What is “Assisted Living” and How Much Should it Cost?

Choosing a long-term care option for an aging loved one is a stressful life decision, one that often puts you at odds with someone that you love. The stress of moving, especially from a family home, can be hard on everyone. A knowledgeable perspective is the best approach to transitioning a loved one from independent living to a care facility.

The purpose of this guide is to provide you with information that will make the decision easier. By weighing the potential benefits of assisted living over other care options, a number of factors come into play, including the cost, location, amenities, and care services. We also review the potential downsides of the transition to assisted living, as well as potential ways to pay for this new step in your loved one’s life.

What Is Assisted Living?

Assisted living provides residential senior care with a focus on personal care services, including meal preparation, housekeeping, and activities of daily living (ADLs) like bathing, eating, and dressing. Many assisted living facilities or ALFs also offer lifestyle services, including transportation, scheduled activities, and on-site amenities like beauty salons and barbershops.

ALFs are suited for seniors who need assistance with daily tasks and/or those who predict they will need it in the future. It is not suited to anyone in need of high-level medical care since ALFs offer only day-to-day medical services like first aid. Fortunately, residents can access as much or as little non-medical assistance as they need, which allows them to retain as much independence as they can with the help of 24/7 staff.

How Much Does Assisted Living Cost?

According to the 2023 Genworth Financial Cost of Care Survey, assisted living services in the United States cost an average of $4,774 per month. However, the difference between states can be much higher or lower than the average, with high-cost-of-living areas like New Hampshire averaging $6,422 per month and low-cost-of-living areas like Missouri averaging $3,182 per month. Note that the difference could save (or cost) your family over $38,000 per year.

What Can Affect Assisted Living Cost?

Even within the same town, assisted living costs can vary since different facilities offer unique amenities and services. A luxury community with extra amenities like a spa, tennis court, or concierge will cost more than a facility that only offers the basics, even if they’re next door to each other. Prospective residents and families should inquire into each ALF for its pricing structure and amenities since the average for the location may not be the price you’re paying.

Pay particular attention to the pricing schedule since many ALFs charge residents via an all-inclusive monthly bill while others itemize the charges for each service. Those on a set budget should prioritize communities with a more predictable pricing structure.

The Cost of Assisted Living Versus The Cost of Other Senior Care Types

*National averages taken from Genworth’s Cost of Care Study (2021)

For seniors who require assistance with their ADLs, assisted living may be more economical than in-home health care in the long run. This is because in-home care is often charged hourly, so as the need for care increases, so does the bill.  For example, 2 hours of care per day from a home health aide cost an average of $1,738 per month, using averages for 2023. At 5 hours per day, the cost becomes $4,344. Over that, the price becomes higher than the national average for assisted living.

However, both in-home and assisted living care are more affordable than nursing homes, which cost $8,390-$9,584 per month on average, depending on whether the room is semi-private or private. The level of care is much higher and includes medical assistance, so matching the level of care to your loved one’s needs (both now and in the future) is crucial to finding care services you can afford.

How to Pay for Assisted Living

Many families struggle to pay for assisted living out-of-pocket, especially after learning that Medicare does not cover these expenses. However, several alternative financial assistance options could help you manage the cost of senior living services. Note that not everyone will be eligible for each method, but low-income seniors and their families will likely have at least one avenue to explore.

Medicaid

Medicaid is a joint federal and state program that provides health insurance to low-income Americans, including seniors. Each state has its own Medicaid program with unique services and eligibility requirements. Most offer some coverage for assisted living costs, though most do not cover them 100%.

If your state’s Medicaid program excludes assisted living costs, look into a Medicaid waiver program to expand your coverage to additional services. For instance, Home & Community-Based Services (HCBS) waivers, also known as 1915(c) waivers, expand Medicaid coverage to help seniors receive long-term care in their preferred environment, like an ALF. Seniors eligible for Medicaid coverage can apply for these waivers, but they must meet additional qualifications to receive the benefits. There may also be a waiting list.

Veterans Benefits

Veterans and their spouses may qualify for aid from the Department of Veterans Affairs (VA). Though the VA does not directly cover living costs, it offers financial aid programs that can be used to cover them, such as the Aid & Attendance Benefit (A&A). The A&A is a needs-based monthly payment that veterans with long-term care needs can receive in addition to their standard VA pension.

To be eligible for A&A benefits, a veteran must meet at least one of these criteria:

• Requires assistance with activities of daily living, such as bathing, dressing, eating, or managing prosthetic devices
• Is bedridden
• Resides in a nursing home due to a mental or physical impairment
• Has a severe visual impairment, defined as a correction of 5/200 or less in both eyes or concentric contraction of the visual field to 5 degrees or less

Though eligibility varies, the benefits can pay for a significant portion of assisted living costs. Contact your local VA office or an elder law expert to determine whether you or your loved one qualifies for these programs.

Long-Term Care Insurance

Long-term care insurance (LTCI) can hedge your financial situation against the possibility of eventually becoming ill or disabled. But like Medicaid, its application to assisted living costs can be ambiguous since the premiums are high and the coverage varies between policies.

For example, some “facility-only” policies only cover costs accrued in a licensed assisted living or skilled nursing facility, leaving the costs of in-home care services and those rendered by unlicensed facilities to the resident. Most policies require the beneficiary to need assistance with at least two ADLs, but again, this varies.

Additionally, most LTCI policies can only be bought up to a certain age. Therefore, LTCI policies can only benefit you or a loved one if you buy them long ahead of time. Even then, assisted living may be only partially covered, if at all. If you’re interested in one of these policies, make sure to check the benefit terms and amount before signing the contract.

Reverse Mortgages

Reverse mortgages use the value of a home as collateral to convert part of its equity into cash. They can help pay for the transition between a home and an ALF without requiring a rushed sale. Just remember that, unlike other types of aid, reverse mortgages must be repaid with interest within the timeframe of the contract.

Life Insurance

Seniors with life insurance policies could cash in their policies early and use the funds to pay for assisted living care. Since the purpose of life insurance is to provide for your family once you’re gone, using it to ease the financial burden of long-term care could be more beneficial than waiting.

Note that some policies have an accelerated death benefit or ADB, which allows the policyholder to collect a portion of the benefit while they’re still alive, tax-free. The amount available is usually a percentage of the death benefit, often 2-3% of the total per month.

Additionally, life insurance can be used to pay for care costs by selling the policy to a third-party company in exchange for a lump sum, usually a percentage of the death benefit. When you pass, the full benefit will go to the company rather than your family, so be sure that the transaction is advantageous before finalizing it.

Pros and Cons of Assisted Living

For seniors who need regular personal care assistance without needing medical care, assisted living communities represent a way to receive care without completely losing independence. Yet, depending on each person’s needs, preferences, and means, assisted living communities may not be the right choice. Consider the pros and cons of assisted living before signing with one of these communities.

Benefits of Assisted Living Communities

• Independence: Residents of assisted living communities receive the benefits of 24/7 care without losing their independence. Even if they need assistance with ADLs, they are free to live independently in other aspects.
• Emergency Support: While assisted living staff does not provide high-level medical care, they are trained to assist residents in emergencies. Some communities have resident doctors or nurses to help in such cases, but this is not the norm.
• Security: Residents of ALFs live in a secure environment with controlled access. The risk of break-in or robbery is low, especially compared to a private residence.
• Socialization: Independent living can be potentially isolating for seniors. Assisted living communities provide ample opportunities for social interactions, including organized group activities and wellness programs. Some even have libraries, chapels, and solons on-site where residents can bond over common interests.
• Simplicity: ALFs simplify daily life for their residents. Staff members handle housekeeping, meal preparation, and maintenance so residents can enjoy their stay without worrying about day-to-day tasks.

Possible Drawbacks of Assisted Living Communities

• Cost: Unlike nursing homes and even in-home care, most assisted living facilities are not covered by Medicare. Consider the financial aid options mentioned above to help pay for care, but many seniors will still find assisted living costs prohibitive due to the lack of federal coverage.
• Level of Care: Assisted living facilities rarely offer high-level medical care. Prospective residents who have a serious illness, reduced mobility, or dementia should seek more specific care services like a dedicated memory care facility or nursing home.
• Change in Environment: Despite retaining more independence than the residents of a nursing home, the residents of assisted living facilities do not retain full control over their lives. Especially for seniors used to living alone, this transition can be difficult.

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