Guide to Assisted Living
As nearly 80 million baby boomers reach Social Security age, life expectancy may be rising, but chronic conditions are here to stay. In fact, it’s estimated that 60 percent of boomers will be dealing with a chronic condition by 2030. In all likelihood, many of these individuals will at some point need more than in-home health support. However, not all will need the 24/7 medical supervision that institutions like nursing homes provide. This is where assisted living communities come into play, providing day-to-day assistance for personal needs but not round-the-clock medical care.
Whether you are researching assisted living communities for yourself or a loved one, navigating all those search results can be a daunting task. To help, I created this guide. Here you will find an overview of assisted living basics, how it works, what is provided, and how to pay for this often costly service.
What Is Assisted Living?
Assisted living is a long-term senior care option for people who need help with personal daily care but don’t need a skilled nurse around the clock. Assisted living aims to balance a resident’s maximum independence with minimal personal care assistance, simple health services, 24-hour security, and group leisure activities. Many communities also offer additional accommodations, such as housekeeping, laundry, and meals.
A Center for Disease Control study determined that roughly 60 percent of assisted living centers offer skilled nursing and less than half provide social work services. Since there’s no federal regulation of assisted living and no official agreement over its definition, these communities can have significantly different setups and rules. There is no legal minimum of services, so it’s vital that you thoroughly research each assisted living residence you’re interested in.
FYI: When it comes to senior housing options, there are many options apart from just assisted living and senior homes.
Are There Different Levels of Assisted Living?
The goal of assisted living is for residents to maintain as much independence as possible while getting help in the areas they need it. For example, one of my former caregiving clients was struggling to stay healthy because it was difficult for him to continue cooking nutritious meals. He also missed interacting with people in his day-to-day life. Ultimately, he chose an assisted living facility with prepared meals and a shared dining space, which allowed him to eat and mingle with others.
If you forget to take your medication and struggle to bathe thoroughly but function well otherwise, an assisted living facility would allow you to live quite normally. You’d simply add a couple of interactions to your week: someone who comes by to remind you to take your medications and someone else who helps you bathe.
Do I Qualify for Assisted Living?
Your loved one will qualify for assisted living if they meet the following criteria:
- Assistance: Unlike nursing homes, assisted living facilities provide what are considered nonmedical services such as dressing and bathing, making one of these communities a good fit for people who need help with these daily tasks.
- Mobility: Those who wish to live in assisted living communities should be able to get around with minimal help, meaning they can either walk or use a wheelchair or scooter independently.
- Self-Efficacy: Since assisted living facilities don’t provide around-the-clock care, residents need to be comfortable living alone in an apartment. With that said, help is naturally available when they need it.
- Health Stability: Potential residents should have no need for ongoing medical attention. If they have a chronic condition such as diabetes or arthritis, they should be able to manage it on their own.
What Is the Average Length of Stay in Assisted Living?
According to the AARP, the average length of stay in an assisted living facility is about 2 1/2 to 3 years. The most common reasons for leaving an assisted living community have to do with declining health and the need for a higher level of care.
What Does Assisted Living Provide?
You’ll often see a few levels of care offered at assisted living residences, and those with more care needs typically charge a higher monthly rate. Although services and amenities are different and based on each facility, below is a list of the most common services:
- Assistance with personal care (bathing, dressing, eating)
- Three cooked meals a day
- Help with medication administration
- Health monitoring and management (not skilled nursing)
- 24-hour security
- 24-hour supervision
- Recreational activities
- Transportation options
- Social service help
- Religious activities
- Educational activities
Does Assisted Living Help with Toileting?
While assisted living communities do not provide medical care — as do nursing homes — they will certainly help residents who need assistance with using the bathroom. This includes both bathing and toileting.
Does Assisted Living Include Meals?
While some assisted living facilities will charge extra for different types of meal services, most communities will include three cooked meals per day as part of your base price.
Pro Tip: Remember always to ask communities you’re interested in for their specific list of available services. These will also help make it easier to compare communities side by side when it comes time to make a decision.
In the United States, there are approximately 30,000 assisted living communities with nearly one million licensed beds. While the average number of licensed beds per assisted living community is 33, many communities include more than 100 beds.
In any given assisted living community, you may find private studio, one-bedroom, and dorm-style apartments. Most often, these single-unit spaces include private restrooms and a small area for cooking or food storage. You can even find locations that include full-sized kitchens. Sometimes these home-like residences come fully furnished. Others are unfurnished, allowing you to make your space your own.
Can a Spouse Live in Assisted Living?
Since most assisted living communities have a variety of room sizes, couples are generally welcome to move in together. In my experience, when spouses transition together to this type of community, they find the experience much more comfortable and enjoyable.
Are Pets Allowed in Assisted Living Facilities?
Most assisted living communities allow residents to have pets. Just like any apartment building, however, there are likely rules regarding pet ownership. Exotic animals such as reptiles and birds might not be allowed, and dogs of a certain breed or size might be restricted. Be sure to ask the facility about their specific rules regarding pets, and also check if they charge an additional pet rent.
Can You Drink Alcohol in Assisted Living?
Unlike pets, which are allowed almost universally, the rules regarding alcohol in assisted living vary widely. Some communities offer alcohol with meals, whereas others only allow residents to consume it with written approval from a doctor. If alcohol consumption is a regular part of your life, be sure to ask a representative from a prospective community about their drinking policies.
Assisted Living Versus Nursing Homes
Although your loved one may receive some help from on-site staff with bathing or medications, life at an assisted living center is much different than living in a nursing home. Still, I find that people are often unaware of the differences in these senior housing options. Here are some of the main differences:
- Medical Care: The primary difference between nursing homes and assisted living is that assisted living strives to provide a truly home-like experience, while nursing homes exist to provide higher levels of medical care, requiring a more clinical setting. On average, a resident of assisted living receives about 12 minutes of nursing care and about two hours of personal care per day. The average nursing home resident receives between 1.2 and 2.7 hours of skilled nursing care each day. While assisted living facilities may help you with medication, nursing homes provide many medical services. Licensed physicians supervise each patient’s care, skilled nurses are present 24/7, and other services like physical, occupational, and speech therapy are also common.
- Expenses: In most states, nursing homes commonly cost more than assisted living, as round-the-clock nursing is required. The cost difference can be quite significant, reaching as high as several thousand dollars per month in certain states.
- Mobility: Assisted living residents usually maintain some level of mobility, while nursing home patients are frequently bedridden. If a person has severe mobility limitations, an assisted living facility likely won’t admit them.
- Rooms vs. Apartments: Assisted living facilities provide one-bedroom or studio apartments. Nursing homes offer single or semi-private rooms without kitchens or separate living spaces.
- Safety: Nursing homes have trained medical staff available at all hours, whereas assisted living facilities generally have these professionals visit at certain hours. This is why assisted living facilities generally have more healthy residents, as the level of care is lower.
When Should You Consider Assisted Living?
Whether you’re an older adult or a loved one, choosing to move from the comfort of your home to an assisted living facility is not a decision that’s made lightly. Still, if aging in place is not an option, most people would prefer to live in an assisted living facility, due to the increased levels of independence. Although we all have personal stories about what led us to consider assisted living, the list below will provide you with an idea of whether or not it might be right for you or your loved one.
It’s always best to have a conversation about assisted living before your loved one needs to move. Facilities often have wait-lists, so if you wait until there’s a crisis, such as a fall or other health emergency, your options will likely be more limited.
If you answer yes to any of these questions, then you should set aside some time to discuss assisted living with your loved one.
- Do you find you are having more frequent accidents, such as falls or small house fires? As our bodies age, moving around becomes more difficult, and serious falls become more common. Many of my clients often leave on appliances such as the oven, leading to potentially hazardous fires.
- Have household tasks, such as laundry and dishes, become exceedingly difficult? Do you notice your loved one leaving chores undone that they would normally do?
- Has caring for your loved one become detrimental to your own health/quality of life? Does providing adequate care feel like a task beyond your capabilities, either in terms of time or specialized skills? Caregiver burnout is when you are emotionally or physically fatigued, leading to exhaustion and illness.
- Are sundowning incidents becoming more intense and difficult to handle? Do you often fear for the safety of you or your loved one?
- Has your loved one lost weight because of a lack of food or gained weight from too much fast food? Are they eating the same thing every day? Does their blood work point to malnutrition?
- Has your loved one been pulled over for erratic driving? Are there dents in their car or garage door? Do they go on long walks and forget how to get home?
- Do they sometimes have accidents because it takes too long to get to the toilet? Is it becoming difficult or dangerous for them to bathe themselves?
- Does your loved one see people regularly? Do they keep in touch with friends and family members? Do they leave the house regularly for any activities or hobbies?
Assisted Living Costs
Long-Term Care Costs in the United States
|In-Home Care||Assisted Living||Nursing Home|
*From Genworth Cost of Care Survey 2017.
The U.S. Census Bureau views the U.S. as four regions.: the Northeast, the Midwest, the South, and the West. We added the non-contiguous U.S. as well.
Average Monthly Cost of Care in an Assisted Living Facility
A number of assisted living facilities charge based on levels of service. The monthly cost will be a combination of a base rate that includes room and board, most utilities (cable and phone are generally extra), and group amenities like activities, transportation, and communal meals. In addition to the base cost, any additional care services needed will have to be add-ons. Services like medication management, toileting, bathing, or safety checks, will all be charged as personal care in addition to the base rent.
Personal care costs can add up quickly. It’s important to understand how the assisted living facility tallies these additional costs. Some are based on a points system (time for care = cost) while others may use a tiered system.
It can be difficult to compare costs between multiple facilities. The only way to accurately predict the charges for your loved one is to request an assessment by the potential facility. This assessment is generally performed in-person by a nurse or administrator and may include reviewing past and present medical records.
When planning for costs, keep in mind there may be additional costs like move-in deposits, cleaning fees, and pet fees. Also, expect to see a 3-6 percent cost of living increase on a yearly basis.
Does Medicare Cover Assisted Living?
Generally, Medicare will not cover the costs of assisted living, as it will only cover the costs of a short-term stay in a skilled nursing or rehabilitation facility. Assisted living is technically not a medical expense and therefore doesn’t qualify.
Does Medicaid Cover Assisted Living?
Age-related programs like Medicare will only cover senior care facility expenses related to skilled nursing, ones that are deemed medically necessary. Other programs, like Medicaid, might cover some of the assisted living costs. Medicaid, which offers government aid to low-income older adults and people with disabilities, often will.
How to Pay for Assisted Living
It’s no secret; assisted living is costly. While personal funds, such as retirement and Social Security, are the most common means of paying for assisted living, many families also manage other payment methods. For example, some families will liquidate investments, settle with a life insurance company, utilize previously purchased long-term care insurance, apply for wartime veteran benefits, or work with their banks on reverse mortgages.
Does Insurance Cover Assisted Living?
Generally, health insurance does not cover the costs of assisted living; however, this varies by provider. On the other hand, a long-term care insurance policy can be used to cover these costs. Be sure to plan ahead with a long-term care policy, as many providers will deny coverage if you have preexisting conditions such as Alzheimer’s, Parkinson’s, or multiple sclerosis.
Does the VA Pay for Assisted Living?
For veterans, the VA will not pay for assisted living facilities. With that said, eligible persons may apply for VA Aid and Attendance benefits. For those who have vision issues or require daily assistance with normal tasks, this type of funding can certainly offset some of the costs of assisted living.
Is Assisted Living Tax Deductible?
Luckily, some or all of your assisted living costs may be tax deductible, qualifying for the medical expense tax deduction. To qualify for this deduction, a person must fit the IRS’s definition of “chronically ill,” meaning that they cannot perform two or more daily acts, including bathing, dressing, transferring, eating, and using the toilet. A licensed health care practitioner can certify this status.
Finding Your Ideal Assisted Living Community
Once you decide to move a loved one into assisted living, your next task is to find your ideal community. Just like searching for a home or apartment, this process can feel quite overwhelming if you don’t have a plan. One way I plan for these kinds of things is by making a list. Try out this list I use to help my caregiving clients find assisted living facilities.
Factors to Consider When Choosing an Assisted Living Community
- The distance of the facility from loved ones (walking and driving)
- Distance from emergency medical care/hospital
- Range of services available with the community (housekeeping, laundry, bathing, etc.)
- Services included in the base plan
- Types of food offered for meals
- Religious services and affiliations
- Social and recreational activities offered
- Levels and types of training staff receive
- Parking and transportation
- Staff attitude and demeanor
- Fitness facilities
- Pet rules
- Online reviews
- Recent complaints filed against the community with the local Better Business Bureau
- Unique aspects about the community, such as an onsite Starbucks
- Results of state or federal inspections.
Once you’ve narrowed your search down to a few facilities of interest, visit them, ideally more than once. Don’t be afraid to show up without a scheduled visit. While you’re there, make sure to interview current residents about their experiences and ask the staff the following questions:
- How do payments work?
- How, when, and by whom are care needs evaluated? If my needs change, will my monthly cost increase?
- Is there a deposit? If so, is it refundable?
- How often do they ask residents to leave? What are the criteria for requiring a resident to move to a higher level of care?
Pro Tip: During your move, make sure you keep any critical medication on your person so it doesn’t get lost.
Transitioning to Assisted Living
Once your loved one arrives at their new home, a facility representative will greet you and show you around. If you haven’t already received a Resident’s Bill of Rights and a copy of your contract, make sure you get them now.
Before moving out:
- Take time to say goodbye.A home is a big part of your loved one’s life. Recognize that they may go through a mourning period, and that’s okay. For my clients, I like to plan a dinner with family members and friends. This is a great way to honor one’s space and create a final positive memory.
- Plan future visits. Leaving one’s home is scary, regardless of age. Many older adults often feel like they’ll be abandoned in care facilities. To assuage these fears, start making plans with them. Perhaps set aside a day or two for regular visits. You could even plan for regular activities out of the center such as trips to a house of worship.
When you get there:
- Make it look like home. Decorate their new place with personal items that make their apartment feel special. Photo albums and family heirlooms are a great way to accomplish this.
- Get involved. Ask an employee for a list of activities in the assisted living facility, and figure out which ones will interest your loved one. Most places will offer cultural, exercise, culinary, and craft clubs that meet regularly. Many of these groups even allow guests, so you could join in.
- Dine with other residents. Living in assisted living can often be defined by the other residents. To help your loved one get adjusted, consider accompanying them to a meal to help them branch out.
When to Move From Assisted Living to a Nursing Home
Assisted living serves the needs of older adults only to a certain extent. At some point, depending on the individual’s needs and the capabilities and rules of the assisted living community, certain individuals may need a higher level of care than the facility can provide.
Suppose the assisted living community has not required a move. In that case, you may also decide it’s time for your loved one to move from assisted living to a nursing facility, memory care community, or smaller adult care home for a number of reasons. Memory care may be more appropriate if your loved one is struggling with a form of dementia, wandering, or exit-seeking. Nursing homes often have on-site physicians who can be more attentive to your loved one’s complex medical needs.
Can You Leave Assisted Living?
One of the best parts of assisted living is the relative amount of freedoms entailed. In most facilities, residents may come and go as often as they please, provided the resident is healthy enough to travel, and they have a loved one to give advance notice to the facility and provide proper support.
Can Assisted Living Kick You Out?
Assisted living facilities can legally evict a resident, even if that person is suffering from a debilitating illness and is unable to properly care for themselves. While nursing homes must abide by certain laws that restrict evictions, assisted living policies are set on a state-by-state basis.
Generally, a facility can kick out a resident if they feel the needs of said resident exceed what can be provided by the facility. In my experience, I have seen residents evicted due to worsening Alzheimer’s that makes residents difficult to keep safe.
It’s certainly a lifestyle change and often costly, but for older adults who are somewhat independent with just a handful of extra care needs, assisted living may just be the best solution. I’m not a huge fan of the price tag. However, considering the funding and finance options we discussed, the expanse of possibilities available for older adults, such as fitness classes and social events — plus the significant stress I’ve witnessed that a move to assisted living washes away from both older adults and caregivers — I’m convinced assisted living is worth a second look for families trying to decide on their next best step.
Frequently Asked Questions
- Can I live with my spouse in assisted living?
Even if you and your spouse have different levels of care needs, many assisted living facilities will do everything they can to accommodate married couples who want to live together in assisted living. However, not all communities have the same options/outlook, so it’s important you ask whether living with your spouse in assisted living will be an option as you survey different assisted living providers.
- Do assisted living facilities allow overnight guests?
Family members are almost always allowed as overnight guests at assisted living communities. After all, it is your apartment. Even communities that lock their doors at night will often buzz in family members who want to stay with loved ones but arrive after regular visiting hours. If you want to have out-of-town friends or romantic partners stay with you, make sure you ask for a detailed overnight guest policy before you sign any paperwork. It’s unlikely you’ll run into any obstacles with family staying over, but some assisted living communities have much stricter policies for overnight guests who are not relatives.
- Are transportation services available?
Most assisted living facilities include transportation services in their fees. These services can range from rides to and from doctor appointments to group transport for a shopping trip at the mall.
- Are assisted living apartments furnished?
Some assisted living apartments are furnished. Others are not. It depends on the facility. Even in furnished apartments, residents are encouraged to bring in some personal items to help make the place their own.
- Who can live In assisted living?
While requirements for assisted living residence vary, most communities insist residents be at least 60 years of age. Certain facilities have other rules such as “residents must be mobile enough to escape on their own or with little aid in the event of an emergency.”