What Is Assisted Living?
Assisted Living Facilities (ALFs) vs. Nursing Homes
Assisted living facilities (ALFs) are sometimes confused with nursing homes, another long-term residential care option for seniors. But, the two differ in a few key ways. First and foremost, nursing homes provide a higher level of medical care than what one will find in an ALF. Nursing homes are intended for those with a serious medical condition that requires around-the-clock care, or those who need that type of care in the short term as they recover from an illness, injury, or surgery. Assisted living facilities provide supportive services and assistance from trained staff, but the goal is to help residents remain as independent as they wish while ensuring they have the assistance they need. Assisted living is a form of senior care that provides residents with supportive services and assistance with the activities of daily living (ADLs). ADLs include things like bathing, eating, hygiene, and dressing. Assisted living services may also include basic first-aid and assistance with medication management. It does not include regular medical care, rehabilitation services, or skilled nursing care. Assisted living communities typically offer both semi-private and private rooms, a robust activity schedule and social opportunities for residents, and will have communal areas for residents to enjoy such as a fitness center, lounge, courtyard, or pool.
Additionally, while nursing homes are a clinical setting, ALFs are a more social community setting. Thus, the primary focus of nursing homes is resident health, while ALFs are intended to support relatively active and independent seniors.
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Types of Care , Services and Amenities Provided in Assisted Living Facilities
Assisted living facilities provide care to ensure that residents remain healthy and safe while enabling them to retain as much independence as they would like. This care may include:
- Assistance with ADLs such as grooming, bathing, dressing, and eating
- Medication management or assistance with self-administered medications
- Basic first-aid
Assisted living facilities do not provide regular, high-level medical care and are not the appropriate setting for a senior who needs around-the-clock care. Most facilities do offer around-the-clock emergency assistance, however. ALFs may also have visiting physicians or nurses regularly come to the facility to provide medical services for residents, but this is not guaranteed and will vary from facility to facility.
Other Assisted Living Services
In addition to the care described above, most ALFs also provide the following services:
- Meal preparation
- Laundry and linen services
- Interior and exterior maintenance
Common Assisted Living Facility Amenities
Assisted living facilities are designed to be social communities, so most offer extra amenities that promote social interaction and enhance residents’ quality of life. Some common amenities you may find in an ALF include:
- Indoor or outdoor pool
- Fitness center
- Courtyard and/or garden area
- Walking paths
- Coffee shop, bistro, and/or cafe
- Private dining room for special events
- Concierge services (package drop-off and pick-up, dry cleaning, etc.)
- Religious groups and services
- Beauty salon, barbershop, and/or spa
- Guest suite and guest parking
Who Should Consider Assisted Living?
Seniors who need some daily assistance, but have no major medical conditions
Assisted living is ideal for seniors who need some help with their day-to-day tasks, but do not have any major medical needs and would like to retain some of their independence. ALFs are structured so that residents can get the assistance that they need with ADLs, but can still live as independently as their capacities allow. Because seniors have the ability to continue to live independently if they wish, ALFs may be an appealing option for seniors who have been resistant to moving to a long-term care facility in the past.
Seniors who live alone and would like a community of other older adults
Seniors who live alone in their own homes may feel isolated or lonely. Moving to an ALF provides a built-in community of others in the same life stage, plus the security of assistance and support from staff. Those who are looking for a community feeling should choose an ALF with a lively activity schedule and try to visit communities in-person to gauge how frequently residents socialize and participate in community events.
Seniors who are ready for a stress-free lifestyle
Assisted living facilities provide peace of mind that help is just a call away when daily tasks become too difficult to manage independently. Additionally, most offer housekeeping and linen services for residents’ apartments, interior and exterior building maintenance, and, in some cases, extras like valet parking. These services may come at an extra fee at some facilities, so be sure to ask about all costs and fees before signing on with any community.
Seniors interested in living in a community with luxurious amenities
While the amenities offered at ALFs will vary, some are designed to feel more like a hotel than a residential care facility. This type of ALF may have pools, a full-service spa, boutique fitness classes, chef-prepared meals, and more.
Seniors who don’t need as much care may fit better in senior apartments or an independent living community
While ALFs do allow residents to live independently until they need care, some active seniors may prefer to live in an environment where everyone else is completely independent, too. Senior apartments or independent living communities may be a better fit for a senior who truly does not yet need assistance with any of their daily activities. These communities are designed with seniors and accessibility in mind, but there is no type of assistance provided. Independent living communities may have scheduled activities and outings, but senior apartments typically do not offer any type of services.
Seniors who need consistent help with ADLs but desire a home-like setting may find care homes to be a better fit
Many people enjoy the large community environment of ALFs, but it is certainly not for everyone. Those who prefer a home-like setting should consider a residential care home. Like ALFs, care homes provide assistance with ADLs and may provide meal preparation, housekeeping, and other assistive services. But, they are much smaller, typically with less than 10 residents in a home. This makes care homes feel more like a “regular” home versus a complex setting and may be preferable for those who get overwhelmed in large groups or who want a more personal experience.
Seniors with dementia or Alzheimer’s should consider a memory care community
Adults living with Alzheimer’s or another form of dementia have specific needs for their health and safety that may go beyond what an ALF can provide. However, some assisted living communities do have special memory care units. These units should have higher security measures than the rest of the community to prevent wandering, and the care team should have more specialized training in working with those with memory impairment. Some seniors and their families may also prefer a dedicated memory care facility.
Seniors who need around-the-clock skilled nursing are best served in a nursing home
While ALFs do provide 24-hour emergency assistance, the communities and their staff are not equipped to provide around-the-clock medical care. Seniors with those needs would be best served in a nursing home where the focus is on resident health and more experienced medical personnel are always present on-site. Seniors in this position may also consider home health care with a trained aide.
Seniors who feel anxious about their potential future needs may prefer a CCRC
Continuing care retirement communities (CCRCs) offer a continuum of care from independent living to assisted living, memory care, and/or skilled nursing care. By offering all of these types of care in the same community, seniors can essentially “age in place” in their chosen community as their needs change over time. CCRCs are an appealing option for those who worry that they may develop the need for a higher level of care in the future and are concerned about the process of moving to a new community in old age. Some CCRCs also offer financial protection against prohibitive long-term care costs for things like memory care and skilled nursing care.
The Cost of Assisted Living
According to Genworth Financial’s 2019 Cost of Care Survey, the average monthly cost of assisted living in the United States is $4,051. However, depending on your location and the type of facility you choose, you may face significantly higher or lower costs. Some communities include meals, care, and extra services like housekeeping in their monthly cost, while others charge a lower monthly rate but have extra fees for any service or amenity that goes beyond that community’s “baseline” rate. Additionally, some communities are simply more expensive because they provide residents a more “luxurious” living experience, with recently renovated apartments, perhaps, or state-of-the-art amenities. When selecting an ALF, be sure to ask exactly what is included in the monthly rate and what will cost extra.
Assisted living costs typically rise and fall in accordance with an area’s cost of living. The cost of assisted living in an area with a high cost of living is likely to much higher than in a less expensive area. For example, the average cost of assisted living in California is $4,500 per month. This is higher than the national average, but is expected, as California has one of the highest costs of living in the U.S. Meanwhile, in North Dakota, the state average is $3,405 per month.
Even within states, the cost can vary drastically. In the San Francisco area, one of the most expensive places in the country, the average cost of assisted living is $4,750 per month. However, in less expensive cities the cost is significantly lower. For example, in Bakersfield, California, the average monthly cost for assisted living is $3,650.
Paying for Assisted Living
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 private insurance policy. Similar to health insurance policies, the price varies greatly depending on the age of the policyholder, general health of the policyholder, and amount of coverage. Coverage could be denied for people with pre-existing conditions such as Alzheimer's disease or Parkinson's disease, or for people above a certain age. Not all insurance will deny based on these conditions, so it is important to explore different insurance companies. You can learn more about long-term care insurance by visiting https://longtermcare.acl.gov/.
Medicaid is a combined federal and state health insurance program for those with low income and limited assets. Administration of the program is overseen by the Centers for Medicare and Medicaid Services (CMS), but policies vary from state-to-state. Medicaid does not directly cover the cost of living in a long-term care facility like an ALF but may pay for services used in conjunction with the facility’s care such as visits from a home health aide. This is typically through Medicaid waiver programs, which are provisions that allow states to cover additional services, such as long-term care, that aren’t covered under federal Medicaid guidelines. An example of a common waiver that can help cover the costs of assisted living services is the Home and Community-Based Services Waiver. Medicaid has strict eligibility requirements, and eligibility requirements for specific waiver programs may be even more stringent.
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 ALF. Medicare Supplement Insurance or Medicare Advantage plans may, in some cases, cover the cost of long-term care other than just skilled nursing. If you’re hoping to find coverage for assisted living-related expenses with one of those two options, be sure to check the specifics of your plan, as they do vary.
Aid and Attendance Benefit for Veterans
According to the VA website, the Aid and Attendance (A&A) benefit may be accessed by 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. You can learn more about the eligibility requirements and how to apply for these benefits at VeteransAid.org.
Some life insurance policies may provide options that can help pay for assisted living. Depending on your specific policy and situation, using life insurance to pay for long-term care may or may not be a good idea. It's best to discuss your options with an insurance broker or financial advisor before making any decisions. The following options are some of the ways in which life insurance may be used to pay for an ALF:
- 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, this type of reverse mortgage 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.
Evaluating Assisted Living Facilities
All seniors and their loved ones will have different preferences when it comes to finding the “right” assisted living facility. But, the following general points can be indicative of a high-quality, safe, enjoyable community, and should be considered when selecting an assisted living facility for yourself or a loved one.
Activities and Socialization
One of the reasons that many seniors choose to live in an ALF is the opportunity to socialize with other residents of the community. If this is something that’s important to you or your loved one, be on the lookout for a facility with an active community and regularly updated calendar of activities. If you have the opportunity to visit the community in-person, pay special attention to whether residents seem to be congregating and participating in activities, or keeping more to themselves. This observation may help you decide if a community is the right fit.
Even more important than the social culture of an ALF is the safety of the residents. The security measures of each facility vary- some employ 24-hour security staff while some use automatically-locking doors or surveillance cameras, or all of the above. For the safety of residents, many have a community-wide emergency response system. You and your family will know what security features you need to feel comfortable, but it is not to be overlooked.
If you’re specifically looking at a memory care unit within an ALF, be sure that the area has special safety measures in place to prevent wandering.
A facility should be able to tell you up-front how much you can expect to pay, what is included in the monthly cost, and any extra fees you may face. Aside from the financial elements, all staff should be able to provide you with information about resident life and the care they provide. To ensure that a facility is being completely transparent, ask to view the following documents:
- 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
In addition to helping ensure that a facility is transparent, viewing these documents can help you compare the details of what one facility offers versus another. Most importantly, 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.
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. The checklist covers everything from safety to resident rights to fees.
Assisted Living Regulations
Assisted living communities are not regulated nationally like nursing homes. Rather, each state has its own laws, regulations, and licensing standards. Though the details vary, there are certain rules and regulations that essentially all states have in place. These regulations include:
- Staff Training: Almost all states require that staff undergo some sort of training- in some states, as many as 25 hours of training are required for the caregiving staff while other states may have no training requirements (though facilities may take it upon themselves to provide staff training).
- Staffing Requirements: Many states require that at least one staff member remain on-site around-the-clock. Some states may have more specific requirements, such as that the on-duty staff member must have CPR training or have other medical credentials. Additionally, some states maintain minimum staff-to-resident ratios.
- Admissions Requirements: Assisted living facilities are not equipped to provide care for all seniors, specifically those with certain medical conditions that require care beyond the facility’s scope. States typically dictate who can and cannot be admitted to an ALF.
- Scope of Care: States can dictate the type and level of care ALFs may provide to residents. For example, a state may allow ALF staff to assist residents with opening bottles of medications or adhering to a medication schedule, but not physically assist with medication administration. In general, all ALFs will be permitted to provide assistance with activities of daily living and serve meals to residents. Beyond that, the scope of care of ALFs varies between different states.
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.
Assisted Living FAQs
What is the difference between an assisted living community and a continuing care retirement community (CCRC)?
Assisted living facilities are specialized communities intended for seniors whose primary need is assistance with the activities of daily living. While seniors in ALFs can live as independently as they please, the communities are designed for seniors with more advanced needs. CCRCs, on the other hand, provide a continuum of care and are intended for seniors who anticipate their needs changing over time. Most CCRCs offer the full spectrum of independent living, assisted living, memory care, and skilled nursing care. Seniors would likely find the same services, care, and amenities in the assisted living section of a CCRC as they would in a dedicated assisted living community.
Learn more about Continuing Care Retirement Communities.
What are the top things to look for when touring an assisted living facility?
The best way to determine if an ALF will be the right fit for yourself or a loved one is to visit the community in person. It provides an opportunity to pick up on things that wouldn’t be apparent on paper, such as whether or not residents are socializing, if the staff is attentive to resident needs, and if the community’s grounds and common areas are kept clean and tidy.
Learn more about what to look for when touring an assisted living facility.
Will moving to an assisted living facility take away my independence and privacy?
Assisted living facilities provide residents with as much- or as little- assistance as they need. If you are able to complete any, or all, of your ADLs independently and safely, you are free to do so. ALF staff is there to support residents when they need it so that they can retain independence in other aspects of their lives as much as possible.
Learn more about common misconceptions about assisted living facilities.
What is an assisted living needs assessment?
A needs assessment is an evaluation that all residents will undergo upon first moving into an assisted living facility. It is designed to test the senior’s physical and cognitive health to determine the best care plan to meet their needs while living in the community. Additional documentation and records from one’s physician are always useful, but will not replace the needs assessment.
Learn more about the assisted living needs assessment and its importance.
What should caregivers do to prepare for a loved one’s move to an assisted living facility?
Transitioning from one’s home to a residential care facility can be an emotional experience for both a senior and their loved ones. Because ALFs employ a team of caregivers, family members will no longer be responsible for the bulk of their loved one’s care. But, caregivers and family members may be responsible for packing up their loved one’s things and coordinating the move. Additionally, they can provide emotional support and work with the ALF to make sure that their loved one’s needs are being met.
It’s also useful for caregivers and family members to familiarize themselves with common assisted living terms so they can best navigate their loved one’s care. Learn more about the key terms every caregiver should know.
Are there any financial assistance options for paying for assisted living?
Assisted living costs an average of $4,051 per month in the United States, which is out of reach for many seniors. Financial assistance options, such as Medicaid waiver programs, VA benefits, and long-term care insurance are available. The assistance programs available to you- as well as the cost of assisted living- will vary depending on your location.
Learn more about how to pay for assisted living.
Top Articles on 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.
Gracefully Greying contributor -Senioradvice.com