Americans continue to live longer than ever before, resulting in a growing population of seniors. While just 14.5% of Americans were aged 65 or older in 2014, the Census Bureau predicts the proportion to increase to 23.5% by 2060. This comes out to approximately 98 million seniors, many of whom need long-term care or residential living options. In the past, seniors had limited choices for long-term care, with skilled nursing care being the only option in many cases. In the 1970s, the assisted living movement came to fruition when it became clear that more intermediate-care facilities were needed to meet the country’s elderly population’s needs.
Today, assisted living has expanded dramatically, and there are currently almost 30,000 assisted living communities in the United States. While all communities provide the same basic care, their amenities, extra services, environment, and culture makes them unique. And though it’s great to have options, the vast number of communities to choose from can make finding an assisted living community for yourself or a loved one quite challenging.
We created this guide to help seniors and their families learn more about assisted living, its services, and its costs. We also cover details of financial assistance options for assisted living and the aspects one should focus on when choosing a community for themselves or a loved one.
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The Basics of Assisted Living
Assisted living is a type of senior care that provides older adults with personal care assistance and assistance with the activities of daily living (ADLs). Residents of assisted living facilities (ALFs) can retain as much independence as they’re able while still receiving necessary assistance with personal care tasks such as laundry, meal preparation, and grooming. Most ALFs also offer opportunities for socialization and entertainment, such as planned activities and seminars. They also frequently have some on-site amenities such as a fitness center, barbershop, and formal dining rooms.
Assisted living communities do not provide skilled medical care. Seniors who need this high level of care are better suited for nursing home care. However, ALFs do assist residents with medication management, transportation to and from appointments, and first-aid and emergency care. Staff also remain on-site around-the-clock to assist residents during any emergencies.
Benefits of Assisted Living
Staff is available around-the-clock
Though ALFs are not the best fit for seniors who need high-level, around-the-clock care, the staff is on-site at all hours of the day and night to assist residents when needed. Staff are always present to provide support during emergencies and get residents the help they need. Having staff readily available at all times can give peace of mind for both residents and their families that help is always there if an emergency does occur.
Communities have on-site amenities for residents to enjoy
Most ALFs feature on-site amenities such as a fitness center, art studio, barbershop and beauty salon, and common areas. Having all of these amenities on-site makes them easy for seniors to enjoy and eliminates the need to organize transportation to participate in fulfilling activities. On-site amenities also serve as a community meeting place where residents can get together and enjoy the community’s amenities as a group.
Care is tailored to each individual’s needs
ALFs provide care to residents on an as-needed basis. So, someone who only needs assistance with one or two of their ADLs have access to that care, but can otherwise live independently. In this way, assisted living residents receive all of the care that they need, and nothing extraneous that they do not.
Residents can choose how they’d like to spend their time
Other than scheduled meal times, residents have their entire days to spend as they please. They have the freedom to decide whether to spend their day relaxing, using group transportation to run errands, or participate in on-site events. And because amenities and activities are available on-site, seniors who no longer drive or struggle with mobility still have plenty of options available to them. Alternatively, introverted or quiet residents have the freedom to spend their days independently.
Residents have many opportunities to socialize
Assisted living communities, especially the larger ones, are social environments. Living in a community of other seniors provides many opportunities for residents to form friendships and socialize with one another. On-site events and activities like musical performances, art classes, and holiday parties present many changes for residents to engage and mingle, helping stave off feelings of isolation that sometimes come with old age.
Community staff handles all exterior and interior home maintenance
Household tasks like cleaning and landscaping can be physically taxing and dangerous for those who have mobility or balance challenges. Assisted living staff handles all aspects of interior and exterior maintenance, including apartment repairs and housekeeping. Residents can be free of the burden of home maintenance and simply enjoy all that the ALF has to offer.
The Scope of Care Provided in Assisted Living
Assisted living residents live independently in their own apartments but have access to personal care services and trained staff around-the-clock. While these communities do not offer skilled medical care, they do provide residents with many other services. The most common assisted living services include:
- Personal Care Services: Personal care activities, or the activities of daily living, include everyday tasks such as getting dressed in the morning, bathing, and eating. Assisted living staff is available 24 hours a day to help residents complete their ADLs as needed.
- Laundry and Housekeeping: ALFs typically provide basic housekeeping services, including vacuuming, dusting, and changing linens. Staff is also available at all times to help with unexpected messes like spills. Laundry services are standard for assisted living communities, but note that many apartments do not have in-unit washers and dryers because of this.
- Interior and Exterior Maintenance: As a resident of an ALF, seniors will never have to worry about any type of exterior maintenance or landscaping. Maintenance staff is also available to help residents with interior maintenance or repairs, such as fixing a leaky faucet.
- Transportation: Most communities provide transportation for outings like grocery shopping and other group trips, and provide residents with scheduled chauffeur services for any personal needs like appointments or errands. Sometimes, private transportation costs an extra fee.
- Social Activities and Events: Assisted living communities offer group activities to make it easy for residents to socialize. Most offer organized events like exercise classes, visiting lecturers, and book clubs and have common rooms or community amenities available for casual socializing. Residents may also participate in scheduled group outings. As part of their licensing standards, some states require ALFs to provide a minimum number of hours of social activities per week.
- Health Care: ALFs do not provide high-level medical care like a nursing home. But, some health services are available to residents, such as emergency first-aid and medication management. Some communities schedule on-site doctor’s or nurses’ visits for residents and assist residents in setting up appointments and transportation for seeing outside physicians.
- Safety: Assisted living staff are present around-the-clock to ensure that assistance is available 24 hours a day. In the event of an emergency, staff will always be on-site to get residents the care they need. Many communities also utilize medical alert systems that enable residents to signal that they need assistance immediately.
Signs That It’s Time for Assisted Living
Assisted living offers a wide range of services, and seniors with needs can benefit from moving to an ALF. But as with many other senior care options, it can be challenging to determine if your loved one is a good fit for assisted living. Below, we cover some signs that it’s time to move to an ALF and that someone will benefit from assisted living.
- Personal Care Challenges: One of the main reasons seniors choose to relocate to assisted living is difficulty with personal care tasks. If your loved one is starting to struggle to complete ADLs like dressing, grooming, and bathing independently, assisted living is likely a good fit. ALF staff assist with these personal care tasks as needed, so residents can live independently while still having access to assistance when needed.
- A Decline in Cleanliness: As mobility declines, keeping up with housework like cleaning and laundry becomes increasingly difficult. If you notice that a loved one’s home has become more cluttered or dirty, it may indicate that they’re struggling to keep up with housework. ALFs relieve seniors of these responsibilities while allowing them to retain their independence.
- Loneliness: Living at home, especially if the person no longer drives, can leave seniors feeling isolated and lonely. Prolonged periods of loneliness have been linked to health problems like depression, obesity, and Alzheimer’s disease. The community environment of ALFs can be a positive change for many seniors.
- Safety Worries: Falls, injuries, or other accidents in the home are a common problem for seniors. If your loved one lives alone, you may worry about them having an emergency while home alone. Assisted living staff are on-site around-the-clock and available for emergency assistance at all times, so you never have to worry about your loved one being without help during an emergency.
- Difficulty Driving: Many seniors give up driving at some point, leaving them frustrated and isolated at home. ALFs typically provide transportation services for residents to attend appointments, social events, and run general errands. This service enables residents to still get out of the house and enjoy their favorite places even without driving themselves.
- Frequent Forgetfulness: All people experience forgetfulness sometimes, but for some, it becomes more frequent and burdensome with age. Forgetting appointments, to lock the front door, or to set the alarm can have severe consequences if it becomes regular. ALFs provide a safe environment for seniors and can provide appointment reminders and transportation, helping to solve the problems caused by memory loss. If memory loss becomes more severe, some communities have dedicated memory care units.
Assisted Living Costs
In the United States, assisted living costs an average of $4,051 per month. This national average reflects a high variation in cost between different states. For example, in New Hampshire, the average cost of assisted living exceeds $7,000 a month, one of the highest costs for assisted living in the country. But, in other areas of the country, prices are far lower than the national average. In Alabama, for example, assisted living costs an average of $3,250 a month as of 2019.
In addition to location, other factors can affect how much a community costs. Assisted living communities with more amenities or those that have been recently renovated are likely to cost more than communities that offer more basic services. If amenities like a state-of-the-art fitness center or finely appointed apartments are important to you, be prepared to spend more.
Cost structures also vary between different communities. Most ALFs charge an all-inclusive monthly rate that includes one’s individual or shared accommodation, meals, personal care assistance, access to community amenities and activities, and housekeeping services. However, some may simply charge a “rent” fee for one’s apartment and then charge on an as-needed basis for any extras like laundry, meals, use of transportation, and even use of personal care assistance. It’s imperative to make sure you understand what is and is not included in a community’s listed price before signing a contract to move in.
Financial Assistance for Assisted Living
Many seniors utilize one or more forms of financial assistance to pay for assisted living. First and foremost, it’s important to note that Medicare does not cover ALFs- something many seniors and their loved ones are surprised to learn when they first start looking into assisted living. Still, there are other options available. Below, we explain some of the most common sources of assistance.
Medicaid and Medicaid Waiver Programs
Medicaid does provide some financial assistance for assisted living for seniors who qualify for the program. Unlike Medicare, which is federally regulated, Medicaid is a joint program between the federal and state governments. Thus, each state can set its own Medicaid guidelines, and coverage of assisted living can vary.
In most states, Medicaid covers assisted living costs through a waiver program. Medicaid waivers allow states to add benefits and coverage to their state’s program that may fall outside federal guidelines, like coverage of long-term care for seniors. The Home and Community Based Services (HCBS) Medicaid waiver program expands senior care coverage to give seniors more autonomy over the type of care they use and prevent unnecessary moves to skilled nursing homes. The availability of HCBS waivers and what is covered varies by state, so be sure to check your state’s Medicaid coverage and eligibility guidelines.
The Department of Veterans Affairs offers several financial assistance programs for aging veterans, including the Aid and Attendance benefit. Aid and Attendance (A&A) is a monthly payment that eligible veterans receive in addition to their standard monthly VA pension to help finance long-term care services, including assisted living.
To be eligible for A&A, veterans must first be eligible for and receiving a VA pension. Veterans must also meet one of several eligibility qualifications, one of which is needing assistance with ADLs, making A&A a feasible option for most veterans in need of assisted living. To receive the benefit, veterans must undergo an examination by a physician and complete the accompanying VA form.
Life Insurance Settlements
Though not its original purpose, life insurance policies can sometimes be used to help seniors pay for long-term care like assisted living. In some cases, a third-party company will buy the policy for a lump payment of 50-75% of the policy’s initial value. Some insurance companies will allow policyholders to access their benefit early, in what is known as an “accelerated death benefit.” Like with the previous option, accelerated death benefits are almost always not the full value of one’s initial death benefit. But, having liquid cash to use during one’s lifetime is worth it to some.
Regardless of what avenue you choose to achieve a life insurance settlement, forfeiting your life insurance policy’s death benefit is a significant decision. Be sure to weigh the pros and cons of accessing your benefit now and consult reliable resources before you make a decision.
In some cases, seniors can use a reverse mortgage loan to help cover the cost of assisted living. Reverse mortgages allow homeowners to convert some of their home’s equity into cash, or in other words, take out a loan against the value of their home. The payment is typically tax-free and enables seniors to move to a residential care community like an ALF without feeling like they need to rush to sell their home prematurely to have the money for their care.
Reverse mortgages do have their limitations and are not the right choice for everyone. Notably, reverse mortgages can “use up” a home’s equity, leaving fewer assets for the homeowner’s spouse or heirs. Additionally, be on high alert for scam companies or untrustworthy loaners. When possible, it’s best to use the federally-insured Home Equity Conversion Mortgage (HECM) loan. In addition to being backed by the federal government, HECM loans typically result in larger advances at a lower total cost than loans from private companies.
Long-Term Care Insurance
Long-term care (LTC) insurance is a type of private insurance policy that covers senior care, including personal and custodial care services. This type of insurance is most likely to directly cover assisted living than Medicaid and private health insurance plans. But, it is usually not possible for seniors to sign up for an LTC insurance policy; this type of insurance is typically only available to those who signed up for a policy earlier in life. Once one needs assistance with their ADLs, they typically cannot get an LTC insurance policy.
Additionally, LTC insurance policies vary dramatically in terms of what they do or do not cover. It’s important to check the policy’s specifics to determine if assisted living is covered, and if so, the maximum amounts that the policy will pay per day and year.
Assisted Living Laws and Regulations
Assisted living communities are regulated at the state level. Each state’s Department of Health and Human Services, Department of Social Services, or a similar department is responsible for both creating and enforcing assisted living laws and regulations.
States all have their own long-term care models, and thus the exact role of and services provided in assisted living can differ. While the specifics vary, the below categories are some of the most important:
- Scope of Care: How much care are ALFs legally allowed to provide? Can they only provide personal care services, or are they allowed to offer some medical services?
- Admissions Requirements: Under what circumstances may a person be admitted to an ALF? What conditions, behaviors, or needs disqualifies someone from residing in an ALF (i.e., high-level medical needs, aggressive behaviors)?
- Staff-to-Resident Ratios: How many staff members must a community have on-site at all times to adequately meet the needs of their residents?
- Staff Training: How much training must staff undergo before beginning employment? Are there any continuing education requirements? Do the requirements change based on the specific staff position?
- Care Plans and Monitoring: What evaluations and care planning must be completed prior to resident move-in? Are there any monitoring requirements or requirements to update the care plan?
- Memory Care: Are ALFs permitted to care for people with dementia or Alzheimer’s disease? What specialized training must staff undergo to provide memory care? Are there any building requirements for dedicated memory care units?
How to Select An Assisted Living Community
Selecting an assisted living community for yourself or a loved one is a major undertaking. Determining the “right” community will depend on your budget, care needs, interests, health status, and personal preferences. Because there are so many different elements to consider, we recommend getting clear on a few things before you even begin the process of looking into ALFs in your area. Thinking about the following categories from the start of the process can help you save time and focus your search only on those communities that truly meet your needs.
- Budget: How much can you comfortably spend per month on an ALF? How does this compare to the average cost in your area? Knowing the average costs in your city compared to your budget can help you manage expectations or modify your plan to find care that better fits your budget.
- Care and Health Needs: Does your loved one need assistance beyond the basic ADLs? For example, is chauffeur service necessary, or an on-site nurse to help with medication administration? Besides offering assistance with ADLs, services available at facilities can vary, so be sure you know what services you need to be available on-site.
- Interests and Sociability: Do you plan to pursue your hobbies and interests, and if so, are any on-site amenities required for you to achieve this (i.e., an on-site swimming pool for an avid swimmer)? Are you a social person and plan to spend time socializing with other residents? If so, it’s important to choose a facility that offers your preferred on-site amenities and offers many group activities for residents.
- Tastes and Preferences: What is most important to you when it comes to an ALF? Do you care most about having spacious apartments, a spotlessly-clean facility, or high-end, luxurious design and features? Getting clear on what matters most to you can help you narrow your search down to only include those communities that meet your personal standards.
Top Factors to Consider When Choosing an ALF
Senior care tends to be expensive, and assisted living is no exception. To avoid frustration and disappointment down the line, always find out about a community’s cost before spending much time researching or visiting it, and make sure the price fits in your budget. To get a sense of how much assisted living costs in your city, you can check the Genworth Financial Cost of Care Survey.
It’s also important to keep in mind that cost structures can vary between different facilities. While one may charge just one monthly all-inclusive fee, others may charge a much lower monthly base fee and then charge for services on an as-needed basis. Be sure you understand exactly what is and is not included in a community’s monthly cost to avoid any surprises or financial stresses in the future.
While all ALFs across-the-board provide personal care services and assistance with ADLs, other services can vary. For example, some communities may have an on-site nurse who can tend to residents’ higher-level medical needs, while others do not offer any medical care beyond basic first-aid. Find out what services are available at all of the communities you’re considering, especially if there are any “must-haves” for you like on-site therapy services. Even if you do not need any type of health care yet, you may decide that you would like to live in a facility that offers these services in case the need arises in the future.
For some seniors, an ALF’s location can have a significant impact on their quality of life. In most cases, seniors and their families want an ALF this is located near other loved ones. But, that’s not the only location factor that one should consider. It’s also important to think about the surrounding area’s noise level or if there are any parks nearby, or how close it is to doctors’ offices or grocery stores. Living too far away from friends and family, health services, or nature can all potentially have a negative impact on the resident.
If you have family members and close friends who live in several different states, it may be worth considering assisted living costs in each of the states and their regulations. In some cases, it may make more sense to choose one state over another because of price or because ALFs in those states can offer a wider variety of or higher levels of services.
ALFs come in many different sizes. Some house only a few residents at a time, creating a much more personalized experience. These “care homes,” as smaller ALFs are often referred, provide more personal attention than larger communities, but may also have fewer amenities, activities, or social opportunities for residents. Many larger ALFs house over 100 residents, and are likely to have more amenities and activities than care homes. But, larger facilities can come with their own downsides, like larger buildings for residents with mobility challenges to navigate.
While there is no “right” or “wrong” when it comes to the size of an ALF, it can affect your quality of life, so be sure to think about what size facility is the best fit for you.
Your ALF will become your home, and it’s important to choose a community where you feel comfortable. When researching and touring communities, pay attention to staff and resident interactions and their participation in community activities and events. If possible, tour a community in-person and talk to current residents to see if it’s culturally and socially a good fit. When in-person tours are not possible, be sure to read online reviews from other residents to get a sense of how they feel about the ALF.
Focusing on the above factors can help you both narrow down your initial search and serve as a useful way to compare and contrast communities to see which best meets your needs. To learn more about your local assisted living options, view the listings below. To learn more about assisted living in your area, select your city or state from the list below.
Frequently Asked Questions
What Is the Difference Between a Nursing Home and an Assisted Living Facility?
The biggest difference between a nursing home and an assisted living facility is that nursing homes provide skilled medical care while assisted living facilities do not. Rather, assisted living facilities provide personal care services such as housekeeping, assistance with daily living activities, and transportation. Thus, nursing homes are better suited to care for those in need of regular medical care and therapy services.
How Much Does Assisted Living Cost?
Assisted living costs an average of $4,051 per month in the United States. It is more expensive than independent living and less expensive than skilled nursing care. Assisted living costs vary by location and depending on the community’s amenities and other features.
When Is It Time for Assisted Living?
In general, it is time for assisted living when one can no longer independently complete their daily living activities. The “right time” for assisted living varies depending on the individual person. In addition to needing assistance with ADLs, other signs that it is time for assisted living include accidents or injuries occurring in the home, mobility challenges, and a decline in cleanliness.
What Services Are Usually Included in Assisted Living?
Personal care assistance, prepared meals, and housekeeping and maintenance services are usually included in assisted living. Transportation is also frequently included in an assisted living community’s monthly cost. High-level medical care and therapy services are usually not available at assisted living communities.
How Do You Choose an Assisted Living Facility?
To choose an assisted living facility, consider factors such as your budget, how much care you need, your preferences for facility features and amenities, and the community culture you’re looking for. It’s best to do some online research of facilities in your area to understand your options and try to visit your top choices in-person or do a virtual tour.
Learn More About Assisted Living in Your Area
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Rhode Island
- South Carolina
- South Dakota
- West Virginia
- Ann Arbor
- Cedar Park
- Delray Beach
- Fort Lauderdale
- Idaho Falls
- Kansas City
- La Mesa
- Laguna Hills
- Las Vegas
- Mount Pleasant
- New York City
- Palm Bay
- Palm Beach
- Palm Springs
- South Bend
- Spring Hill
- Saint Louis
- The Villages
- Traverse City
- Walnut Creek
- West Chester
- Woodland Hills