Calling all 30,200 assisted living facilities in the U.S. the same is like calling all colleges the same. Here's what's to consider.
If you need some help with activities of daily living like cooking for yourself or getting into the shower, but don’t need the type of round-the-clock skilled nursing care a nursing home provides, an assisted living facility may be for you. “It’s ‘in-and-out’ service,” explains Mariel Schwartz, a hospice and palliative care social worker in the greater Detroit area and former assisted living facility employee. For example, a staff member may help you take your meds on time or button your blouse each morning, but he or she won’t need to hang out with you all day.
“it’s really built on this idea of maximizing independence, offering socialization and focusing on well-being while still offering a home-like environment,” says Rachel Reeves, a spokesperson for the National Center for Assisted Living, which represents about 4,000 assisted living communities nationwide.
But calling all 30,200 assisted living facilities in the U.S. the same is like calling all colleges the same: Sure, they serve the same general population and support the same general goals, but they vary widely by size, culture, specialties, cost, perks and yes, even dining. “Food is very important to assisted living communities,” Reeves says. Here are some of the differences to consider when you’re searching for an assisted living facility:
Often, the objective is simply to remain in the local area or to be close to loved ones. But where facilities are located also makes a difference in how they operate, due to the laws in that area, Reeves explains. For example, some states limit how much medical assistance the residences can offer, so if you need a significant amount in those states, you may not be the right candidate for an assisted living facility after all — or you may consider looking at another state. If you’re pretty independent, though, states with those limitations can work well for you, since the assisted living facilities in those places tend to focus more on socialization than medical care, Reeves says. Specific state data is available on NCAL’s website.
The smallest assisted living facility in the U.S. has only four licensed beds; the largest has almost 500, according to NCAL. Size matters in different ways to different people, though what may matter more is staff-to-resident ratio, says Schwartz, who points out that “adult foster care” is one emerging type of assisted living facility that generally has few residents and as many as one staff member per five or six residents. “That [ratio] is a good thing to consider,” she says, as well as the general attitude of the staff. Does working with an aging population seem to be their passion, or do they simply clock in and clock out? Size can also affect the types of services offered. Larger ones, for instance, may be more likely to offer amenities like movie theaters and swimming pools, or specialized units for memory care, Reeves explains.
While the typical assisted living facility offers dining services, housekeeping, exercise and wellness programs, and medication management support, some provide tailored services based on specific health needs. “This is based on supply and demand,” Reeves says. For instance, nearly 60 percent of communities now offer an Alzheimer’s disease or dementia program, the same percentage has a diabetes program and about half of facilities house heart and depression programs, NCAL reports.
Many facilities also invest in programs that enhance quality of life — think art and pet therapy, computer and piano lounges, and community outings. “[Ask about] what other amenities they can offer to bring more of the outside world to residents,” Schwartz suggests.
4. Transitions to Higher Care
The idea of moving from total independence to a residence with care can be daunting, for sure, so it’s natural to resist trying to consider the next move at the same time. But doing so is worth it, says Dr. Sebastian Sepulveda, an emergency medicine physician and nephrologist in Chelmsford, Massachusetts, who specializes in end-of-life care. “We graduate through different stages of life and assisted living is one of the big ones,” he says. “People should think a little bigger … and think about what’s coming. Assisted living isn’t forever.”
Specifically, some assisted living facilities are part of a larger continuing care retirement community, Reeves explains, and allow residents to move from assisted living to skilled nursing facilities if and when they need to. Others may have relationships with other health care providers they refer to once the resident’s needs exceed what the residence offers. “It’s easy to get bogged down in the here and now,” Reeves says, but it’s important to think about what you or a loved one might need in a year or two — and ask the facility how and if those needs can be met — and what they could cost .
Whether or not you can afford an assisted living facility makes or breaks whether you should consider living there. “Most assisted living residents are paying through personal finances,” Reeves says, like savings, long-term care insurance, home equity life insurance, benefits for veterans or likely some combination of resources. Folks who qualify for Medicaid, meanwhile, will have a smaller bucket of options, since assisted living is a sort of interim service that isn’t always viewed by Medicaid as a necessity. “It’s a luxury in some ways; it shouldn’t be,” Schwartz says. Still, some facilities take a handful of residents who use Medicaid and other communities are entirely residents on Medicaid.
Facilities differ in how you pay for them, too, Reeves says, whether based on an upfront cost, monthly rent, a la carte services or a tiered system. Once you narrow down your options to those facilities you can afford, evaluate them the same way you would regardless of cost, Schwartz recommends.
You can’t really know what it’s like to live in an assisted living facility until you do it. But you can get a very telling taste if you visit your potential options first. “In today’s age, it’s highly understandable that folks would like to do an internet search and find something quickly and be done,” Reeves says. “But this is also where you or a loved one is going to live for the foreseeable future — you wouldn’t buy a house [from an internet search].” She recommends visiting the facility, talking to the staff and residents, attending a meal and getting a sense of the environment. “That’s the biggest piece of advice we can give people — make sure it feels like the right environment.”