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Assisted Living Facilities: Weighing the Options

What family caregivers need to know about services, costs and finding the right place

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Assisted living facilities are designed for older people who are no longer able to manage living independently and need help with daily activities such as bathing or dressing, but don’t require the round-the-clock health care that a nursing home would provide.

“Typically, residents need a little bit of help,” says Rachel Reeves, director of communications for the National Center for Assisted Living (NCAL), an industry group. “Assisted living is there to offer that assistance, while maximizing their independence.”

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Assisted living facilities usually provide residents with their own apartments or rooms, as well as some common areas. They offer around-the-clock supervision and a range of services, including meals, housekeeping and laundry, as well as assistance with personal care and help with medications.

Assisted living also aims to offer a “rich social environment” where residents can get plenty of interaction that’s beneficial to their health and mental well-being, Reeves says. That can include social and recreational activities, such as book clubs, trips to movies and concerts, and exercise and wellness programs. 

Facilities typically offer multiple levels of care depending on what residents need and what they and their families can afford.

Assisted living facilities, which are mostly regulated at the state level, have a lot of variation among them.

To ensure that you find one that’s a good fit for your loved one, it’s important to follow a structured, methodical search process and ask a lot of questions. Carefully evaluate the facility’s contract before you sign it.

And “include your loved one, if you can, in the decision-making,” Reeves says. It’s imperative that the person who will be moving there be involved in choices about care.

Range of assisted living services

Nationwide, 28,900 assisted living facilities nationwide have nearly 1 million beds, according to the most recent data available from the National Center for Assisted Living.

They vary widely in size, from fewer than 10 residents to more than 100, with an average capacity of 33. More than half of assisted living facilities are part of national chains with the rest independently owned.

Most facilities provide some basic health care services, according to the organization.

  • Access to a pharmacy: 83.6 percent
  • Dietary and nutritional guidance: 82.8 percent
  • Physical, occupational and/or speech therapy: 71.4 percent
  • Hospice care: 67.7 percent
  • Skilled nursing care: 66.1 percent
  • Mental health services or counseling: 55 percent
  • Social worker services: 51.1 percent

Some offer specialized services for people with dementia, sometimes called memory care. A little more than 14 percent of assisted living facilities have a special memory care unit, wing or floor, and another 8.7 percent accept only dementia patients.

Some also offer services tailored for people with intellectual and developmental disabilities or particular medical conditions such as Parkinson’s disease.

How to find facilities in your area

Start by making a list of residences to visit. These resources can help you get started:

• Your local or state Area Agency on Aging can tell you if your state maintains a searchable database of assisted living facilities. Many do. Use the federal government’s Eldercare Locator online or by calling 800-677-1116 to find the nearest aging agency.

• The Yellow Pages website has assisted living facilities that you can search for in your ZIP code, city, town or state.

• LeadingAge, a nationwide association of organizations that provide aging-related services, offers an Aging Services Directory that enables you to search for nonprofit assisted living facilities in your area that are LeadingAge members.

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• Argentum, a trade association for senior living communities, provides an online directory that lets you search for assisted living facilities by typing in your ZIP code.

• Relatives, neighbors, friends or your loved one’s doctors also could offer recommendations.  

Once you’ve compiled a list of facilities, call them to get more information. AARP’s Caregiving Checklist suggests some basic questions such as these:

1. What are the size and types of units available?
2. Do any units have kitchens or kitchenettes?
3. Are all the rooms private?
4. Are bathrooms private?
5. Is special care available for residents with Alzheimer’s disease or other conditions?
6. Does each resident have a written care plan, and is the person involved in creating it?
7. Is a contract available that details fees, services and admission and discharge policies?
8. Are additional services available if a resident’s needs change?

Remember that the person you speak with will most likely be a marketing or sales representative whose job is to promote the residence.

What to look for when you visit

Once you’ve narrowed down your list to a few facilities with the services and price range you’re looking for, schedule visits to tour them and talk with administrators, staff and residents. Take your loved one with you and let them handle as much of the talking and decision-making as possible.

NCAL recommends visiting each facility multiple times. Arrange to be there during mealtimes and perhaps even have lunch with residents, to give you a better sense of what it’s like to live there.

From AARP’s checklist, here are some other things to look for:

  • Cleanliness
  • An emergency generator or alternative power source in case of an outage
  • Enough common areas, such as dens and living rooms
  • A floor plan that's logical and easy to follow
  • Large enough rooms for your family member’s needs
  • Rooms and bathrooms with handrails and call buttons
  • Safety locks on doors and windows
  • Security and fire safety systems
  • Services such as banking, a beauty salon or a café
  • Well-lit stairs and hallways with well-marked exits

The National Center for Assisted Living advises that you ask plenty of questions about staff members, including their qualifications and whether they receive additional training from the facility.

On your visits, observe how employees interact with residents. Ask about the facility’s suggestion, complaint and grievance procedures, and whether it has resident and family councils to provide feedback.

Before signing a contract

Look carefully at the facility’s contract. Take it home with you and go over it with other family members.

Consider having a financial adviser and a lawyer review it. The National Academy of Elder Law Attorneys has a searchable, national database of practitioners.

Make sure you clearly understand the terms, and if you have questions, get them answered before you sign. From AARP’s checklist, some key questions:

• How much are entrance fees and monthly rent, and is a security deposit required?

• What level of personal and health care services are provided?

• What privileges do residents have? For example, are they permitted to bring personal furniture?

• What are the transfer and discharge policies? What specific reasons would lead to a resident being asked to move out, and how much notice would be given?

• Is a resident’s space held if he or she has to be hospitalized?

• Does the contract put any limitations on your right to bring legal action for injury, negligence or other causes? Consumer Reports cautions that many residences include arbitration clauses, which require disputes to be settled outside the legal system via a third party.

Do a background check

Your state’s regulations for assisted living facilities are on the National Center for Assisted Living’s website. The list also contains contact information for each state's regulators, who can guide you on how to find information about a facility.

If your state requires a license for an assisted living facility, make sure it has one. Ask to review the most recent licensing report.

Licensing agencies may have online facility-complaint databases.

Paying for assisted living

Assisted living can be expensive: Insurance company Genworth, which tracks long-term care costs, reports a median monthly rent of $4,300 for assisted living units. Most people pay some or all of that cost out of pocket.

In weighing this housing option, consider carefully whether you and your loved one can afford it long term. A facility’s rates likely will rise over time (although price growth has slowed during the COVID-19 pandemic as occupancy rates have declined, according to real estate services firm CBRE), and changes in your loved one’s condition might require care and services that cost extra.

Some financing options to keep in mind:

Long-term care insurance. If you have a policy, it probably covers assisted living, but Medicare and most private health insurance plans do not.

• Medicaid. The federal/state health care program for people with low incomes and limited assets, may provide some help if you’ve exhausted other financial resources.

Most states offer some level of financial aid to qualified assisted living residents. Contact your state’s Medicaid agency or Area Agency on Aging to learn more.

• The Department of Veterans Affairs (VA). Former service members may be able to get federal help. The Aid and Attendance benefit, a supplement to VA pensions for older veterans who need help with daily living activities, can help pay for assisted living.

Comparing the cost

The median annual cost of assisted living vs. other types of long-term care:

  • Nursing home, private room: $105,852
  • Nursing home, semi-private room: $93,072
  • Assisted living: $51,600
  • Home health aide, full time: $54,912
  • Adult day care: $19,236

VA health care does not pay for room and board at an assisted living facility but might cover some additional services. Contact the VA pension management center that serves your state or your regional VA office for details.

Editor's note: This article, originally published in 2010, has been updated with more recent information.

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