..Assisted Living
     

Introduction

Assisted living is for individuals who need some assistance with normal activities of daily life, but who do not need the medical care provided in a nursing home. A primary goal of assisted living is to limit the loss of independence that often results from institutionalization. Another goal, however, is to protect the individual's safety and well-being by providing an active, supportive and watchful environment where assistance is available as and when needed.

Residents of assisted living range from very impaired to very healthy. The average age is the early 80's. Part of the reason that the health status of residents varies a lot is that many individuals are able to avoid nursing home care for quite a long time by entering assisted living at a time when they are still relatively healthy. The help they receive in assisted living keeps them more independent for longer than they would be if they had continued to live alone in the community.

A growing number of facilities are offering so-called "Alzheimer's units," which are designed to care for those with moderate to severe dementias but few other medical problems. These normally are locked facilities that specialize in the unique kinds of supervision, structure, support and personal care required by those with serious dementia problems.

Criteria for Suitability

Assisted living may be appropriate for you if:

  1. You need some assistance with your daily routines, such as dressing, bathing, cooking, walking or similar activities;
  2. You do not, however, have medical needs that require skilled nursing assistance on a daily basis;
  3. Cost or other considerations prevent you from receiving adequate assistance at home;
  4. You enjoy the company of others; and
  5. You have the financial means to pay for an assisted living facility.

Facilities and Services

The physical layout of assisted living varies considerably, but all facilities provide both private living quarters and common areas for meals, socializing and activities. Structures may range from high-rise to single-story; most facilities are housed in two- or three-story buildings. Attached or detached housing is not compatible with assisted living.

Private quarters range from separate one- or two-bedroom apartments to double-occupancy rooms that may resemble a hotel. All facilities offer private bath for each room or unit, and baths are equiped with handrails and other aides for those who have difficulty using toilet and shower facilities. Apartment-style assisted living usually will include a kitchenette or full kitchen.

Facilities offering dementia-care floors or wings have a number of physical adaptations suited to this special purpose. Dementia units generally are locked to prevent wandering, or they may use electronic monitoring equipment, such as the "WanderGuard" system. Increased staffing, clearer and better rules for administering medications, and other unique characteristics generally result in a more institutionalized feel to dementia units than is found in less specialized kinds of facilities.

Common areas in assisted living facilities usually include a dining room, sitting rooms and one or more meeting/function rooms. Variations in the layout and design of these arrangements are limited only by the imaginations of the designers and operators of assisted living facilities.

The services provided by assisted living facilities are limited to non-medical assistance. This includes providing staff to help residents to walk, dress, socialize, bathe, do laundry and other personal activities. The facility also provides housekeeping services and meals three times a day.

Most facilities offer the above services as one or more "service packages," most of which are available for an added fee. If you are moving into an assisted living facility, be sure to inquire into exactly which services are included in the basic monthly rent, and which services must be paid for as an extra charge.

Medical services, such as administration of medication, cannot be provided in assisted living facilities. Staff can provide related kinds of help, such as reminding residents that it is time for them to take medication. But if they actually administer medical care -- such as giving out the medicine, instead of just reminding the individual about it -- the facility may fall under the regulatory jurisdiction of the state's public health agency. Hence, assisted living facilities are careful to separate personal care from medical care, and to offer only the former.

Those who need medical care in assisted living can obtain it through Visiting Nurse Associations and other agencies that provide on-site medical services, just as they would if they lived at home. Depending upon the availability of quality care from such agencies, residents in assisted living may be able to avoid nursing home care for a long time. The cost of all medical care in assisted living, however, must be borne by the individual, using whatever health insurance is available. The potential need to incur such added costs must be kept in mind when budgeting for a move to assisted living.

As mentioned above, a growing number of assisted living facilities now offer specialized treatment for Alzheimer's disease and other forms of dementia. These services usually are provided in a separate wing of the facility, but in some cases the entire facility may be devoted to dementia-related care.

In these units, skilled nursing staff are present to provide a higher level of diagnosis and care monitoring. Other services usually include psychiatric assessment services, increased overnight staffing and a multidisciplinary team approach to all services. These services, while non-medical in nature, can greatly increase the comfort and well-being of residents suffering from dementia.

Cost

The cost of assisted living varies as much as the facilities themselves. At the low end, costs will compare roughly with rents for better-quality apartments in the area. For example, the low end in urban Massachusetts is $1,500-2,000 per month. The high end is about twice that figure. In other parts of the country, costs will vary in accordance with real estate values where the facility is located.

Most financing for assisted living is private, although Medicaid is available in a tiny but growing number of facilities. Medicaid for assisted living is very different from Medicaid for nursing home care. In Massachusetts, for example, benefits in assisted living are provided only through the "Group Adult Foster Care" program in that state. Other states may have similarly arcane methods of financing assisted living.

Ironically, the cost to pay privately for assisted living is likely to be greater if the facility accepts Medicaid financing than if it refuses Medicaid. This is so because the amount Medicaid will pay for assisted living is far below cost, which forces the facility to make up the lost revenue through its charges for privately paying residents. In effect, those who pay privately must subsidize those who need Medicaid.

If you have enough resources to pay only for a year or two in assisted living, you should find out whether the facility will accept Medicaid after your money is gone. Sometimes facilities make other arrangements to keep residents whose funds have run out. It is vital that you know the details of what will happen when your money runs about, before you begin spending your assets for assisted living.

For an in-depth discussion of topics related to Assisted Living, ElderNet recommends readings by Lawrence A. Frolic, Professor of Law at the University of Pittsburgh School of Law, published by Warren Gorham & Lamont.

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