Assisted Living Facilities

Assisted Living Facilities

These facilities target seniors with physical or cognitive impairments that make it difficult for them to perform an average of two ADLs without assistance (Golant, 2004). The typical occupants of assisted living facilities are women living alone in their late 70s and 80s. These shelter and care options are known by different and confusing labels: residential care facilities, personal care homes, catered living facilities, retirement homes, adult care homes, board and care homes, domiciliary care homes, rest homes, community residences, and sheltered care. Since the 1980s, however, the private sector has favored the assisted living label to distinguish its professionally managed residences from the board and care option serving poor seniors. Most assisted living facilities are owned by for-profits or are publicly held. Most for-profit facilities are stand-alone and for seniors only, while nonprofit assisted living facilities are usually part of an age continuum. State governments increasingly recognize assisted living facilities as a distinct seniors housing category in their regulations (Mollica, 2002).

Eligibility for Assisted Living Facilities

It is important for seniors to know about the state laws and regulations that determine eligibility for being accepted into an assisted living facility. In addition, seniors should consider the importance of reading and understanding all the terms and conditions of the facility's contract. Seniors would also benefit from legal and tax advice prior to signing any contract.

Assisted living facilities offer all the services - meals, housekeeping, and planned social and recreational activities - of congregate living facilities. What distinguishes this alternative is its on-site staff, who are available 24 hours, seven days a week for protective oversight to meet both the scheduled and unscheduled needs of their more frail residents. Thus, assisted living facilities distinguish themselves from most home care delivered by professional agencies that offer assistance only at scheduled fixed times and for minimum blocks of time.

Even as they need assistance with several of their everyday activities and may require some nursing services, seniors in assisted living facilities tend to be less impaired and have fewer health problems than nursing home residents. Most assisted living facilities are unable to deal with the medical conditions of residents who require continuous assistance and monitoring. Thus, they will not accept residents who need around-the-clock skilled nursing procedures or who require ongoing supervision because they get confused, wander, or have memory, judgment, or behaviral problems. Generalizations must be made carefully, however, because a growing share of assisted living facilities now accommodate persons with dementia in designated sections of their properties (Golant, 2004).

Assisted living facilities come in all sizes and range from one-story buildings to high-rises. They may be freestanding or part of a building or campus that also contains a nursing home or a congregate living facility. On average, they consist of just over 50 units (or beds). They generally appear more residential or hotel-like than nursing homes. Their accommodations typically include two-bedroom apartments or studios with kitchenettes or comfortably furnished private rooms with their own baths or showers, doors that lock, and individual temperature controls. They are likely to have grab bars in their bathrooms, some type of emergency call system, and design features sensitive to the needs of physically frail clientele, but they will eschew nursing stations, long corridors, and institution-like tile floors (Brecht, 2002; U.S. Senate Special Committee on Aging, 1999).

A unique philosophy of care also distinguishes assisted living facilities from nursing homes. Assisted living facilities seek to treat residents with dignity and respect and allow them to ahve more say over planning their assistance and care, and to give residents more independence and privacy without jeopardizing their safety or security.

"If You've Seen One Assisted Living Facility, You've Seen One."

An overview of the assisted living alternative is hardly enough to use in making a decision, though. You must be aware of why selecting an appropriate facility may be very difficult.

Assisted living facilities can deviate spectacularly from each other. Absent federal regulations, each state regulates its own version of this option. Within any state's guidelines, individual assisted living operators operate very different facilities.

The result is that assisted living facilities can have very different design, management, safety, and, most important, admitting standards. Some will ahve architectural styles and design features that resemble either upscale or bargain-rate hotels. Others will look more like nursing homes because of their hospital-like appearance and because residents must share their rooms and toilet and sink facilities. Some assisted living facilities will admit residents with frailty profiles that resemble those of nursing homes, while others will only accept or accommodate less impaired and healthier residents.

Thus, seniors and their families must make two critically important judgements:

  • Ascertain whether a prospective assisted living facility will accept and continue to care for or accommodate their physical and mental impairments even if they worsen. Will an assisted living facility be their last residence or merely a temporary stop on their way to a nursing home?
  • Decide whether even the most desirable stay in an assisted living facility can justify the considerable time and energy demanded by moving again (American Health Care Association, 2004; Coalition of Institutionalized Aged and Disabled & Nursing Home Community Coalition, 2003). A good source of information is CareGuide.

Some seniors will have no decision to make because of this option's high costs. The 2003 monthly abse fee for assisted living units averaged $2,379 (MetLife Mature Market Institute, 2003a). Potential residents must also scrutinize carefully what services are included in this base rate. Often, when residents become more impaired, the facility will charge them substantially higher monthly costs to pay for heavier duty care. Monthly feeds may also increase just because of ordinary cost-of-living increases.

Be Alert to Cost Creep

The fact that costs and fees can increase over the base rate is called cost creep. Advise your senior clients exploring the possibility of moving into an assisted living facility to examine the facility's contract carefully to determine if it allows cost creep to occur. Seniors should seek counsel from their lawyers and tax advisors in making their final decisions. Although many assisted living facilities do not operate this way, other facilities do.

Most occupants will pay for the assisted living alternative out of their own pockets because Medicare, Medicaid, and many long-term care policies do not offer coverage. Some states subsidize the costs of these accommodations through their Medicaid Waiver program, but these affordable units are scarce.

Residents typically handle their costs for assisted living by one or a combination of the following:

  • relying on their incomes (typically, interest on investments, Social Security, and private pensions)
  • drawing on their savings (often from the earlier sale of their homes)
  • receiving financial assistance from their grown children

The information above is reprinted from Working with Seniors: Health, Financial and Social Issues with permission from Society of Certified Senior Advisors® . Copyright © 2009. All rights reserved.