1 in 5 adults 85 and older who are living in the U.S. say they need or currently receive help with daily living. These daily functions, or activities, are referred to as activities of daily living or “ADLs”. Assisted living is long-term residential care for those who need assistance with ADLs or can benefit from supportive personal care services, planned daily activities, social engagement, as well as potentially assistance with some basic medical needs.
What are the Benefits of Assisted Living
In addition to help with ADLs, providing a safe environment, and basic health care services (such as medication management), there are many other benefits of living in assisted living communities for older adults:
Healthy Meals
Healthy meals and quality nutrition are important for seniors. Assisted living may provide 3 meals a day with unique menus that meet dietary needs as well as provide a welcoming and social dining experience.
Personal Care and Check-ins
Medication may be crucial to maintaining quality of life for a senior. Assisted living facilities may provide medication management and distribution under direct supervision of a licensed healthcare professional.
Assisted living facilities may also assist with personal care such as getting dressed, bathing, housekeeping and laundry, as well as security with supervision and access to onsite staff which may reduce senior and family stress.
Community
Assisted living facilities may create an important foundation for a sense of community. This may greatly benefit seniors by providing access to services that promote friendship and a sense of belonging. A sense of community may alleviate boredom and isolation which can lead to depression among other health problems.
Social Activities
Social activities in an assisted living facility benefit seniors by providing opportunities to stay physically active. This may include indoor and outdoor activities like yoga and gardening. This may help with blood sugar, circulation and heart rate.
At residential care facilities there may be greater access to transportation which allow for important outings such as a doctor’s office visits.
Who is a Good Fit for Assisted Living
Assisted living is appropriate for older adults who are in need of custodial care – assistance with activities of daily living (ADLs). This may include assistance with: personal care, hygiene, meals, mobility and medication. State regulated assisted living facilities may accept individuals based on individual care requirements.
Assisted living may not be appropriate for those with severe mental impairment (although some facilities vary on this), demonstrate certain behavioral symptoms (such as wandering), have broad medical requirements, require skilled nursing care, or require daily nursing services.
What Services Do Assisted Living Facilities Provide
Residents in assisted living facilities may have their own apartments or private rooms but share common areas such as dining rooms and areas for recreational activities. Although assisted living facilities may vary depending on state regulations, many assisted living residents have access to services such as: routine meals, help with personal care such as dressing and bathing, and assistance with medications. Many offer additional amenities such as, housekeeping, laundry, supervision, security and on-site staff, as well as providing a sense of community and enriching activities.
Activities of Daily Living (ADLs)
Activities of Daily Living, or “ADLs” are an important facet of assisted living facilities. ADLs are defined as basic self-care tasks learned from early childhood such as:
- Feeding
- Toileting
- Walking
- Transferring (moving from one body position to another)
- Bathing
- Dressing and grooming
These skills can vary in terms of how much assistance is required (for example: needing a little bit of help to complete dependency on others).
Do Assisted Living Facilities Provide Memory Care?
Memory care is a type of long-term residential care for people with memory issues such as dementia. Many of the ADL support systems are the same as assisted living facilities but may include supplemental safety and structured environments with set routines. Some assisted living facilities may have memory care units, though memory care can also be its own stand alone facility.
Read More: Memory Care vs. Assisted Living
What Services Are Not Provided By Assisted Living Facilities
Many assisted living facilities vary by services provided. However, many provide overall services for ADLs. Some services are not provided in assisted living facilities but rather in medical-like settings such as skilled nursing facilities.
Some common services not provided by assisted living facilities but in skilled nursing facilities are:
- Significant around the clock medical care (a ventilator or respiratory therapy) from a registered nurse / skilled nursing care
- Daily therapy services only provided in a skilled care setting
- Significant physical care
In-home care is a good option for seniors who maintain overall quality of life and generally need less than four to five hours of support with ADLs.
It is important to contact individual facilities in order to fully understand the scope of services provided.
How is Assisted Living Different Than Other Types of Senior Living?
Typically assisted living facilities are for those who need help with ADLs, are in overall good health and want to maintain a sense of independence as well as community.
Assisted Living vs. Independent Living
Independent living refers to communities where residents may live in their own apartment, condo, town home or house within a larger senior community such as a retirement community. There is an emphasis on independence within these communities as well as benefits such as being surrounded by other seniors and access to social activities and onsite facilities. Unlike assisted living facilities, independent living residents are completely able to care for themselves.
Assisted Living vs. Nursing Homes (SNFs)
Skilled nursing facilities or nursing homes provided a more medical-like setting and level of care. They can be used as accommodations for a short period of time. Unlike assisted living facilities, residents of nursing homes may receive 24/7 nursing care from a certified healthcare professional such as a registered nurse. Often, the goal of a skilled nursing facility is to rehabilitate and transition back into long-term care such as assisted living.
Assisted Living vs. Continuing Care Retirement Communities (CCRSs)
Continuing care retirement communities provide a mixture of independent living, nursing home services and assisted living. Residents of these communities can have any level of care as needed because CCRCs offer a range of long term care on campus. This may mean offering more medical care without having the resident move out of the CCRC or out of their social circle and from caretakers.
Assisted Living vs. In-home Care
In-home care may provide services to seniors living at home such as: companionship, transportation and daily assistance with meal preparation, housekeeping, bathing, toileting, dressing and grooming. This level of care can vary based on need, may be customizable and typically nursing care is not included. The benefit of in-home care for seniors is to remain in a comfortable and familiar place like home while also maintaining a level of independence.
When is it Time to Move to Assisted Living?
There are some common signs it may be time to move into assisted living. Examples to look for include:
- Medical conditions that are worsening with time
- Falling and struggling to get up
- Money issues and trouble with financial responsibility
- Unaddressed or difficulty with bills or taxes
- Susceptibility to financial scams
- Isolation
- Depression
- Addiction
- Decreased moral
- Un-kept living space
- Inability to prepare and eat meals
- Keeping spoiled food
- Poor hygiene
It may be challenging discussing the time to move into assisted living with seniors. Some helpful tips for family members engaging in this conversation include:
- Preparing for the conservation by researching senior care
- Making sure the discussion is done early on, in-person and with a non-rushed attitude
- Planning conversation starters
- Preparing for a repeated discussion
- Taking care to not overload with information
- Planning visits to facilities
See this guide for helpful information about moving into assisted living.
How to Choose an Assisted Living Facility
Assisted living facilities can vary greatly in terms of quality, services offered and pricing. It is important to research different assisted living options and gather information on what each facility has or does not have. This AARP article on assisted living facilities provides a starting point for locating facilities as well as tips for what to look for when researching and touring an assisted living facility.
There are a few important steps to take when looking for assisted living. 1. Create a list of must-haves. 2. Ask a lot of questions. 3. Read the contracts 4. Include the senior(s) in the decision-making process.
Some questions to ask facilities include:
- What are the types and sizes of rooms/apartments/units available?
- Do they have kitchens or kitchenettes?
- Are the rooms shared or private?
- Is there a memory care unit?
- Is there a special unit for other conditions?
- Does each resident have a care plan and is the senior involved in the creation of this plan?
- Is there a way to review the contract in order to see fees, services and policies?
- What are the additional services available?
When deciding to tour a facility that is within price range and meets personal requirements, look for the following:
- Sanitation and cleanliness
- Large enough space
- Living spaces and bathrooms with safety measures (handrails and call buttons)
- Safety locks (on doors and windows)
- Security and fire safety (alarms)
- Lit-up stairs, hallways and marked exits
- Services (banking, salon, cafe)
- Multiple common areas
- Alternative power source (such as a generator)
It is recommended to tour the facility multiple times, arrange a visit during meal time, do a background check on the facility and review the contract. It is important to witness how staff interact with residents and to talk with various staff and administration personnel. See this list of interview questions for an assisted living facility.
How Much Does Assisted Living Cost?
Assisted living costs can vary based on type of facility, location and services provided. According to Genworth Financial, in 2020 the average cost of assisted living was $4,300 per month with costs rising to $4,429 in 2021. See how much assisted living costs here.
Each assisted living facility may have a different structure when it comes to pricing. Sometimes, there is only one monthly fee. Others may have additional fees for services based on usage.16
How to Pay for Assisted Living
Many seniors and their families choose to pay for assisted living through selling or renting a living space (such as a house or condo) or by personal savings.
Seniors and their families may find it difficult to pay for assisted living out of pocket. If this is the case, there are some various options to assist with financial coverage. Many low-income seniors may qualify for some of the following options:
- Medicaid
- A federal and state health insurance program for low-income individuals. May cover some expenses of assisted living.
- Home and Community-Based Service (HCBS) waivers are programs for supplemental Medicaid coverage for long-term care. There may be a waitlist for these benefits.
- Veterans Benefits
- Veterans and spouses may receive benefits through the Department of Veterans Affairs (VA) and can cover some costs.
- Aid and Attendance (A&A) benefit is an as-needed monthly payment veterans and their spouses may receive in addition to a pension. These can be used to cover costs of assisted living.
- Long-Term Care Insurance
- Policies have unique benefit amounts, durations, and restrictions; long term care insurance premiums typically cost $2,000 – $9,000 per year.
- Related: Does Long-term Care Insurance Cover Assisted Living?
- Reverse Mortgage
- A loan taken out against a home that makes some home equity change to liquid funds. May help cover assisted living costs without hurrying to sell a home. There are timelines with these loans for repayment and interest.
- Life Insurance
- Previously enrolled policies may provide “cashing out” opportunities to pay for assisted living.
- Accelerated death benefit (ADB) allows for tax-free advances while a senior is still living. These may have monthly limits.
- Life settlements mean a policy is sold to a third-party company and that company pays an amount to be used for long-term care. These amounts may not be as much as the death benefit.
See a complete guide on how to pay for assisted living.
Does Medicare Cover Assisted Living?
Medicare does not cover costs associated with assisted living. However, it may pay for medical costs. These payments do not go toward personal care or room and board. Some Medical Advantage plans may cover personal care while in assisted living.
Review more about Medicare coverage for assisted living.
Does Medicaid Cover Assisted Living?
Medicaid coverage may vary by state and enrollment criteria. Typically, services covered by Medicaid within an assisted living facility include: personal care, housekeeping services (meal preparation and laundry), case management, transportation and personal emergency response systems.
Does Long Term Care Insurance Cover Assisted Living?
Long-term care insurance policies do cover assisted living care. However, there are some variances between policies and what they cover. Some policies cover care in a licensed only facility. Policy requirements may also include needing help with at least two or more ADLs before covering costs of assisted living. There may also be age eligibility. Make sure to check with the insurance provider regarding policy coverage and criteria.
See more about long-term insurance coverage of assisted living.
Do Veterans Benefits Pay For Assisted Living?
Under the Aid and Attendance benefit, assisted living may be covered for veterans and their spouses. This is a supplemental payment along with a VA pension which helps cover assisted living costs.
According to Vetertanaid.org, cost coverage includes:
- $1,881 per month for a single veteran needing care
- $2,230 per month for a veteran and spouse needing care
- $1,209 per month for a surviving veteran spouse needing care
Requirements include an application and paperwork. Many veterans and their families are unaware of this program. Visit this Veterans Aid and Attendance eligibility page to see if a senior veteran and/or spouse qualifies.
Reverse Mortgages
A reverse mortgage means borrowing on a personal home equity. The equity is the difference between the appraised value of the home and what is owed on the mortgage. The equity decreases according to how much cash is received. The loan is due at the borrower’s passing or a year after moving out. Profit from the sale of the home goes toward repayment of the borrowed amount of the reverse mortgage and interest. Additional profit belongs to the beneficiary.
There are different types of reverse mortgages. Reverse mortgages may be used to pay for long term care; however, there are various pros and cons, eligibility and rules. See more about reverse mortgage options.
Tips For Moving into Assisted Living
Once a facility has been chosen, a contract signed and a move in the works, transition into an assisted living facility can dredge up some big feelings for a senior and their family. Here are five tips in order to ensure a smooth transition into assisted living.
Empowerment
Ideally, the senior plays a role in the assisted living decision making process. Their wishes about the facility are met and their choices regarding various details such as decorations, items brought with them from home and other personal choices are honored. Even small ticket choices such as picking a move-in day can help ease the transition into assisted living by providing the senior with a say and being a part of the discussion.
Tour and Familiarize
Transition into assisted living may go more smoothly if there are plenty of opportunities to tour the facility and become familiar with the space and the people working there. Allow time for seniors to get to know their new surroundings before move-in. This could also include getting involved in community activities ahead of time to establish friendships with staff and other residents.
Decorate
Transition into assisted living may prove easier when the space looks and feels like home. Bring personal items from home such as art and pictures to hang on the wall and provide a sense of comfort. Obtaining a unit’s floor plan can help in the decoration planning process. Engage in discussion about the transition of items brought and left behind.
Plan Out Moving Day
Moving into assisted living may involve a lot of hard work, planning and emotions. Pack a suitcase with immediate and necessary personal items such as: clothes, pajamas, personal products and medication. Pack an essential “must get-to” box of items such as: coffee supplies, kitchen essentials, paper goods and snacks. These items should go in the car instead of the moving truck for easy access.
Think about how the day will go. Maybe enjoy a favorite activity such as lunch while pack-up is occurring (with someone else taking charge of the move out process) and create a time for seniors to say goodbye to the old residence. Make sure to spend time on move-in day at their new facility by walking the grounds together or staying for a meal.
Get Involved
Giving a senior transitioning into assisted living a sense of future visits will help with the adjustment. Provide some future times for visiting and put it on the calendar. Extending the invitation to family members and friends to attend events may give seniors visits and experiences to look forward to.
The transition in assisted living may be hard on the senior and the family member(s). Allow for the experience of wide-ranging emotions about the situation and acknowledge the change. It can feel relieving and sad at the same time. Some correlate it to “empty nest syndrome.” Acknowledging the transition is a part of the process.
Resources
- Where You Live Matters “Learn About Assisted Living (Video)” 11 August 2021. https://www.whereyoulivematters.org/assisted-living-defined/. 9 February 2022.
