Levels of Care and Costs in Assisted Living

For most people, as we age, we start to need a little extra help with everyday tasks. Typically, the human body slows down, gets creaky and often, health issues crop up in the latter years of life. Eventually, some people may need ongoing assistance, and that’s where assisted living communities come in.

This long-term care option can be a huge benefit to seniors who need some help with the activities of daily living but who don’t need as much medical care as you’d find in a nursing home.

These activities include:

— Personal hygiene including bathing, grooming and dressing.

— Eating.

— Toileting.

— Moving and getting around.

— Shopping and meal prep.

— Housework.

— Life and household management.

But living in an assisted living community isn’t just about having help with these activities. “It’s also about belonging to a community of your papers and being able to have some camaraderie,” says Han Hwang, executive vice president of partner sales and success for Caring.com, an online resource for people seeking information and support in caring for aging parents, spouses and other loved ones.

Assisted living communities provide important social contact that helps alleviate loneliness, which is “one of the biggest challenges for seniors,” Hwang adds.

[READ: What Activities Are Best for Seniors in Assisted Living or a Nursing Home?]

How Assisted Living Communities Charge for Services

Assisted living communities cost money, and they aren’t necessarily cheap. It varies greatly from one place to another, but according to a 2019 survey conducted by Genworth Financial, the median yearly cost for an assisted living community is $48,612, up from $28,800 in 2004.

If you’re considering moving into an assisted living community, it’s important to think about finances and how you’ll pay for that care in your golden years, especially as your health needs change over time. Part of this means understanding how these facilities charge for their services.

There are two primary ways in which assisted living facilities structure fees:

All-inclusive. An all-inclusive price gives residents one monthly payment to cover everything, from the room itself and food, to utilities, activities, transportation and in some cases, health services. “People who have a lot of needs may want to choose the all-inclusive option,” Hwang says, because everything is covered under one monthly bill and you’re not adding services as you go and having to think about every dime you spend.

Ala carte. With ala carte pricing, residents select only the services they want and pay for those as individual line items. In some cases, you can add or remove services month to month depending on the contract at the community. “For folks with fewer needs, ala carte might be the better option,” Hwang says, because you can pick and choose only what you need and you’re not paying for any services you’re not using.

With assisted living, a large chunk of what you’re paying is covering the rent on the unit where you’re living and the food you’re eating. Because fewer medical services are provided than at a typical rehab or nursing facility, medical costs may cost extra, depending on how the individual community structures its fees and service contracts.

The available services vary greatly from one community to another. Some facilities offer a lot of medical support on site, while others have only very basic services. Some also offer memory care and escalating levels of health care, but not all do.

Costs similarly range widely from community to community. “The cost really depends upon your level of care. If you need high levels of care and more attention, some assisted living communities can provide that, but it usually becomes more expensive when you need more care,” Hwang explains.

[READ: 5 Signs It’s Time for Memory Care.]

Levels of Care

Across the U.S., the average monthly cost of assisted living runs roughly $4,000, Hwang says. This varies greatly by location, with some regions of the country being significantly less expensive than others. But which level of care you need can also alter how much it costs to move into an assisted living facility.

Most assisted living facilities classify residents by the levels of care they need. Levels of care are not dictated by any overseeing body, and each assisted living facility has its own definition of care levels and what’s on offer.

Each facility has its own approach for matching residents with the ideal level of care for individual needs, which makes it difficult to generalize across such a widely variable industry.

The following three categories are typical:

1. Lower levels of care.

Lower levels of care are for residents who need less assistance. These residents can walk on their own or with a cane or a wheelchair to get to the dining room or activity sessions. Lower care level residents also have no memory loss and can advocate for themselves. They might need assistance with certain tasks, for example buttoning buttons or tying shoes when getting dressed in the morning because arthritis in the fingers makes these dexterous movements challenging. But they can usually manage their own hygiene, grooming and toileting.

A nursing aide or other caretaker likely assists to make sure they’re taking the right medications at the right time and monitoring any medical conditions. This level of care is less intensive for caregivers, and the resident may pay less for this type of assistance than those who need more support.

2. Higher levels of care.

Seniors who need higher levels of care in assisted living need more help. They usually need hands-on assistance when getting around, and need an arm to guide them or an aide to push their wheelchair. They also usually need more one-on-one assistance in bathing, grooming, toileting and getting dressed.

They may have some memory loss or need more guidance from caregivers. Decision-making may be more difficult for them, so often a caregiver will help them manage complex tasks and help them take medications and see to other health needs. Residents at this level may have more complex medical needs and may be at higher risk of falling or other safety concerns. This type of care requires more intensive one-on-one assistance, sometimes from caregivers who have a higher level of training, and as such this level of care tends to be more expensive.

3. Memory care.

Some assisted living communities also include a memory care wing or floor where people who have Alzheimer’s disease or dementia can get the focused support and assistance they need. Staff typically have a higher level of training in the specific needs of residents with memory problems, as residents in memory care need more support. Memory care tends to be more expensive than the two preceding levels.

As you need more care, you should expect your costs to increase too. And these expenses can add up over time. Hwang says you could be adding $250 to $1,500 a month on top of the base living fee, depending on the care you need.

[READ: Assisted Living Versus Senior Home Care.]

How Care Is Billed

Exactly how much a service costs and how it’s billed to the resident “really depends on the operator and what their decision making is,” Hwang says. Many operators are “for-profit companies, and they need to make a profit. Like any business, each one has a different pricing strategy.”

Personal care services such as those offered in an assisted living facility are usually a labor-based cost, rather than materials or equipment driven, so the hourly wage of the caregiver plus any profit margin are typically used to calculate a service fee.

For the consumer, “I think it’s really important to know exactly what you’re getting, and do an apples to apples comparison” when choosing the right assisted living community, Hwang says. For example, if you’re considering a community that charges $4,000 per month but then offers add-on services ala carte, you might end up spending more like $6,000 per month for what you need. How does that then compare to the $6,100 per month facility up the street that’s using an all-inclusive model?

Bottom line: Make sure it’s clear up front what to expect in terms of fees and costs, and Hwang says you should “anticipate what services you’ll need over the next 12 to 24 months” to help develop a budget.

When You Need More Care

When a senior needs more support than an assisted living facility can provide, they will likely need to move into a skilled nursing facility or nursing home.

A key point of note, Hwang says, is that assisted living and nursing homes are not the same thing, and that’s not always completely understood. “Assisted living is really focused on activities of daily living, primarily non-medical related.” For medical needs, you should be looking to a nursing home.

If and when you do need that additional level of care, you should know in advance the policies of the assisted living center and how and when you can leave, says Amie Clark, co-founder and senior editor of TheSeniorList, a Clackamas, Oregon–based website that connects seniors and caregivers with resources, products and services. “Before signing a contract, make sure you ask about any additional deposits/fees or move-in/move-out costs. Also, make sure you understand your obligations in the event of needing to move out.”

Some communities require that residents give notice, and how much time varies from place to place. “In the event of a hospitalization or rehab stay, what are your options for payment while no one is residing in the apartment?” she asks. Understanding these important issues can help you determine how much it will cost for you to get the care you need in an assisted living community, especially as your health needs evolve.

No matter which assisted living facility you end up selecting, Clark says it’s wise to look for one that has “graduated care services, as care needs do change over time.” The more services and options are available, the longer you can expect to live comfortably there before having to make the next move.

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Levels of Care and Costs in Assisted Living originally appeared on usnews.com

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