Assisted Living: Weighing the Options

Source: AARP.org | February 1, 2004

As people get older and less able to live on their own, other living arrangements must be considered. Assisted living is one choice. It helps residents be as independent as possible while giving assistance when needed. The facilities usually include a room or small apartment and meals, along with personal care and support services, social activities, and 24-hour supervision. Some facilities offer health-related services, too.

Assisted living homes are very different from one another in size, appearance, and the types of services they offer. Some provide only meals, basic housekeeping, and help with activities of daily living (ADLs) such as bathing, dressing and grooming. Others also arrange transportation and certain health services. Costs vary greatly, and the monthly fee varies depending on the services provided.

The facility could be a small home with just a few people or a high-rise apartment-style building with as many as 200 or more residents. Living areas could be a single room or a full apartment with a small kitchen, with prepared meals also served in a common dining area.

This arrangement is good for people who can't live on their own but who don't need a nursing home. Older people have many different needs. Those needs often change over time, so assisted living offers different levels of care at different costs. Residents who live in an assisted living facility that is associated with a nursing home may be able to get additional services if they need them later.

If an assisted living facility sounds like the right choice, a personal visit is important before you make a final decision.

Compare Facilities

Start with making a list of several facilities in the area. It's your best chance to see what different places are like, to compare them and ask questions of the staff and residents.

Each state separately decides how to license and oversee its assisted living facilities. Ask your local Area Agency on Aging (AAA) or state health department about your state's rules. Don't consider any facility that isn't appropriately licensed. If one of them isn't, cross it off your list.

The state licensing agency and ombudsman's office can tell you if there have been any complaints filed against any of the facilities on your list. After all, having a state license doesn't assure quality care.

Call

Once you have your list of facilities, call each one. What's important to you in a new home? Location? Size? Types of services? Remember that the person you speak with will most likely be a marketing or sales person whose job it is to sell you a contract for that place.

If you are still interested after asking all your questions, ask them to send your more information. Ask for brochures a price list, a map or floor plan, a list of their residents' rights and rules, and copies of all the documents that need to be signed before moving into the facility. Most importantly, ask them to mail you the contract. Some facilities may call their contract a residency, occupancy or admission agreement. Once you receive the materials, read them carefully. Write down questions that come to mind so you won't forget them later. Only now are you ready to visit.

The Visit

Take the list of questions you wrote as you read the materials. You'll want to ask the staff about them during your visit. Take the AARP checklist with you. As you meet with staff and take a tour, pay attention to how you feel and what is going on around you. Spend time with the staff and residents. Ask them what they like and don't like about where they're living. Try to make more than one visit. An unscheduled visit on a weekend or in the evening might be very helpful in making your decision.

The Contract

Of all the materials you have collected and all the questions you have asked, the contract is the most important part. The contract is the legal document that states what arrangements you and the facility have agreed to. It doesn't matter what else was promised in conversations, brochures and other sales pitches. Only the contract matters. The more specific the contract, the greater your legal protection will be regarding promised services. A few tips:

• Compare information in the sales brochure with what is in the contract. Pay close attention to the fees, level of care, health care services and discharge policies. Services that a facility promotes in a brochure should also be described in the contract.
  
• Make sure you understand what the contract is saying. Have them add any information about care, rights, costs and services that is not there. Remember that facility can promise anything in a brochure, but is only bound legally by what is the signed contract.
  
• A good facility would want a possible resident to review the contract in advance.
  
• Never sign a contract the day you visit. Before making a decision about a facility, take the contract home and review it with family members. Consider reviewing it with a financial advisor and lawyer.

Weighing the Cost

Assisted living can be costly. Most people pay for it out of their own pockets. Medicare dos not cover assisted living, and while more states are beginning to cover some services under Medicaid or other government programs, public payment is not common... State Medicaid agencies can provide information about eligibility and covered services. Before seriously considering assisted living as an option, decide if the monthly cost is affordable over along time. Keep in mind that the monthly cost will most likely increase over time due to cost-of-living increases. There could also be monthly increases for extra services if a resident's needs change.

Brochures might only discuss fees in a general way, so it is important that a contract spell out in detail all of the costs and expected payment methods.

AARP Resources

Navigating Your Way to an Assisted Living Facility
An easy-to-take, free one-hour online seminar from AARP.

My Parents - How Do I Know if They Need Help?
Questions to ask to help you determine if your parent needs extra help.

Selecting Senior Housing
Eight practical suggestions to ease the transition.

Additional Resources

Assisted Living Federation of America (ALFA)
State-specific list of its member facilities, mostly for-profit facilities. The list does not include all facilities in each state.

American Association of Homes and Services for the Aging (AAHSA)
State-specific list of non-profit facilities that are members of AAHSA.

Books

Find these books online at Barnes & Noble.com

" Consumer Reports Complete Guide to Health Services for Seniors: What Your Family Needs to Know about Finding and Financing Medicare, Assisted Living, Nursing Home, Adult Day Care with Ratings of Medic Hmo's and Supplemental Policies," Trudy Lieberman, Consumer Reports Books Editors, 2000

" Choose the Right Long-Term Care: Home Care, Assisted Living, and Nursing Homes," Joseph L. Matthews, J. L. Matthews, 2002