If you live long enough, you’ll need assistance managing your life. This means being able to perform “Activities of Daily Living” (ADLs): bathing, dressing, eating, toileting, transferring (getting into and out of bed, chairs, the shower, etc.), and remaining continent.
Needing assistance with ADLs is different from needing skilled nursing care. Assisted living facilities are not certified to provide medical services though a licensed nurse may make rounds a few times a week. In nursing homes, a registered nurse must be available for at least one shift each day.
Assisted Living Facilities
The idea behind assisted living is for people to be as independent as possible. The staff help residents dress, bathe and use the bathroom as needed. Most or all meals are provided, along with housekeeping and laundry services. In addition, most assisted living facilities offer recreational activities, health and exercise programs, transportation to appointments and medication reminders. They may also provide short-term care during recuperation after a stay at a nursing home or hospital.
Assisted living facilities fill a narrow niche between independent living and needing to be in a nursing home. By the time you need assistance with two or more ADLs, you probably need skilled medical care as well. Since assisted living facilities don’t provide medical services, outside practitioners may be brought in (at extra cost) but the facilities offer nothing in the way of oversight. Beyond medication reminders, medical oversight is considered a family responsibility.
Because assisted living staff aren’t certified to make medical decisions, a small incident like a minor fall may result in a trip to the emergency room. This deflects litigation but such trips are enormously hard on frail, elderly individuals. The nightmare of being shunted between facilities and emergency rooms is vividly described by Jane Gross in A Bittersweet Season, about caring for her aging mother.
Choosing an Assisted Living Facility
Facilities range from “Care Homes” — big houses accommodating 10-20 individuals in private or shared rooms — to complexes providing apartments and studios for hundreds of people. All have group dining areas and common areas for social activities.
Some assisted living facilities — “Memory Units” — are for seniors with Alzheimer’s. These must meet higher standards than regular facilities and are generally separate from them, even if in the same building.
Your choice of an assisted living facility is limited by what’s available in your area, your finances and your needs. If there are multiple possibilities nearby, your local Area Agency on Aging can help you narrow the choices. If you wait until the last minute, lack of availability may be a problem so think about what matters to you and plan in advance. Do you want a lot of activities or peace and quiet? A mountain view? An in-house dog or cat? If you can, visit or have a surrogate visit unannounced, perhaps during a mealtime, so you can sample the food and observe the service.
There’s a lot of good information about evaluating assisted living facilities on the web; I like this checklist. (PDF).
Paying for Assisted Living
Medicare covers skilled nursing care provided in an assisted living facility but it doesn’t cover residential costs. Assisted Living is largely a for-profit enterprise. At the high end, facilities sport gracious entryways, dining halls and common rooms. According to Dr. Cheryl Woodson, “10 Things to Know About Assisted Living,” these are aimed at well-off adult children who feel guilty about putting their parents in a facility. They may cost upwards of $10,000 per month.
For $3000-$5000 per month, you can get a shared room in a “care home,” a converted house that holds 10-20 old people. Most residents in these facilities are in their nineties. They’re provided with meals, housekeeping services, TVs, puzzles, toys, and limited outdoor space. Life is very slow. While tidy, these care homes had an unmistakably forlorn quality.
When people have exhausted all their resources, they become eligible for Medicaid, which covers assisted living as well as medical care. Those who exhaust their resources paying for assisted living will then receive government assistance.
Medicaid often contracts with non-profit agencies for services. Dr. Woodson, among others, speaks to the superiority of non-profit facilities, where income goes toward care rather than executive perks. She notes that government data shows not-for-profit nursing homes to have fewer deficiencies and higher staffing ratios. You can check to see if there are non-profit assisted living facilities in your area. Check out also this Senior Home Living Guide website.
Assisted living is generally covered by long-term care insurance policies.
Other Options for Assisted Living
For those unable to afford assisted living but aren’t poor enough to qualify for Medicaid, there are adult daycare facilities which provide many kinds of support for those able to be home alone at night.
Web Resources
Next: Nursing Homes