and insurance plans (including life settlements), trusts and stock market investments. Home equity and bridge loans can also be used when transitioning to an assisted living facility or increasing care services. Social Security is used by over half of those in assisted living as their primary means of paying for housing, and this can be an ideal solution for those who are receiving most of their care, including transportation, medication, and meals, through these facilities.
Who Should Choose a Continuing Care Retirement Community?
Continuing care retirement communities (CCRCs), also called life care communities, offer different levels of service in one location. Many of them offer independent housing (houses or apartments), assisted living, and skilled nursing care all on one campus. Healthcare services and recreation programs are also provided.
If you anticipate that your loved one will need specialized care for dementia in the future or skilled nursing care for deteriorating medical conditions, a CCRC can be a good choice. Even if they don't need these services now, it might be make sense to choose a facility that can respond to their changing needs over time. That way, you can avoid the expense and disruption of moving.
How to Know if Assisted Living isn't a Good Fit
My loved one cannot walk or move around well on his/her own.
Assisted living residents generally must be able to get around on their own. Although walkers and canes are okay, bedridden seniors are not good assisted living candidates. Their families should explore nursing homes. Seniors in wheelchairs should explore the accessibility of the assisted living community. While a limited number are able provide one or two-person transfers, or even use mechanical lifts, most cannot.
My loved one is recovering from hospitalization or surgery.
Rehabilitation services are not offered at assisted living communities. However, your senior could be placed at a nursing home (and be covered by Medicare for up to 100 days). After the rehabilitation process, they could transfer to an assisted living community if they no longer need ongoing medical services or physical therapy.
My loved one has late stage Alzheimer's or dementia.
While assisted living communities may be able to offer care to people with early to moderate dementia, they are usually not equipped to care for people in the advanced stages. In this case, dedicated memory care is required. Sometimes this can be offered at an assisted living community with a special memory-care unit, but a nursing home with an Alzheimer's specialization is most often preferable.
My loved one needs medical attention on an ongoing basis.
Assisted living communities can offer a high level of care with activities of daily living such as bathing, dressing, toileting and so on, but this kind of care is considered non-medical. If your loved one needs medical attention from a doctor or nurse on an ongoing basis, nursing homes are better equipped to handle this need.
Assisted Living Assessment
Most assisted living facilities will do an in-house assessment to get a better idea of the senior's current condition, so they can determine what type of care is appropriate for that individual resident. The actual assessment will vary from facility to facility but typically it includes evaluations of the following areas:
- Cognitive Condition – The staff will assess a person's cognitive and mental condition and whether they are experiencing confusion or dementia. They 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.
- Medical Needs – Many seniors have 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. They will look for vision and hearing problems and incontinence issues, so they can provide the best care possible. It's also important to share your loved ones' medication list and if any prescriptions need to be administered by an on-staff nurse.
- Special Support – This can be a special diet, assistance with oxygen, or the need for a staff member to push their wheelchair to meals.
- Personal Care and Hygiene Needs – 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 other daily activities.
The assisted living facility will conduct follow-up needs assessments to determine if an existing care plan is working in the best interest of the senior. Typically, needs assessments will be performed every few months, or when staff members think there are signs of changing or worsening conditions in a resident.
Evaluating Assisted Living Facilities
As you begin to tour assisted living communities, keep a list of standard questions so you can compare answers across all your contenders. AARP provides a printable resource (with room to write your notes) Caregiver Checklist for Evaluating Assisted Living Facilities. Their checklist covers everything from safety to resident rights to fees.
At the end of your tour, make sure you request the following documents. They can help you compare the details of one facility versus another.
- Sample admission contract
- A copy of the Resident Bill of Rights
- A copy of the most recent survey results from state regulatory inspectors
- A recent list of weekly activities and events
- A recent weekly menu of meals and snacks
Once you've collected all the information, study the fees and the contract. Make sure you understand what services are included in the monthly fee. Find out what is available for extra costs. Take the contract home to look at it thoroughly or to have an elder law attorney look at it.
Don't overlook your instincts. You want your loved one to be safe, happy, and healthy. If something feels "off," it's best to trust your gut, or investigate whatever prompted your concern.
Assisted Living Regulations
Assisted living communities are not regulated nationally like nursing homes. Each state has its own laws, regulations and licensing standards. In some states, as many as 25 hours of training are required for the caregiving staff while other states have no training requirements. The National Center for Assisted Living (NCAL) maintains a summary of all state regulations, updated each year. Be sure to review this when it comes time to decide about assisted living communities.
Further Reading on Assisted Living
- What to Look Out for When Touring an Assisted Living Facility
- Misconceptions about Assisted Living Communities
- Assisted Living Needs Assessment
- The ABC's of Assisted Living: Key Terms Every Caregiver Needs to Know
- Continuing Care Retirement Facilities: Understanding Services, Contracts, and More
- More on How to Pay for Assisted Living
There are many benefits to choosing assisted living such as socialization, safety, meals, transportation, and less worry for the family. While assisted living isn't the answer to every elder's needs or budget, it is an option that can contribute to a healthier, happier and longer life in the elder years.