Friday, August 17, 2018

The goal of assisted living is to allow your parent or loved one to stay independent in a home-like setting. A quality assisted living facility can have a tremendous positive impact on your parents' mental, physical, and social well-being. But you need to find the right one. The checklist on the left will guide you.

The goal of assisted living is to allow your parent or loved one to stay independent in a homelike setting. The checklist on the left will guide you.

Understand the Basics

Are your parents or other loved ones having trouble with activities of daily living? Have you exhausted other care options? Time to consider an assisted living facility.

An assisted living facility usually include a room or small apartment and meals, along with personal care and support services, social activities, and 24-hour supervision.

Some also offer health-related services. Their mission: to help your loved one enjoy the freedom and independence of private living.

Assisted living provides relatively independent seniors with assistance and limited healthcare services in a homelike atmosphere. They are designed to:

  • Minimize the need to relocate;
  • Accommodate individual residents’ changing needs and preferences;
  • Maximize residents’ dignity, autonomy, privacy, independence, choice and safety; and
  • Encourage family and community involvement.

Services include 24-hour protective oversight, food, shelter, and a range of services that promote quality of life. The facilities are licensed by state governments.

They may be called many different names, including residential care, board and care, congregate care, and personal care. Assisted living care is not the same as nursing facility care.

Because there is no common definition for assisted living facilities, it is difficult to pinpoint the exact number of facilities. However, it is currently estimated that there are 36,000 assisted living residences nationwide.

The "typical" assisted living customer is 85 years old. Three quarters of assisted living residents are female. About 68 percent need assistance with bathing, and almost half need help with dressing.1

Assisted living homes are very different from one another in size, appearance, and the types of services they offer. Some provide only meals, basic housekeeping, and help with activities of daily living (ADLs) such as bathing, dressing and grooming. Others also arrange transportation and certain health services. Costs vary greatly, and the monthly fee varies depending on the services provided.

The facility could be a small home with just a few people, or a high-rise apartment-style building with as many as 200 or more residents. Living areas could be a single room or a full apartment with a small kitchen, with prepared meals also served in a common dining area.

This arrangement is good for people who can't live on their own but who don't need nursing homes. Older people have many different needs.

Those needs often change over time, so assisted living offers different levels of care at different costs. Residents who live in an assisted living facility that is associated with a nursing home may be able to get additional services if they need them later. 2

Services and Activities

The services and activities provided or arranged for in assisted living residences generally include:

  • 24-hour supervision;
  • Three meals a day in a group dining room;
  • Personal care services (help with bathing, dressing, toileting, etc.)
  • Medication management, or assistance with self-administration of medicine;
  • Social services;
  • Supervision and assistance for persons with Alzheimer’s or other dementias and disabilities;
  • Recreational and spiritual activities;
  • Exercise and wellness programs;
  • Laundry and linen service;
  • Housekeeping and maintenance; and,
  • Arrangements for transportation.

In most states, assisted living residences are registered, licensed or certified by an appropriate department or agency.

Each resident receives individualized services to help him/her function within the residence and within the community. Upon admission, a service plan is usually developed to coordinate the delivery of services to each resident.

The agreement, which includes an assessment or evaluation of the resident’s physical and psychosocial needs, is reviewed and updated regularly by the staff, and as the resident’s condition indicates. The resident and family or responsible party are encouraged to play an active role in the development of the service plan.

A resident care or wellness coordinator is usually designated to oversee the process of developing, implementing, and evaluating the progress of the service plan. A copy of the service plan is provided to the resident, family, or responsible party upon request.

Personal care and health services

Assisted living residences provide supervision or assistance with activities of daily living (ADLs); coordination of services by outside healthcare providers; and monitoring of resident activities to help to ensure his or her health, safety, and well-being. Assistance may include the administration or supervision of medication, or certain personal care services by a trained staff person.

The residence may assist in arranging the appropriate medical, health, and dental care services for each resident. The resident generally chooses his or her doctor and dental services.

Residents who have periods of temporary incapacity due to illness, injury, or recuperation from surgery often are allowed to remain in the residence or to return from a rehabilitation center, skilled nursing facility or hospital if appropriate services can be provided by the assisted living residence.

It is important to remember that assisted living residences are bridges between living at home and living in nursing homes. Assisted living residences do not typically provide the level of continuous skilled nursing care found in nursing homes and hospitals.

Residence accommodations

A residence is defined by the scope of services it provides, not by the number of residents it serves. It is important for residents and families to understand what services the residence offers, as well as the costs and limitations of those services.

Accommodations and options may vary greatly from one assisted living residence to the next (e.g. private rooms, private baths, kitchenettes, etc.). Personal needs and preferences are important criteria for selecting a residence and the amenities it offers.

Most residences are constructed and equipped to comply with a host of local, state and federal regulations. Assisted living residences are designed to be operated, staffed and maintained in a manner appropriate to the needs and desires of the residents served.

Caring for residents with Alzheimer’s or other dementias and disabilities requires a residence design and philosophy that assure resident safety and autonomy. Such services should be provided in an appropriate and safe setting that adheres to appropriate local, state and federal regulations.3

3Long Term Care Living


Moving into an Assisted Living Facility

Nursing Home Care
Medicare Pays in full for days 0-20 if you are in a skilled nursing facility following a recent hospital stay. If your need for skilled care continues, may pay for days 21 through 100 after you pay a $119/day copayment
Private Medigap Insurance May cover the $119/day copayment if your nursing home stay meets all other Medicare requirements.
Medicaid May pay for care in a Medicaid-certified nursing home if you meet functional and financial eligibility criteria.
Your out-of-pocket-costs If you need only personal or supervisory care in a nursing home and/or have not had a prior hospital stay, or if you choose a nursing home that does not participate in Medicaid or is not Medicare-certified.


Assisted Living Facility (and similar facility options)
Medicare Does not pay
Private Medigap Insurance Does not pay
Medicaid In some states, may pay care-related costs, but not room and board
Out-of-pocket-costs Everything, except as noted under Medicaid, if eligible.


Continuing Care Retirement Community
Medicare Does not pay
Private Medigap Insurance Does not pay
Medicaid Does not pay
Out-of-pocket-costs Everything


Adult Day Services
Medicare Not covered
Private Medigap Insurance Not Covered
Medicaid Varies by state, financial and functional eligibility required
Out-of-pocket-costs Everything, except as noted under Medicaid, if eligible.


Home Health Care
Medicare Limited to reasonable, necessary part-time or intermittent skilled nursing care and home health aide services, and some therapies that are ordered by your doctor and provided by Medicare-certified home health agency. Does not pay for ongoing personal care or custodial care needs only (help with activities of daily living).
Private Medigap Insurance Not covered
Medicaid Pays for, but states have option to limit some services, such as therapy
Your out-of-pocket costs Personal or custodial care, except as noted under Medicaid, if eligible.

Paying for nursing home care

People usually pay for nursing home in one or more of the following ways:

  • Privately. Some people pay for long-term care with their own savings for as long as possible. When that is no longer possible, they may get help from Medicaid. If you think you may need to apply for Medicaid at some point, make sure the nursing home accepts it. Not all homes do.
  • Medicaid. This is a state program for people with low incomes. Each State decides who qualifies. Contact your state government to learn if you qualify. Keep in mind that getting approved for Medicaid can take three or more months.
  • Long-term care insurance. Some people buy long-term care insurance on their own, or through a group plan at work or an association. It can pay part of the costs for a nursing home or other long-term care. This type of insurance is sold by many different companies, and benefits vary widely. Look carefully at several policies before choosing.

Many people believe Medicare will pay for a long stay in a nursing home, but it doesn't. It is important to check with Medicare and private "Medigap" (Medicare add-on) insurance to find out the current rules. For example, Medicare may only cover the first 100 days in a skilled nursing home for people needing special care after leaving the hospital.

When thinking about costs, keep in mind that there can be extra out-of-pocket charges for some supplies; personal care, like hair appointments; laundry; and other services that are outside routine care.2

1© 2005 National Endowment for Financial Education. All rights reserved.
2© National Institute on Aging, "Age Page, Nursing Home: Making the Right Choice," National Institute on Aging, U.S. National Institutes of Health, viewed 8/3/2010 at:


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