What is “Assisted Living” and How Much Should it Cost?
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 an assisted living center or other 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 center over other options. A number of factors will figure into your decision, including but not limited to cost and level of care needed. This guide will help you answer three key questions that will arise in your decision process:
- What are the benefits of choosing an assisted living center as my elder care option?
- What is the difference between an assisted living center and a nursing home?
- How do I choose the right assisted living center?
We'll begin with an overview of the benefits and drawbacks of assisted living centers, so you'll know if this type of facility is the right choice for you and your family's needs.
The Advantages and Disadvantages of Assisted Living Centers
An assisted living center 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 center is an attractive option for many families who don't require round-the-clock health care for an elderly patient, 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 Centers
One of the reasons that assisted living centers are appealing to many people is that they offer a relatively high level of independence. If your parent or grandparent 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 center is similar to having a private apartment, complete with private bathroom and kitchen, but you can rest easy with the knowledge that 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 like bathing and dressing where necessary, and provide transportation services.
Assisted living centers also 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 also commonly the target of scams to solicit money. 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 for companionship. At an assisted living center, 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 or chapels where seniors can bond over common interests. According to Loren Shook, president and CEO of Silverado Senior Living, social interaction even has cognitive benefits for seniors! It also reduces the incidence of depression.
Another benefit that can't be downplayed is cost. Although we want the best for our loved ones, costs can be a very real limiting factor when it comes to choosing a residence. While assisted living centers aren't cheap, they do represent a more affordable option than nursing homes and similar long-term care facilities, since residents retain more independence.
Drawbacks of Assisted Living Centers
Despite their benefits, assisted living centers aren't for everyone. Though they are one of the least costly care options, the monthly expenses do prove too high for some families. Depending on the location of the facility, the services available and other variables, an assisted living center can cost anywhere between $1500 and $5000 per month.
If costs are prohibitive for you, keep in mind that you may be able to seek financial relief through avenues such as:
- Medicaid: You can speak with an expert about whether your family member qualifies for Medicaid assistance. Though assisted living usually isn't covered by Medicaid, Medicaid can help with the costs of a nursing home.
- Veterans' benefits: Veterans and spouses of veterans may qualify for aid from the Department of Veterans Affairs. Eligibility varies, but the benefits can be significant. Again, speak with an expert to determine qualification.
- Long-term care insurance: If your family member has purchased long-term care insurance, payments can be applied toward the cost of an assisted living center.
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 patient in question has more extensive medical needs, an assisted living center may prove to be insufficient in terms of services offered. If your loved one is very ill, has greatly reduced mobility or dementia, a nursing home may be required. An assisted living center will assess the needs of the patient when evaluating whether or not it's a good fit. Note that there are assisted living centers which provide specialized care for some types of illness, including Alzheimer's. These are sometimes called 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 centers generally offer a high level of privacy and independence, but still less than a private residence. Additionally, each assisted living center will be governed by its own set of rules and regulations. For example, there are usually restrictions on pets and smoking.
These are some of the pros and cons that will affect your choice of senior care. In the next section of this guide, we'll review the differences between assisted living centers and nursing homes.
Assisted Living Centers 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 center and a nursing home has to do with the level of care provided by staff. At an assisted living center, 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 center. Assisted living facilities have fewer staff members than nursing homes, so they're not a good option if the patient can't move around on their own.
A nursing home, on the other hand, is more 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 about $69,000 per year, or $5750 per month. Options to help you cover these costs include:
- Medicare supplemental insurance (such as Medigap)
- Managed care plans
Assisted living centers 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 $1000 and $3000 per month. Monthly costs in Alaska, Hawaii, Vermont, Washington D.C. and Wyoming are higher than average, sometimes up to $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 center is about half that of a nursing home facility. For this reason, unless the patient requires a high level of care on a daily basis, an assisted living center 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 center provides more privacy than a nursing home. Residents' apartments feel more like a private residence, with your own bathroom and kitchen. At a nursing home, there is more foot traffic in and out of the room, and patients may be forced 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 center, 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 below table outlines these primary differences and can 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, dressing, bathing, 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 $1000 and $3000 per month on average.||Upwards of $5000 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 center 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 Center: 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 centers 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 to ask. (And do evaluate each center in person! We don't recommend choosing an assisted living facility sight unseen – websites and brochures can be deceiving.)
The answers to the below questions will help you determine which assisted living center in your area is the best possible 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 centers may offer both private and shared rooms for different rates.
How many residents live at the center? Assisted living centers 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 centers that are more like families.
Is there current availability? Some assisted living centers will already be at capacity, in which case you may need to 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 aid to resident ratio? How many aids are on staff at the center and how does this compare to 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 as well as 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 centers 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. This may also influence your choice between a single-level and multi-floor facility.
Is the facility close to a hospital? You may wish to find an assisted living center with close proximity to a hospital in case your relative ever needs urgent care. Some assisted living centers are affiliated with a hospital or nursing home.
Is the facility full licensed and sanctioned? Check to make sure the assisted living center 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 center from your own place of residence? Distance from your own 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 by staff?
How large are the rooms? Depending on your relatives' furniture and other belongings, square footage may be a limiting factor. Ask about storage space.
What is included in the room? Get a tour and see what, if any, furnishings and appliances are provided with the room. For example, does the kitchen include a refrigerator and/or microwave? Is there cable access?
What are the grounds like? Investigate the outside of the center as well as the indoor facilities. Are there gardens and other outdoor spaces? Is this important to your relative?
What wellness programs are available? Does the center offer health and wellness programs to keep seniors active?
What other amenities and on-site services are offered? Some assisted living centers offer gyms, swimming pools, hobby rooms, libraries, salons, chapels and other on-site amenities. These are a big draw for some seniors, so see what's available.
What are the dining options? Inquire about food service including meal times and the types of meals offered, as well as flexibility. It will likely be worthwhile to try a meal at the center and ensure that your relative is happy with the service.
Are transportation services offered? Most assisted living centers provide some form of transportation for residents to reach 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 toward helping you decide which assisted living center is the right fit. Don't be afraid to be inquisitive and demand 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 through this very difficult 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 below resources:
- 101ElderCare.com http://www.101eldercare.com
- AGIS http://www.agis.com/default.aspx
- Care.com http://www.care.com/senior-care-directory-find-p1071.html
- Care Pathways http://www.carepathways.com/
- Elder Care Locator http://www.eldercare.gov/Eldercare.NET/Public/Index.aspx
- Helpguide.org http://www.helpguide.org/
- Medicare.gov http://www.medicare.gov/default.aspx
- National Association of Professional Geriatric Care Managers http://www.caremanager.org/
- National Center for Assisted Living http://www.ahcancal.org/ncal/Pages/index.aspx
- National Senior Citizens Law Center http://www.nsclc.org/