By Elaine K. Howley, Contributor Nov. 12, 2018, at 9:52 a.m.
FOR MANY OLDER ADULTS, advancing age means they’ll face a time when living alone is no longer feasible. Certain aspects of daily living become more challenging, and if you find that you often need assistance to do things like caring for your home and yourself, it might be time to consider moving into an assisted living facility. But what does that mean and what can you expect? Here, we explore the basics of what you need to know about assisted living facilities and how they can help older adults with difficult tasks while offering social contact and activities that stimulate and support.
What does assisted living mean?
Depending on the state and the individual facility, assisted living can mean different things and it may go by other names such as residential care settings or personal care homes. By-and-large, the concept of assisted living is simply that: Older adults move to a facility where they can receive assistance with the daily tasks of living. These facilities can be large or small, privately owned or corporate, not-for-profit or for-profit, but they all offer some level of care or assistance to older adults who are unable to manage the tasks of living on their own, such as cooking, bathing or toileting.
A Place for Mom, a senior care referral service based in Seattle, reports that “an assisted living residence is a long-term senior care option that provides personal care support services such as meals, medication management, bathing, dressing and transportation.” The National Center for Assisted Living reports that “there are 30,200 assisted living communities with 1 million licensed beds in the United States today. The number of licensed beds within a community range from 4 to 499, and the average number of licensed beds is 33.” Each state has its own regulatory agency that handles licensing of these facilities.
Perhaps not surprisingly, more assisted living communities are located in the West and the South – popular parts of the country for many retirees to move to. NCAL data show the following geographical distribution of assisted living facilities: 42 percent in the West, 28.1 percent in the South, 21.8 percent in the Midwest and 8.2 percent in the Northeast.
The National Institute on Aging reports that “assisted living residents usually live in their own apartments or rooms and share common areas.” One feature that can be especially attractive is the fact that most assisted living facilities offer 24-hour supervision and security, meaning that an elderly loved one is less likely to wander off or fall without having access to immediate help.
“Assisted living can relieve some of the stress around an older adult living independently,” says Dr. Tanya Gure, section chief of geriatrics and associate clinical professor in internal medicine at the Ohio State University Wexner Medical Center. Particularly for families where children live far away from their aging parents, having the option of moving a loved one into an assisted living facility can lessen the burden and worry for the family and take pressure off other caregivers.
What services does assisted living provide?
The services offered by individual assisted living facilities can vary greatly. Among them are activities that support health and wellness, such as:
- Group exercise classes, hobby classes and social outings
- Dining services and meal preparation
- Personal care services, such as assistance with bathing and dressing
- Housekeeping and living space maintenance
- Medication management
- Transportation to and from medical appointments and other sites off campus.
This variability in what’s offered means then when it comes time to find an assisted living facility for yourself or a loved one, you need to do some homework to find the one that will best serve your needs.
How much does assisted living cost?
This is a big question and a major hurdle for many families, says Roxanne Sorensen, an Aging Life Care specialist and owner of Elder Care Solutions of WNY in Rochester, New York, a case management consultancy. “Each state is different” in how it administers assisted living facilities, and cost ranges can differ significantly from region to region. In addition, depending on the level of care that’s needed and the specific services being purchased, the monthly cost of entering an assisted living facility can vary wildly, with $2,000 to $5,000 monthly being a common range.
A 2017 survey by Genworth Financial found that the median monthly cost for an assisted living community in the U.S. was $3,750, which adds up to about $45,000 annually. It can be hard to predict how long you’ll need to live in such a facility, so hopefully your retirement savings will last as long as you need.
Does Medicare or Medicaid pay for assisted living?
Medicare and most private insurers don’t cover the cost of assisted living, though you may be able to find some long-term care insurance plans that will cover some of the cost of these facilities. In some cases, Medicare, which is a national, government-funded health insurance program for adults over the age of 65, might cover the cost of certain health care expenses incurred while you’re living in an assisted living facility, such as wound care administered by a registered nurse or a doctor, but it does not cover the cost of the assisted living facility itself.
Meanwhile, “Medicaid is a whole different system and is a beast in itself,” Sorensen says, but like Medicare, Medicaid does not cover the cost of assisted living. Medicaid is a joint federal and state program that provides health coverage for low-income families and other people with very limited financial resources. Medicaid typically kicks in once an older adult has spent down all of his or her resources. “When you run out of money, you have to look for facilities that accept a Medicaid benefit,” Sorensen says, but these are not going to be assisted living facilities.
Is assisted living the same as going to a nursing home?
There are many different types of long-term senior care facilities out there, and it can get confusing to sort out which is the best one for you and how they differ. One thing that’s certain, assisted living facilities are not nursing homes, which are also sometimes called skilled nursing facilities.
The National Institute on Aging reports that “assisted living is for people who need help with daily care, but not as much help as a nursing home provides.” Nursing homes are intended for patients who need round-the-clock skilled nursing care. This includes meals, medical care, 24-hour supervision and assistance with many daily activities. Many nursing homes also provide rehabilitation services such as physical or occupational therapy. Some may also provide speech therapy, which may be helpful for older adults who have suffered a stroke or other potentially speech-damaging medical events.
The Centers for Disease Control and Prevention reports that there are 15,600 nursing homes with a total of 1.7 million beds in the U.S., and as with assisted living facilities, they come in a variety of shapes, sizes and levels of care. The NIA says that while some nursing homes are intended to be short-term recovery locations, others are a permanent arrangement for older adults who need intensive long-term care because of a debilitating or deteriorating physical or mental condition.
Who is assisted living for?
Dr. Susann Varano, a geriatrician at Maplewood Senior Living, a Westport, Connecticut–based senior living residence company, says a common scenario for who should be considering assisted living is an older adult who’s still somewhat independent, but for whom things have started to change. She gives the example of a “husband and wife who’ve been married for 50 or 60 years. The wife passes on, and now the husband is a fish out of water. He never took on the role of food shopping. He went along sometimes, but he didn’t know what to buy. Cooking, shopping, cleaning, doing the laundry – all those activities of daily living were not his role,” but rather were taken care of by his now deceased wife. In this example, she says perhaps he’s 88 and “he has no interest or desire” to learn what needs to be done or the ability to do it.
In addition to not being able to keep up with household chores, this person may begin to feel very isolated. “After losing his wife of all those years, to be alone in the home is socially isolating, and he’s aware that he needs some form of outside stimulation. This is a classic case of someone who can no longer live alone,” Varano says, and this person, who in this case is still cognitively intact, should consider looking for an assisted living facility that allows him to be as independent as possible, but that takes care of those household chores he can’t or won’t do for himself.
“He can still go to doctors’ appointments, he can still visit family, however his room is cleaned, his laundry is done and his meals are prepared. Someone is always there if he wants a conversation.” This is the ideal candidate for an assisted living facility.