Assisted living facilities, also known as residential care facilities, provide seniors and non-seniors that need additional support with non-medical care and supervision; they are suited for individuals who need assistance with daily activities but are able to maintain some level of independence. An assisted living facility may look and feel like apartment living, but has onsite staff to help with things like personal care, prescription management, housekeeping and laundry, meals, social activities and 24-hour emergency care. However, they do not provide the level of medical or nursing help that a nursing home would provide.
Typically, there are a few levels of care (usually with a sliding fee scale) with limits to the amount of care that can be provided. Residents who need more care may have to move to a nursing home or pay privately for additional outside care if that is allowed by the facility.
When to Move to Assisted Living
One indicator that a person may need to move from independent living or in-home care is when they need more help than they can give themselves or is available from family, friends, and others.
What are some signs that a person may need to move to assisted living? Signs may be big or subtle. Is there enough food at home? Is it being eaten? Are medications being taken? Is the home still in good repair and clean and orderly?
Sometimes the signs are subtle—a person is lonely and perhaps depressed and does not have the energy to do anything about it. It takes a lot of energy to manage a household, even a household of one, and people get tired.
Being alone much of the time is a recipe for depression in older adults. HelpGuide offers information on how to spot depression in older adults. Having an active social life is vital to health and happiness. The social aspect of assisted living can be a huge benefit for seniors and non-seniors. Good facilities offer a range of social and recreational activities and the community environment also gives the opportunity to make new friends.
A good overview of assisted living facilities and programs is available on the American Health Care Association / National Center for Assisted Living website.
Who Pays for Assisted Living?
Assisted living facilities are usually paid for by the resident. Costs for assisted living communities vary greatly and depend on the size of rooms, amenities, services provided, and location. Calculating the approximate cost is important, as is understanding what happens if private, personal funds are depleted.
Several private health and long-term care insurance policies include assisted living/residential care coverage. There is a feature built into some life insurance policies that allow a policy holder to receive a tax-free advance on their life insurance death benefit while still living in order to help pay for long term care needs. However, the majority of assisted living costs are paid through personal finances of residents and/or their families.
Do Assisted Living Facilities Accept Medicaid and Medicare?
While Medicare does not cover assisted living, certain healthcare services may be available under specific, limited circumstances.
Supplemental Security Income may cover some costs, and some facilities may participate in grant programs or the Medicaid program; some may also offer internal assistance programs. The assisted living facility’s management should be able to answer your questions concerning available assistance programs.
Under certain conditions veterans and/or their spouses may be eligible for benefits to help pay for some of their care in an assisted living community. For more information about the Veterans Administration’s Aid and Attendance program visit www.VA.gov or contact your regional VA office.
What to Consider When Selecting an Assisted Living Facility
It is a good idea to visit a facility several times at varying times of the day, if possible; at least one of these visits should be without notifying the facility that you are coming.
Facilities should willingly provide consumers with key information regarding base rates, specific fees for additional services, occupancy levels, staffing, and ownership. Obtaining this information is crucial in choosing the appropriate assisted living or residential care community.
When gathering information, here are some questions to ask when evaluating an assisted living community:
- What is the cost, is it paid monthly, is there an entrance fee?
- What are the credentials, certifications and license status of staff and facility?
- What services – healthcare and other types – are included in the monthly cost?
- Can hired services from outside sources be utilized?
- Does insurance, Medicaid or Medicare cover any of the costs to live there?
- What are the social and recreational activities available to residents?
- Is cable available – who pays?
- What is the meal plan and what is the meal schedule?
- How are specific dietary and care needs met?
- Can a resident choose their own doctor and manage their own care plan?
- Is there medication delivery and distribution?
- What kind of safety measures – like a fire emergency plan – are in place and how do the staff manage emergencies?
- What types of staff members are available and is staff there 24 hours a day?
- What is the minimum care and maximum care that a resident can receive?
- Can families of residents visit and stay in their living space overnight?.
- Can a resident live there for the rest of their life?
- Which hospices does the facility work with and are they open to a different one if that is the preference of the resident?
- Is there a situation when a resident would need to move out?
Read more about other things to consider when moving care out of the home.
Requirements and Regulations for Assisted Living Facilities
The Centers for Medicare and Medicaid Services (CMS) do not regulate assisted living facilities; there is no federal regulation or inspection such as there is for nursing homes, which are often paid for by Medicare. In general, assisted living facilities are licensed by each state. The best way to get information about assisted living facility rules, regulations, and licensing in your state is to visit the website of your state’s Department of Public Health and Human Services. Some states, such as California, have extensive licensing requirements. (Source: California Department of Social Services)
The Centers for Disease Control and Prevention (CDC) also has developed guidelines to prevent the spread of infections for long-term care facilities such as nursing homes and assisted living facilities.
Other Alternatives to In-Home Care
Depending on your or your loved one’s needs and level of independence, other alternatives to in-home care may be worth exploring. Learn about:
