People who turned 65 in 2020 have a 70% chance of needing long-term care in their remaining years, according to the Administration of Community Living. For many, that will mean home health care. For others, moving to an assisted living facility may be the best option.
If you or a loved one are considering moving to an assisted living community, you may be wondering what levels of care they offer and who each level is designed to support.
Here, we break down the common levels of care in assisted living communities to help you determine how best to take advantage of the benefits assisted living can offer older adults.
What Are Levels of Care in Assisted Living Communities?
Assisted living communities are dedicated to supporting and caring for older adults with varying needs. They typically help with medication management, bathing, dressing, toileting and emergency assistance. They also generally keep an eye on your loved one, making sure they’re eating well and engaging with other residents.
“When home care is no longer an option, assisted living can be a godsend,” says Dr. Elizabeth Landsverk, a geriatrician based in the San Francisco area. She offers an online telemedicine, education and support resource for eldercare professionals, caregivers and families.
[READ: Having the Conversation With a Loved One About Senior Living.]
Levels of Care in Assisted Living
No two communities are exactly alike, but most tier their care along three, four or five levels.
Level 1: No assistance
This lowest level is for seniors who don’t need ongoing assistance. At this level, they effectively live independently
and manage their own affairs, but they have access to assistance and support if they need it. For example, this resident may benefit from reminders to take their medications as directed. Or, when a resident needs assistance with a complicated task — like programming a new smartphone or setting up a new television — staff can lend a hand.
This resident is active — they may still be working or volunteering and are usually able to drive off campus as they wish. Their decision to join the community is often driven by a desire for social contact and access to age-appropriate activities or to alleviate the demands of maintenance or upkeep of a home. Access to communal meals and dining options can also free up the resident to pursue other interests and reduce the burden of managing dietary needs, grocery shopping and meal preparation.
Level 2: Low or minimal assistance
Adults residing in this level of assisted living are still largely mobile and don’t require ongoing supervision, but they typically need support with one of the activities of daily living, such as bathing or dressing. This resident may also benefit from more contact with staff and other residents. For example, if they recently lost a spouse, more frequent check-ins may prevent a slide into depression, which often leads to more intensive care needs.
In addition, residents at this level typically show some signs of difficulty with some of the more complex tasks of daily living. For example, this resident may have lost some of their dexterity due to arthritis and need help opening pill bottles or buttoning a shirt. Many also benefit from reminders about meal times, when to take medications and how best to manage personal hygiene.
Level 3: Moderate assistance
Residents who’ve progressed to this level of care typically retain some mobility and independence but likely need assistance or supervision with most or all activities of daily living. For example, a resident at this level might be able to dress on their own but need staff to help them with bathing.
Residents in the moderate assistance tier typically aren’t able to manage meal preparation or medication management, but they can still benefit greatly from social interaction and activities with staff and other residents.
Level 4: Full assistance
What is the highest level of care in assisted living? In many facilities, it’s Level 4. At this level, residents need near-constant support and assistance with most if not all activities of daily living, including dressing, toileting and personal hygiene. They may not be mobile and often require intensive hands-on support to eat, bathe, dress and perform other daily tasks.
Activities and social interaction are also important for keeping this individual mentally engaged. At this level, the care resembles services rendered in a nursing home but is less medical and more focused on helping the resident do what they still can for themselves, whether that’s eating with a fork, brushing their hair or participating in group craft project according to their ability.
Level 5: Memory care
Communities that offer memory care often list it as a separate level because of its specialized nature. In facilities that offer memory care, the Level 5 resident is a patient with dementia or other cognitive impairment who is unable to care for themselves. At this level, residents get ongoing support and supervision based on their needs. Care typically covers all the activities of daily living with staff who have been specially trained in techniques to assist people with dementia and other cognitive impairments.
“Dedicated memory care ‘neighborhoods’ are generally equipped to care for a senior through end-stage Alzheimer’s and dementia with the various behaviors associated with those diseases,” explains Haidy Andrawes, center administrator at Park Vista Assisted Living in Fullerton, California.
Communities that cater to memory care patients may break down their levels of care even further, with categories for Alzheimer’s disease, dementia, Parkinson’s disease and other conditions that lead to cognitive decline. Since these conditions are progressive, patients in earlier stages typically need less hands-on support than people with advanced dementia.
[READ: Who Qualifies for Assisted Living: Eligibility Requirements]
What Is Enhanced Assisted Living Care?
Some assisted living communities offer an additional tier of care that’s sometimes called enhanced assisted living care. This type of personalized care features medical support, such as nurses or a doctor checking in regularly, and is aimed at supporting residents with complex medical needs.
This care is similar to but still less intensive than what’s typically found in a nursing home. It may also share some similarities with memory care, as people with dementia, Alzheimer’s, Parkinson’s disease and other progressive, chronic conditions can benefit from more intensive medical intervention.
A key difference between enhanced assisted living care and more conventional assisted living is the staff-to-patient ratio. Residents in an enhanced assisted living situation will have more contact with staff, and those workers typically have some additional training to better manage medically complex residents.
[READ What Are the Levels of Senior Living?]
How Do Assisted Living Communities Make Care Assessments?
Assisted living communities typically use a formal evaluation process to determine the appropriate level of care for a prospective resident. These assessments may consider a wide range of factors, such as:
— Whether the senior has any medical conditions or chronic diseases that require daily intervention
— Whether the senior is experiencing any loss of cognitive function
— How well the senior is able to communicate needs and preferences
— Whether the senior is able to perform any or all of the activities of daily living without assistance
— How involved family members plan to be while the senior is in assisted living
These assessments are made in several ways, including:
— Observation of the senior and how they engage with others and perform tasks
— Reports from any caregivers (family or a home health aide, for example) who have been involved in the senior’s care previously
— The senior’s doctors or other health care providers
— A physical exam that checks mobility and fine motor skills
— Questioning and evaluation for mental health challenges or loss of memory or reasoning ability
Once staff at the assisted living facility have evaluated the senior, they can draw up a personalized care plan that caters to their specific needs.
You can also bring in a geriatric care manager to aid in the assessment process, says Jenny Munro, a gerontologist with Home Instead, an Honor Company headquartered in Omaha, Nebraska.
Geriatric care managers have varied educational and professional backgrounds with a specialized focus on issues associated with aging, Munro adds. Through consultation, assessments, care coordination and advocacy, these senior care professionals can help develop the right approach for your loved one.
How Levels of Care Affect Cost
Generally speaking, the more care you need, the more it will cost. But there is broad variation in pricing depending on the type of facility, location and which services are used.
Genworth Financial’s 2023 Cost of Care Survey found the median cost of assisted living in the U.S. to be $5,350 per month. Dementia Care Central reports that specialized memory care adds about $1,200 per month on top of that, totaling roughly $6,550.
National Investment Center for Seniors Housing and Care reported in December 2023 that assisted living totals about $6,000 monthly or more than $72,000 annually, while care in a memory care unit clocks in at nearly $7,900 per month or almost $95,000 per year. But these are just averages, and your costs could be higher if you’re in a more expensive geographic location, such as New York City, or if you need more hands-on support.
Explore Top-Rated Assisted Living Facilities with U.S. News
To aid you in your search to find the best assisted living facility near you, visit U.S. News’ top-rated assisted living communities. Nearly 400,000 survey responses from residents and their family members evaluating over 3,500 senior living communities highlight communities that have excelled in delivering high-quality services and ensuring residents feel safe and well cared for at just the right levels.
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Assisted Living Categories and Levels, Explained originally appeared on usnews.com
