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Choosing an Assisted Living Facility
What should I look for when considering assisted living?

Assisted living is appealing to people who do not need skilled medical help that a nursing home provides. Instead, you want to maintain a higher level of independence and still enjoy the company of others who are active, like you. Each state regulates and license assisted living facilities in which they operate. Each facility offers a wide range of services, personal care options, and amenities.

For many seniors, it is an inviting alternative over maintaining a house, preparing meals, and coping with living alone. For some, the decision to move to an assisted living facility comes when a change in health occurs, like after a fall and sustaining an injury. Assisted living is a good option for older adults who need a little help and want social interaction too.

How to Know if Assisted Living is Right for You

Choosing an Assisted Living Facility
Choosing an Assisted Living Facility

If you don't know whether assisted living is the right senior housing option, answer the following questions. Your answers give insight into how much help you need and if assisted living is a good fit.

Answer these questions:

  • Do you need help with getting into and out of a shower safely?
  • Do you need help with general housekeeping?
  • Do you need help with managing medications?
  • Do you need a little help with managing personal care?
  • Do you need help with supervision for personal safety?

If you answer "yes" to one or more, it is time to start your search for an assisted living alternative lifestyle.

Where to Start in the Search for a Facility

Search for assisted living

When you decide to begin the search for an assisted living residence, the question becomes, "How do I or we choose the one that best suits my or their lifestyle and care needs?"

Planning early helps you to avoid a rushed and frantic decision, one that might lead to a wrong choice. Do not wait till you or a loved one is in a crisis or a state of emergency. Give yourself time to explore and visit all the available options, settings, and services. Your current physical and mental needs serve as guideposts and will direct the questioning and discussions with admissions personnel when the time comes.

Get input and recommendations from your medical team, friends, church members, and local community agencies. Visit your local Area Agency on Aging or State Office on Aging to find valuable information and guidance on regulations, rules, and assisted living facilities in the area.

Choosing a Community

Look for an assisted living facility that embraces "consumer choice" as described by the National Center for Assisted Living and the American Health Care Association.

As a resident expect to:

  • Be treated with dignity and respect
  • Be informed of services available and the limitations of those services
  • Manage your personal funds
  • Retain and use your personal possessions
  • Interact freely with others both inside the residence and in the community
  • Have freedom of religion
  • Control your health-related services
  • Maintain your privacy
  • Be free to exercise your rights and responsibilities as a resident
  • Have the right to voice or file grievances

Choosing a Location

The location is the most significant of factors. It's important to live close to friends, family, your medical team and the local business community. Try to choose a residence within a 20 to 30-minute drive, in order to encourage visitors and maintain medical providers.

Services and Costs

Assisted living service fees vary by the community size and number of services offered in the base rate. Other services are an added cost to the base rate. As needs increase, a resident requires more personal care services.

Check with each community to learn if and what services are in the base fee structure and how much the "extra" personal care services cost. Here's a list of a typical "menu" of services offered:

  • Care management and monitoring
  • Help with activities of daily living
  • Housekeeping and laundry
  • Medication management
  • Recreational activities
  • Security
  • Transportation
  • Two meals per day or more
  • Increase in frequency and time for personal care
  • Incontinence care
  • Laundry service beyond basic service
  • Meals delivered to living quarters
  • Specialized care for dementia

Get Information on the following:

  • The different levels of care
  • How would additional services be determined?
  • Would they be able to move to a higher level of care within the same community?
  • Would the family be notified?
  • When and how is it determined that a resident is no longer appropriate for the community?

Determining your Budget

Budgeting for assisted living

Many seniors do not plan for future care and living options. If you are in the group that hasn't planned, your options may have limits.

The national base rate for assisted living can vary quite a bit from state to state and depending on the services needed. Medical insurance and Medicare does not pay for assisted living. However, long-term care insurance covers assisted living costs, depending on the policy you buy and how comprehensive the terms. If you have a policy, check with your long-term insurance carrier to review the plan in-depth.

Most seniors, living in an assisted living facility, pay out-of-pocket. However, some states provide subsidies or Medicaid waivers for those who meet Medicaid income and asset guidelines.

The State Medicaid waivers provide community-based long-term care services, such as assisted living. Find out more what your state offers by contacting your Area Agency on Aging or State Office on Aging, or contacting the federally funded Eldercare Locator at 800-677-1116.

Pay Options include:

  • Income from social security and other pensions
  • The sale of the family home and other investments
  • Personal retirement savings
  • Assistance from family
  • Long-term care insurance
  • The VA Aid and Attendance Program
  • Settlement of a life insurance policy that is no longer needed
  • Medicaid is available on a limited basis to income-eligible seniors

Choosing to share your apartment

(A less-known pay option is the reverse annuity mortgage, which allows seniors to use the value of the home without giving it up. With this option, instead of the resident paying a mortgage, the financial institution pays the homeowner a lump sum or monthly payment, which the homeowner can then use for senior housing. Most experts suggest the reverse mortgage be considered only for the last five years or so of senior housing.)

It's important to carefully review the agreement to understand billing, bed reservations, refunds, and payments. Do you understand everything in it and does it include all the services you want and need, including health care/personal care--the levels of care?

Size

Most assisted living facilities have between 25 and 120 units altogether. A smaller residence similar to a traditional home in a residential neighborhood, while others provide one room.

Costs vary with sizes and types of apartments too. Find out exactly what the basic rate covers and the charges for special or select services you want. Some bill on a month-to-month lease arrangement, while others request long-term arrangements.

What type of setting would you prefer? The most important factor is a person's care needs and preferences. Be sure to match the community's scope and limits of services to your needs first before looking at the costs.

Staffing

As you review communities, compare and interview the staff. The attitudes of the staff will tell you a lot about the residence. Look into the turnover rate and how they interact with residents. It's best to visit the same community at different times during the day to observe how the staff members balance the residents' needs and how they carry out house rules and routines.

Are the staff members employed directly by the community or by a third-party provider?

Staff members include:

  • Administrators or directors, who manage the residence
  • Nurses, who assist residents with health care services and planning according to state regulations
  • Medication assistants who help residents with their medications; personal care staff, which assist residents with personal needs, such as bathing, eating, and dressing
  • Marketing/admissions personnel, who market the residence and assist with the move-in
  • Dining staff, who prepare and serve nutritional meals to residents
  • Activities coordinators, who organize recreational activities and spiritual programs for residents

Maintenance and Housekeeping

In general, it is up to the assisted living residence's management to ensure that an appropriate number of employees are available to provide for the health, safety, and wellbeing of the residents and maintenance of the buildings and grounds.

Plan for the Services You Need

Keep these questions in mind when planning for the services you may want or need:

  • Can your family be involved in the service planning too?
  • How often are your needs assessed?
  • What staff member completes your assessment?
  • Are special programs designed for residents who have Alzheimer's disease?
  • Are special programs designed for residents with disabilities?
  • What happens if my health care needs change? Services and Activities
  • Will a staff member assist me with medications? If so, what type of training did they receive?
  • Do you have a pharmacy on campus? Will the pharmacy participate in my Medicare Part D prescription drug plan? Does the pharmacy provide a yearly review and consultation services?
  • Are professional nursing services on site? If not, will you help me make arrangements through a third-party home health agency?
  • Is there a wellness program?
  • Is there a therapeutic exercise or fitness program?
  • What are the procedures for getting emergency medical attention?
  • How often do I get health care monitoring?
  • Can a family member be my link to recognize my health care needs are met?
  • How do you accommodate me with my preferred activity interests?
  • Is transportation provided for medical appointments and recreational purposes?
  • Is there a fee?
  • Are there resident and family councils?
  • How often do they meet?
  • What are the suggestion, complaint, or grievance procedures?
  • Can hospice care be offered? If so, do you coordinate that care with my medial team and family?

Specialized Care

For individuals who have a cognitive impairment like Alzheimer's and require supervision, find a setting that 's dedicated to providing that specific specialized care. The specialized care is better prepared for mental and physical health care needs. The specialized care environment increases stimulation for mental and emotional wellness.

How to Evaluate the Quality of Care

Evaluate quality of care

Since assisted living communities are overseen by state governments the regulations vary from state to state. Ask whether the community has a license to operate in your state. To learn about the regulations in your state, you can download the Assisted Living State Regulatory Review, published annually by the National Center on Assisted Living.

This comprehensive guide summarizes the regulations in each state and reviews a wide range of important requirements on such issues as medication administration, staffing, and move-in and move-out conditions. To obtain a printed copy, call 202-898-2855. Another way to check on the community is to contact your local Long-Term Care Ombudsman to see if there are any complaints on file against the community. Or call 202-332-2275 to obtain an ombudsman in your state.

As we get older, we experience frailty and other health complications. You need to understand how the community will justify and charge for the costs of increased services that's needed. You also need to know how the facility determines when they are not able to care for you. It may seem like an uncomfortable dialogue, but knowing the answers to these questions can provide long-term comfort for you.

Ask the community for written material, including copies of the residency agreement that outlines, at a minimum, services, fees, extra charges, move-in and move-out criteria, staffing, and house rules.

As you begin your search for an assisted living community, assess your current needs and be prepared to ask each provider how it might accommodate any changes in your needs over time. Examine your finances and ask about costs. Monthly rates and fee structures vary.

Most of all, if you are a family member, seeking a community for a loved one who cannot visit the community personally, it's important to respect their needs and wishes by including them in the process as much as possible. The result will be their greater satisfaction.

As you assess assisted living communities, you will likely visit a number of them. To help you determine the one that's right for you or your loved one, consider the following questions to evaluate each community based on your needs.

  • The size of the facility desired?
  • The type of room desired (single room, kitchen included, private bathroom, etc.)?
  • Looking for a small house-like environment or large, community type living?
  • Do you want to live with other similar residents (elderly, younger adults, mental issues, etc.)?
  • What are the payment options available? (private pay, Medicaid, etc.)
  • What location is ideal (nearby outside activities) and (comfort of hospitals, doctors, etc. nearby)
  • The costs of the facility?
Carol Marak
Carol Marak

After seven years of helping her aging parents, Carol Marak has become a dedicated senior care writer. Since 2007, she has been doing the research to find answers to common concerns: housing, aging and health, staying safe and independent, and planning long-term.