For many older adults, advancing age means they’ll face a time when living alone is no longer feasible. Certain aspects of daily living become more challenging, and if you find that you often need assistance to do things like caring for your home and yourself, it might be time to consider moving into a senior assisted living facility. But what does that mean, and what can you expect? Here, we explore the basics of what you need to know about assisted living facilities and how they can help older adults with difficult tasks while offering social contact and activities that stimulate and support.
What does assisted living mean?
Depending on the state and the individual facility, the definition of assisted living can mean different things, and it may go by other names such as residential care settings or personal care homes. By and large, the concept of assisted living is simply that: Older adults move to a facility where they can receive assistance with the daily tasks of living. Whatever the assisted living definition is in your region, these facilities can be large or small, privately owned or corporate or not-for-profit or for-profit. But they all offer some level of care or assistance to older adults who are unable to manage the tasks of living on their own, such as cooking, bathing or toileting.
An assisted living home can provide a wide array of services, says Monique Eliezer, chief officer of sales, marketing and strategies for Ingleside, the umbrella organization for three not-for-profit life plan communities in the metropolitan District of Columbia area.
For example, services at Ingleside facilities include:
— Service plans supported by licensed staff on a 24-hour basis.
— All-day dining featuring chef-prepared meals catered to residents’ preferences and dietary needs.
— Housekeeping, laundry and linen service.
— All utilities included.
— On-site, 24/7 security.
— Emergency 24/7 call system with on-site nurse response.
— Diverse social, spiritual, recreational and educational programs.
A Place for Mom, a senior care referral service based in Seattle, reports that “an assisted living residence is a long-term senior care option that provides personal care support services such as meals, medication management, bathing, dressing and transportation.” There are about 28,900 assisted living communities in the U.S., according to the American Health Care Association/National Center for Assisted Living. Those communities provide approximately 1 million licensed beds. The average size of an assisted living center is 33 licensed beds, according to AHCA/NCAL. Each state has its own regulatory agency that handles licensing of these facilities.
Perhaps not surprisingly, more assisted living communities are located in the West and the South — popular parts of the country for many retirees to move to. NCAL data show the following geographical distribution of assisted living facilities: 42% in the West, 28.1% in the South, 21.8% in the Midwest and 8.2% in the Northeast.
The National Institute on Aging reports that “assisted living residents usually live in their own apartments or rooms and share common areas.” Security is often provided at an assisted living home. Most assisted living facilities offer 24-hour supervision and security, meaning that an elderly loved one is less likely to wander off or fall without having access to immediate help.
What’s an assisted community like?
“Assisted living can relieve some of the stress around an older adult living independently,” says Dr. Tanya Gure, section chief of geriatrics and associate clinical professor in internal medicine at the Ohio State University Wexner Medical Center. Particularly for families where children live far away from their aging parents, having the option of moving a loved one into an assisted living facility can lessen the burden and worry for the family and take pressure off other caregivers.
“Assisted living is part of the continuum of senior living options and is best suited for older adults who do not require complex medical care but would benefit from the support provided in a communal living environment,” says Brian Doherty, president and CEO of the Massachusetts Assisted Living Association. “Assisted living residences are highly flexible and supportive communities that offer staff support for activities of daily living.”
Basically, assisted living is for people who can live independently but want or need assistance with some of the tasks of daily living.
On the other hand, nursing homes provide a greater level of care, from “help getting dressed to using the restroom to getting in and out of bed,” according to seniorliving.org. A nursing home setting might be best for someone who needs “frequent or daily medical care, or if your ability to get around has lessened and you feel more secure having people check in on you frequently.”
How to find an assisted living community in your region.
One common issue many people considering a move to assisted living think about is: How can I find an assisted living facility near me?
It’s important to start researching assisted living facilities in your area earlier than anticipated and not wait until a move is need-driven, Eliezer says. “When discussing with loved ones, first ask why assisted living? Have an understanding of what (assisted living) is and what it offers,” she says. “Each person is different so evaluation of their individual needs is important. Consider health, wellness, amenities, program offerings that are needed and desired by the individual. Don’t overlook future health needs (which is a benefit of moving into a life plan community with different levels of care). I recommend thinking about these future needs and including them in part of the initial conversation.”
When it comes to location, consider whether the person wants or needs to move to a different town or state. He or she may want to move to be closer to an adult child or grandchildren. “Don’t wait until the move to engage and interact with the community. It should happen during the research phase as well, even during our more virtual world,” Eliezer says. “At our communities, we offer virtual resident and staff meet and greets, where people can connect and have an opportunity to engage and learn more about us.”
What services does assisted living provide?
The services offered by individual assisted living facilities can vary greatly. Among them are activities that support health and wellness, such as:
— Group exercise classes, hobby classes and social outings.
— Dining services and meal preparation.
— Personal care services, such as assistance with bathing and dressing.
— Housekeeping and living space maintenance.
— Medication management.
— Transportation to and from medical appointments and other sites off campus.
This variability in what’s offered means then when it comes time to find an assisted living facility for yourself or a loved one, you need to do some homework to find the one that will best serve your needs.
How much does assisted living cost?
The issue of assisted living cost is a major hurdle for many families, says Roxanne Sorensen, an Aging Life Care specialist and owner of Elder Care Solutions of WNY in Rochester, New York, a case management consultancy. “Each state is different” in how it administers assisted living facilities, and cost ranges can differ significantly from region to region. In addition, depending on the level of care that’s needed and the specific services being purchased, the monthly cost of entering an assisted living facility can vary wildly, with $2,000 to $5,000 monthly being a common range.
A 2019 survey by Genworth Financial found that the median annual cost for an assisted living community in the U.S. was $48,612, up from about $45,000 annually. It can be hard to predict how long you’ll need to live in such a facility, so hopefully your retirement savings will last as long as you need.
Are there veterans’ benefits for assisted living?
If you’re a veteran, you may be eligible for a wide array of benefits through the Veterans Administration.
According to the U.S. Department of Veterans Affairs, benefits the VA provides for sick or disabled vets include:
— Around-the-clock nursing and medical care.
— Help with daily tasks, like bathing, dressing, taking meds and preparing meals.
— Comfort care with assistance managing pain.
— Support for caregivers who may need skilled help or to take a break.
Care settings can include:
— Assisted living centers.
— Nursing homes.
— Private homes where a caregiver supports a small group of individuals.
— Adult day health centers.
— Veterans’ own homes.
To be eligible for these services, you must be signed up for VA health care. You can access these services if VA officials determine you need a specific service to help you with your ongoing treatment and personal care, and if the service, or space in a care setting, is available near you. You may need to pay a copay for some covered services.
To learn how to access these services, contact your VA social worker or call the toll-free hotline at 877-222-8387. You can also visit the geriatrics section of VA.gov.
Does Medicare or Medicaid pay for assisted living?
Medicare and most private insurers don’t cover the cost of assisted living, though you may be able to find some long-term care insurance plans that will cover some of the cost of these facilities. In some cases, Medicare, which is a national, government-funded health insurance program for adults over the age of 65, might cover the cost of certain health care expenses incurred while you’re living in an assisted living facility, such as wound care administered by a registered nurse or a doctor, but it does not cover the cost of the assisted living facility itself.
Meanwhile, “Medicaid is a whole different system and is a beast in itself,” Sorensen says, but like Medicare, Medicaid does not cover the cost of assisted living. Medicaid is a joint federal and state program that provides health coverage for low-income families and other people with very limited financial resources. Medicaid typically kicks in once an older adult has spent down all of his or her resources. “When you run out of money, you have to look for facilities that accept a Medicaid benefit,” Sorensen says, but these are not going to be assisted living facilities.
Is assisted living the same as going to a nursing home?
There are many different types of long-term senior care facilities out there, and it can get confusing to sort out which is the best one for you and how they differ. One thing that’s certain, assisted living facilities are not nursing homes, which are also sometimes called skilled nursing facilities.
The National Institute on Aging reports that “assisted living is for people who need help with daily care, but not as much help as a nursing home provides.” Nursing homes are intended for patients who need round-the-clock skilled nursing care. This includes meals, medical care, 24-hour supervision and assistance with many daily activities. Many nursing homes also provide rehabilitation services such as physical or occupational therapy. Some may also provide speech therapy, which may be helpful for older adults who have suffered a stroke or other potentially speech-damaging medical events.
The Centers for Disease Control and Prevention reports that there are 15,600 nursing homes with a total of 1.7 million beds in the U.S., and as with assisted living facilities, they come in a variety of shapes, sizes and levels of care. The NIA says that while some nursing homes are intended to be short-term recovery locations, others are a permanent arrangement for older adults who need intensive long-term care because of a debilitating or deteriorating physical or mental condition.
Who is assisted living for?
Dr. Susann Varano, a geriatrician at Maplewood Senior Living, a Westport, Connecticut–based senior living residence company, says a common scenario for who should be considering assisted living is an older adult who’s still somewhat independent, but for whom things have started to change. She gives the example of a “husband and wife who’ve been married for 50 or 60 years. The wife passes on, and now the husband is a fish out of water. He never took on the role of food shopping. He went along sometimes, but he didn’t know what to buy. Cooking, shopping, cleaning, doing the laundry — all those activities of daily living were not his role,” but rather were taken care of by his now deceased wife. In this example, she says perhaps he’s 88 and “he has no interest or desire” to learn what needs to be done or the ability to do it.
In addition to not being able to keep up with household chores, this person may begin to feel very isolated. “After losing his wife of all those years, to be alone in the home is socially isolating, and he’s aware that he needs some form of outside stimulation. This is a classic case of someone who can no longer live alone,” Varano says, and this person, who in this case is still cognitively intact, should consider looking for an assisted living facility that allows him to be as independent as possible, but that takes care of those household chores he can’t or won’t do for himself.
“He can still go to doctor’s appointments, he can still visit family, however his room is cleaned, his laundry is done and his meals are prepared. Someone is always there if he wants a conversation.” This is the ideal candidate for an assisted living facility.
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Update 11/02/20: This article was previously published and has been updated with new information.