Choosing the appropriate care option for an older family member or friend can be one of the most difficult decisions of a person’s life. Any move is stressful, and moving a loved one into assisted living or another elder care facility often involves leaving a residence they called home for many years. If you’re making the decision on behalf of a parent, you may even be saying goodbye to your own childhood home.
To make the transition from private residence to care facility as smooth as possible, it’s best to go into the decision process armed with knowledge. That is the purpose of this guide: to provide you with the information you need to make a considered decision and find the care option that’s right for you and your loved one.
If you’re reading this guide, you are likely already weighing the potential benefits of an assisted living community over other options. A number of factors will figure in your decision, including but not limited to cost, and level of care needed. This guide will help you answer several key questions that will arise in your decision process:
- What are the benefits of choosing an assisted living community as my elder care option?
- What is the difference between assisted living facilities and nursing homes?
- How do I choose the right assisted living community?
- How much does assisted living cost?
We’ll begin with an overview of the benefits and drawbacks of assisted living communities, so you’ll know if this type of facility is the right choice for your family’s needs.
The Advantages and Disadvantages of Assisted Living Communities
An assisted living community is just one of many elder care options at your disposal. Other potential options include nursing homes and private home health care.
An assisted living community is an attractive option for many families whose loved one doesn’t require round-the-clock health care, but they may not be the perfect fit for your needs. Below are some of the pros and cons of choosing this type of care facility.
Benefits of Assisted Living Communities
One of the reasons assisted living appeals to many people is residents’ relatively high level of independence. If your parent, grandparent, or other elder is in good health and doesn’t require much assistance with everyday tasks, assisted living is a terrific option. In fact, residing in an assisted living community is similar to having a private apartment, complete with your own bathroom and kitchen — and you can rest easy knowing trained staff is on hand to help your loved one when necessary.
In addition, residents no longer have to cook for themselves, clean their homes and do their own laundry. This removes much of the burden of living in a private residence, and greatly reduces the likelihood of falls and other accidents. Meals and cleaning services are provided by staff, in addition to on-site medical care such as prescription drug services. Staff can also assist with tasks such as bathing and dressing where necessary, and provide transportation services.
Assisted living communities generally allow residents to decorate their own apartments, so you can create a very homey environment for your loved one, surrounded by the familiar and well-loved furniture and knick-knacks from their previous residence. This can significantly lessen the difficulty of the transition to a care facility.
Another benefit of assisted living is security. Your loved one will be safe in a secure environment with controlled access, so there is very little risk, compared to a private residence, of break-in or robbery. Seniors are often the target of financial scams. Staff can help protect your loved one from these uncomfortable, even dangerous situations.
Assisted living centers also offer social benefits: Your loved one will be in the company of his or her peers. Continuing to live in one’s own residence can become quite lonely and isolating for an elder, even if you hire a private nurse or caregiver for companionship. In an assisted living community, there is no shortage of opportunities for friendship and social interaction. Many offer regular, organized group activities, as well as wellness and exercise programs — even on-site libraries and chapels, where seniors can bond over common interests.
In a recent controlled trial of 200 British adults over 60, those who participated in weekly singing groups for three months had improved mental health (decreased anxiety and depression) compared with those who didn’t sing. These health effects were sustained over a period of at least three months after the weekly singing ended.
No less an authority than H.H. The Dalai Lama agrees social connection and a feeling of usefulness is essential for elders: “In one shocking experiment, researchers found that senior citizens who didn’t feel useful to others were nearly three times as likely to die prematurely as those who did feel useful. This speaks to a broader human truth: We all need to be needed.”
Another benefit that can’t be downplayed is cost. Although we want the best for our loved ones, cost can be a real limiting factor when it comes to choosing a residence. While assisted living communities aren’t cheap, they do represent a more affordable option than nursing homes and similar long-term care facilities, since residents retain more independence.
Possible Drawbacks of Assisted Living Communities
Despite their benefits, assisted living centers aren’t for everyone. Though they are one of the least-costly care options, the monthly expenses can prove too high for some families. Depending on the location of the facility, the services available and other variables, an assisted living community can cost between $2,800 and $5,700 per month, with an average monthly cost of $3628. In some cases, the sale of your loved one’s home can be put toward the monthly costs of an elder care facility.
Another potential drawback is the reduced level of care. If the elder in question has more extensive medical needs, an assisted living facility may prove to be insufficient in terms of services offered. If your loved one is very ill, has greatly reduced mobility, or dementia, they may need a nursing home. An assisted living facility will assess the needs of the patient when evaluating whether or not it’s a good fit. Some assisted living communities provide specialized care for certain types of illness, including Alzheimer’s, in special care units, or SCUs.
Finally, the change in environment may be a difficult adjustment for seniors who are accustomed to living alone. Assisted living communities generally offer a high level of privacy and independence, but this is still less than a private residence, obviously. Additionally, each assisted living community will be governed by its own set of rules and regulations. For example, there are usually regulations concerning pets and smoking — and while smoking restrictions benefit everyone’s health, pet guidelines have evolved considerably in recent years.
In one study, elders who had a dog or cat were better able to perform certain “activities of daily living,” such as climb stairs, bend, kneel, stoop, take medication, and bathe and dress themselves. Assisted living facilities have found that pets reduce resident stress and lower blood pressure, while boosting immunity and mood. So if keeping a beloved pet is important for your family member, look for an assisted living community where pets are welcome, and transform this potential drawback into a benefit.
How to Pay for Assisted Living
If cost is prohibitive for you, keep in mind that you may be able to find some financial relief through avenues such as:
- Medicaid: A federal public benefits program administered by the states, Medicaid is complex, and frequently confused with Medicare. Medicare, a federal program, covers limited periods of inpatient care in a skilled nursing or rehabilitation facility, following a hospital stay — and only under strict guidelines. It does not pay for custodial care, which is the day-to-day, long-term care provided by assisted living communities.
Medicaid, however, may help with assisted living expenses — but it’s not blanket coverage. You may find these Medicaid Myths helpful.
To be eligible for Medicaid, a recipient must be 65+ or disabled, and have no more than $2000 in countable resources. Beyond this, the rules vary by state, and while assisted living is not part of basic Medicaid coverage, in most states it may pay some (but not all) of the costs associated with assisted living. You can speak with an expert, such as an elder law attorney, to find out whether your family member qualifies for Medicaid assistance. If you plan to use Medicaid as financial aid for assisted living, be sure to ask whether the assisted living community you’re considering for your loved one participates in their state’s Medicaid program.
- Veterans’ benefits: Veterans and spouses of veterans may qualify for aid from the Department of Veterans Affairs. Although the VA does not pay for the veteran’s rent, it may cover some of the services provided by an assisted living facility. Known as Aid and Attendance (A&A), this benefit is a monthly, needs-based payment above and beyond the VA pension that can help cover the costs of long-term care. It is important to note that a veteran or surviving spouse may only receive Aid and Attendance or Housebound benefits (if they are unable to leave their home); not both at once.
In order to be eligible for A&A benefits, a veteran must meet at least one of these criteria:
- Need assistance with activities of daily living (ADL) such as bathing, dressing, eating, or adjusting prosthetic devices;
- Be bedridden;
- Reside in a nursing home due to mental or physical impairment;
- Have severe visual impairment, with a correction of 5/200 or less in both eyes or concentric contraction of the visual field to 5 degrees or less.
Eligibility varies, but the benefits can be significant. Contact your local Veteran Affairs office or an elder law expert to determine whether your loved one qualifies.
- Long-term care insurance: Long-term care insurance, or LTCI, can be tricky. While it appears to be a natural hedge against a future possibility of becoming ill or disabled, like Medicaid, long-term care insurance is not a catch-all answer. Here’s why:
- LTCI premiums can be as steep as the cost of care itself;
- What is covered varies by policy. For example, a “facility-only” policy covers care in a licensed assisted living facility or in a skilled nursing facility, but not in an unlicensed facility or in your own home;
- There is usually a “waiting” or “elimination” period before someone is able to access funds. The shorter the elimination period you select, the more expensive the premiums.
Also, some LTCI insurers may ask for a physician evaluation — of the insurance company’s choice — to see if someone’s condition qualifies for coverage, which may be determined in part by their ability to perform two or more activities of daily living.
Be sure to shop around, and understand your elder’s policy provisions thoroughly.
Cost of Assisted Living (with Average Cost Broken Down by State)
When it comes to paying for assisted living, the average cost varies by state. In instances where high costs are a concern or prohibitive, some families relocate loved ones to facilities in more affordable regions.
The table below breaks out some key cost data points, including the daily, monthly and annual cost of assisted living for all fifty states for 2016.
|District of Columbia||$220||$6,700||$80,400|
Assisted Living Communities vs. Nursing Homes: What’s the Difference?
Two of the most common options for elder care in the U.S. are assisted living centers and nursing homes. If you’re at the point of choosing a long-term care option for an elder relative, it’s useful to understand the difference between these two types of facilities, so you’ll know you’re making the right choice for your loved one.
Some of the primary ways that assisted living centers and nursing homes differ include:
- Level of care
Below, we’ll take a look at the key differences between these two types of care facilities in terms of each of these three factors.
Level of Care
The main difference between an assisted living community and a nursing home is the level of care provided by staff. At an assisted living facility, residents are assumed to be capable of maintaining a relatively high degree of independence. Though your parent or other loved one may need a little help with day-to-day tasks (presumably the reason you’re considering the transition to a care facility in the first place), he or she shouldn’t require constant care and attention if you want to consider an assisted living community. Assisted living facilities have fewer staff members than nursing homes, so they’re not a good option if the person can’t move around or manage on their own.
A nursing home, on the other hand, is equipped to provide daily health care services for elders with more complicated medical conditions to monitor, including chronic, debilitating illnesses or severe cognitive impairment. Though a nursing home is not a hospital, the emphasis is on health care services, provided by doctors and nurses, rather than limited care and assistance for older residents.
Nursing Home and Assisted Living Cost
Cost is another significant difference between assisted living centers and nursing homes. Because nursing homes employ more full-time staff members to provide a higher level of care, they are usually significantly more expensive. Costs vary by state, but the average cost for a private room in a nursing home is more than $92,000 per year, or $7698 per month. Options to help you cover these costs include:
- Medicare supplemental insurance (such as Medigap)
- Managed care plans
Assisted living communities are typically much less costly. Again, costs vary by state, but the average monthly cost for an assisted living center in most states is between $2,800 and $5,700 per month, with an average monthly cost of $3628. Monthly costs in Alaska, Hawaii, Vermont, Washington D.C., Connecticut and New Jersey are higher than average, sometimes upwards of $5000 per month. Click here for more information on the cost of assisted living by state.
As you can see, on average, the cost of an assisted living community is about half that of a nursing home. For this reason, unless someone requires a high level of care on a daily basis, assisted living will usually be preferable. However, assistance in the form of insurance or other benefits may narrow or even close the gap between the two options.
Privacy & Atmosphere
An assisted living facility provides more privacy than a nursing home. Residents’ apartments feel more like a private residence, with your own bathroom and kitchen. In a nursing home, there is increased foot traffic in and out of the room, and patients may have to share a room with another resident due to cost and space limitations.
Furthermore, residents have more control over the environment in an assisted living community, because they can decorate their rooms however they choose, creating a more home-like atmosphere. This is a significant benefit for many families, to whom nursing homes can feel cold, sterile, and generic, and therefore stifling to your loved one’s individual personality.
The table below outlines these primary differences to help you determine which elder care option best suits your particular needs.
|Level of Care||Limited; staff is on hand to provide assistance with cooking, cleaning, bathing, dressing, and transportation, as well as medication administration and emergency care.||High; staff provides round-the-clock health care services for chronic, debilitating conditions. However, level of care is more limited than that of a hospital.|
|Cost||Between $2800 and $5700 per month on average.||Upwards of $6800 per month on average; government assistance available in some cases.|
|Privacy||Residents maintain relatively high level of privacy and independence.||Limited. Private rooms are more costly.|
|Other Concerns||More home-like atmosphere and more social interaction. Less regulation means greater variance in services offered as well as quality of service.||Potentially difficult transition from independent living. High regulation can make level and quality of service more predictable.|
By this point, you should have a strong sense of which type of elder care facility is the best fit for your family. If you’ve decided that an assisted living community is the right choice for you, read on to the next section, where we’ll go over some of the questions you need to consider when choosing a facility.
How to Choose an Assisted Living Community: Questions to Ask
Once you’ve decided that assisted living is the best choice for your elder relative, the next step is to find the right assisted living facility in your area. Unlike nursing homes, which are highly regulated, assisted living communities vary greatly in terms of what you get for your monthly payments.
When evaluating assisted living facilities, it’s wise to come prepared with a list of questions. (And do evaluate each community in person! We don’t recommend choosing an assisted living facility sight unseen – websites and brochures can be deceiving.)
The answers to the questions that follow will help you determine which assisted living community in your area is the best fit for you and your family.
What are the monthly and annual costs? Costs may vary depending on level of service required, so ask about base costs and well as tiered options. Some facilities may offer both private and shared rooms, for different rates.
How many residents live in the community? Assisted living facilities can range in size from very small (10 or fewer apartments) to enormous complexes with 400 or more residents. Inquire about size if this is important to you. Some people prefer smaller residences that feel more like living with extended family.
Is there current availability? Some assisted living communities will already be at capacity, in which case you may be added to a waiting list. If this is the case, ask about wait times and where you appear on the list.
What is the aide-to-resident ratio? How many aides are on staff at the facility, and how does this compare with the number of residents?
Is the staff friendly and helpful? First impressions matter. Choose a facility where staff members are friendly and approachable. Pay attention to both how they treat you as a prospective client, and how they treat current residents.
Does the facility offer any specialized care services? If your family member requires special care for Alzheimer’s or a similar condition, be sure to ask if specialized care is available. Some communities offer these specialized services; others do not.
Is the facility wheelchair accessible? If your relative requires the use of a wheelchair or walker, make sure the layout of the facility is conducive to this: wide doorways, ramps, and an elevator if the facility is on more than one floor. This may also influence your choice between a single-level and multi-level facility.
Is the community close to a hospital? You may wish to find an assisted living facility in close proximity to a hospital in case your relative should need urgent care. Some assisted living communities are affiliated with a hospital or nursing home.
Is the facility fully licensed and sanctioned? Check to make sure the assisted living residence is licensed and in compliance with state regulations. You can also investigate online ratings and reviews, and check with the Better Business Bureau to see if any complaints have been filed.
How are emergencies handled? Make sure the staff has a well-defined plan in place to handle emergencies, including medical emergencies and evacuations.
How far is the community from your own place of residence? Distance from your home will likely be a factor in your decision, depending on how frequently you plan to visit your relative.
Is the facility clean and attractive? Are the private rooms and common areas well-maintained?
How large are the rooms? Depending on your relative’s furniture and other belongings, square footage may be a limiting factor. Ask about storage space.
What is included in the room or apartment? Get a tour and see what, if any, furnishings and appliances are provided for residents. For example, does the kitchen include a refrigerator and/or microwave? Is there cable access?
What are the grounds like? Investigate the outdoor areas of the community as well as the indoor facilities. Are there gardens and other outdoor spaces where residents are welcome to spend time? Is this important to your relative?
What wellness programs are available? Does the community offer health, wellness and fitness programs to keep seniors active?
What other amenities and on-site services are offered? Some assisted living facilities offer gyms, swimming pools, hobby rooms, libraries, salons, chapels and other on-site amenities. These are a big draw for some seniors, so find out what’s available.
What are the dining options? Inquire about food service, including meal times, the types of meals offered, special diets, and flexibility. If possible, dine at the community at least once with your relative to ensure your he or she is happy with the food and the service.
Are transportation services offered? Most assisted living communities provide some form of transportation so residents can go to appointments, shopping, entertainment and so on.
Are pets allowed? Be sure to ask if pets are allowed at the facility if your relative will be bringing along a cat, dog or other house pet. Some facilities do not allow pets.
Getting answers to all these questions should go a long way towards helping you decide which assisted living community is the best fit. Don’t be afraid to be inquisitive and persistent when seeking information – this is a big decision, and the extra investigative work will pay off in the long run.
Other Helpful Resources
We hope this guide has helped you navigate this challenging decision. Though change is always hard, transitioning to an assisted living residence is usually a very beneficial step for a senior citizen. You’ll likely find that your relative is happier, healthier and safer in such a facility than living on their own.
If you’re still looking for information about care options for seniors, we recommend the following resources:
- 101ElderCare.com http://www.101eldercare.com
- AGIS http://www.agis.com/default.aspx
- Aging Life Care (Professional Geriatric Care Managers) http://www.aginglifecare.org
- American Health Care Association (long-term care advocates) https://www.ahcancal.org/Pages/Default.aspx
- Benefits Checkup (a service of the NCOA) https://www.benefitscheckup.org
- Care.com http://www.care.com/senior-care-directory-find-p1071.html
- Care Pathways http://www.carepathways.com
- Elder Care Locator https://eldercare.acl.gov/Public/Index.aspx
- Helpguide.org https://www.helpguide.org/home-pages/senior-housing.htm
- HUD.gov Information for Senior Citizens https://portal.hud.gov/hudportal/HUD?src=/topics/information_for_senior_citizens
- Long-term Care Ombudsman http://theconsumervoice.org/get_help
- Medicare.gov http://www.medicare.gov/default.aspx
- Medline Plus https://medlineplus.gov/assistedliving.html
- National Council on Aging (NCOA) https://www.ncoa.org
- National Senior Citizens Law Center http://www.nsclc.org/
- USA.gov: Long-term Care, benefits, medical information https://www.usa.gov/doctors