What Is Assisted Living?
There are around 35,000 Assisted Living Communities licensed and operating in the US today. These communities range widely in size, price and amenities and are all fiercely competing for your business. The real challenge is finding the one that suits your needs, lifestyle, and pocketbook.
The typical Assisted Living model is based on apartment style living with care services built in. This model encourages independence and autonomy while providing supervision and daily assistance with care needs. Meals are typically served in a main dining area with the intent of a social gathering by the residents while enjoying restaurant style dining. Ideally, activities are offered including outings, scenic bus rides, and trips to the grocery store, bank and doctor visits on designated days of the week.
What type of care is provided?
Assisted Living provides custodial care, not medical care. Custodial care is nonmedical assistance for activities of daily living (ADL’s).
What can I expect to pay for Assisted Living?
According to Genworth, the median cost for assisted living care in the U.S. is $43,200 annually. Most Assisted Living communities structure rates on an “a la carte” system. You may be quoted a “base cost” or “room and board” initially that does not include any personal care.
Expect to see additional costs added on right away for care needs based on a “points” or “levels” system and an assessment of care needs. This price can vary monthly, especially if care needs drastically improve or decline over time.
Base Cost or Room and Board may include:
- Weekly Housekeeping
- Weekly Linen Service
- Three meals and several snacks per day
- Utilities, except phone (cable and internet may not be included)
- Transportation to group events and outings
What are the advantages of Assisted Living?
- Less expensive than nursing home care
- Private apartments to optimize privacy, autonomy, and independence
- Three meals a day served in a social dining atmosphere with multiple food choices
- Security and call bell systems
- Designed with accessibility in mind (roll in showers, etc)
- Exercise programs
- Care Services available to be used as little or as much as you require, including medication management
- Activity programs designed to keep residents active, social, and healthy
- Most have a beauty parlor and private post office boxes for residents on site.
What are the limitations of Assisted Living?
- Despite staff presence and encouragement, some residents can become isolated.
- Most do not allow residents to cook, for safety reasons
- Assisted Living generally does not accommodate residents who are wandering or exit seeking. Some communities will have a “wander guard” system in place to prevent certain residents from being able to open doors leading to the outside.
- Minimal staffing requirements in most states. On average, expect to see 1 caregiver for every 30 residents during peak hours, and much less at night.
- While communities may tout their abilities to care for residents through the end of life, many will ask families to hire private caregivers or transfer to a higher level of care if the resident’s needs are beyond the scope of their staffing levels.
Who pays for Assisted Living?
- Private Pay, Cash, Savings (you)
- Long Term Care Insurance Check your policy forcoverage, nursing requirements, waiting periods, etc…
- Medicaid If you already qualify for Medicaid, or willqualify in the near future, make sure the facility you are considering has a Medicaid contract as many do not. You can check with the facility or your local Agency on Aging office for a list of contracted facilities. If a facility does have a contract, chances are they are trying to balance Medicaid versus private pay in the building. Some will have a waiting list for Medicaid, so plan ahead. Do not wait until a crisis to start your search!!!
- MEDICARE DOES NOT PAY FOR ASSISTEDLIVING (more on that later)
- VA The VA offers a variety of long term benefits toveterans and their spouses, if certain criteria are met.
Work with a Partner: Referral and Placement Services
The senior care industry has seen an explosion in Referral and Placement Services over the last decade. Anywhere you have a plethora of housing options for seniors, you will find one or several referral agencies eager to assist you and your family to find the right fit. That’s where the similarities end.
Local vs. Nationwide Coverage
I recommend working with a local company and not an online resource. You want someone who is familiar with the communities and homes they are representing and who aren’t selling your information online.
Hand-Holding vs. a List
Some agencies will simply supply you a list of “recommended” facilities based on a short telephone interview or an online screening. Others may want to visit with you and any involved family, and of course, the soon to be resident to discuss needs, wants, and preferences and then handhold you through the entire process of searching for mom or dad’s next home. For some families, it depends on the time frame. For others, it depends on personality or experience of the agent.
Questions to Ask a Potential Referral and Placement Partner
- How much experience does the agent and/or agency have? How long have they been in business?
- What type of resources are available to them to make sure they are exploring only the best options for your loved one (office staff, database)?
- Is the agency paid by facilities? If so, how many do they work with? Will certain facilities be excluded from your search because they are not contracted with the referral agency?
- Does the referral agency check the public disclosure files of all the housing options in your area (complaints, survey results)? If so, how often? If not, can they provide you with the information to view the data yourself?
- Does the agency preview all homes and facilities that it recommends to you?
- What criteria does the agency use in making referrals to you? Do they perform an assessment? Where do they get their information? Are physicians, social workers, home care agencies, therapists, or other caregivers involved in the information gathering process?
- Do they work with all budgets? Do they work with Medicaid or low income clients?
- Do they belong to any professional organizations?
- How quickly can they provide you with the information you need?
- Can they provide professional and past client references?
How do I find a reputable referral and placement agency in my area?
If you have only recently started your search for a professional referral and placement agency, call your local Aging Services office, hospital, or rehab facility and ask for recommendations. Social workers and case managers work with referral and placement advisors frequently. They will have inside information and recommendations for reputable people and companies available.
It is not recommended to work with more than one agency. However, if you are dissatisfied with a placement business, make sure that you let them know in writing that you are terminating your working relationship with them. This notice will allow another reputable company to provide services to you.
Pre-Planning: Financial and Legal Considerations
Having legal and financial preparations in place can mean a world of difference in the journey of senior care.
Legal preplanning is one of the most important aspects to any senior care plan. No matter how this journey goes for you or a loved one, at some point legal issues will arise. Doctor and hospital visits can become complicated if the proper Power of Attorney documentation is not in place. Banks and financial institutions will not work with anyone who does not have the legal authority to represent the account holder.
I HIGHLY recommend working with an attorney, and if you can, an Elder Law Attorney in order to ensure these documents are correctly administered, signed and notarized if needed. Consider the money spent an investment in you and your family’s future.
The following are important documents to research and have in place. Preplanning is not just for older adults, but adults at any age.
- Power of Attorney– Health Care and Financial
- These documents allow you to appoint another person to make decisions on your behalf and/or in the event you are unable to make decisions for yourself. Also called a Durable Power of Attorney in some states. A person who is incapacitated or cognitively impaired cannot assign a power of attorney (this is where I have personally seen a lack of preplanning have serious repercussions, eg. court appointed guardians).
- Living Will– This document helps spell out healthcarewishes to physicians and family. This ensures that no one else decides for you how your medical care will be administered, or not. Remember Terri Schiavo?
- Will– A legal document that declares how you want yourestate and possessions distributed after your death. Even for those with very few assets, a Will can be an important document to spell out how to distribute personal possessions.
Preparing for retirement is one thing, planning to pay for senior care is a whole other world. As reported by Genworth, the annual cost of home care in 2015 is $44,616 (based on 44 hours/week), Assisted Living $43,200, and nursing home care is $80,300. If those numbers are giving you heart palpitations, you aren’t alone.
Take the time to understand the following government programs that may be able to help pay for the cost of senior care. Remember, qualifying for programs like Medicaid and VA benefits does not happen quickly. Research these programs before a crisis.
- Medicare Medicare does not pay for any long term care.It does pay for short term rehabilitation if specific criteria are met. Many people are misinformed when it comes to the limits of Medicare benefits. Medicare.gov does a great job of explaining what is covered under Medicare benefits.
- Medicaid Medicaid is a federal program, but benefits areadministered by each state and vary widely in criteria to qualify. Generally speaking, Medicaid will cover the cost of long term care in certain settings if specific health and financial conditions are met.
- Veterans Administration The VA offers a variety of longterm benefits to veterans and their spouses, if certain criteria are met. You can find specific information at va.gov about the programs, benefits, and pension options available. My personal experience with an elderly family member was that it took 9 months for her application to be approved, so plan ahead.
What to Look For: Assisted Living
Activities: What activities are offered? Is there a dedicated activity director? Do the activities fit your lifestyle? Is there a resident council? How often do they meet?
Atmosphere: Does the facility have a comfortable atmosphere? Is it clean? Are there any noticeable odors? What safety features are available? Are medical alert pendants available for residents to wear? Is there an additional cost? Are call buttons located in the room?
Cost: What are the costs for the facility? What is included in the base cost? How are additional care costs assessed? Is a deposit required? Is the deposit refundable? Are there any move in fees? Has the community historically had cost of living increases? How often? If the rate is increased due to care needs, how much notice will you receive? Is Medicaid accepted? What happens if your loved one runs out of money?
First Impressions: Are your first impressions of the facility, grounds, furnishings, and caregivers positive? Are you greeted warmly and professionally? Does the person giving the tour want to know about your loved one? Are they asking questions about your situation?
Future Care Needs: At what point can they no longer care for your loved one? Does the facility accept tube feeding? Are they able to manage a two person transfer? How much notice will you receive if they can no longer care for your loved one? What support can they offer in the event your loved one needs to move out of the community?
History and Management: How long has the facility been operating? Who owns the facility? Who manages the facility? Do they own other assisted living communities?
Interaction: Do the residents interact well with each other and staff based on your observations? Do staff acknowledge the residents by name and with a smile?
Meals: Ask to have lunch during your tour. Are there adequate options if you don’t like or can’t have what’s on the menu? Can family or friends join residents for lunch? How much are guest meals? What times are meals served? Do these times fit with your routine? What if you want to take your meals in your room or aren’t feeling well is there an extra charge? Can special diets (diabetic, gluten free, lactose intolerant, kosher) be accommodated?
Nursing: What are the nursing hours per week? Does the nurse work full time? Does the nurse work at other communities? What is the role of the nurse in the daily lives of the residents?
Pets: Are pets accepted? Are there weight limits for dogs? Are there separate costs for pets? Who will care for the pet if the resident is ill? Are they allowed in common areas? How are apartments deep cleaned between residents for those with allergies?
Planning: How often is the care plan reviewed? Is the responsible party involved in this review? Is the resident involved in the care plan process?
Reporting: How are incidents (falls, altercations, change of condition etc…) handled? How is this information relayed to the responsible party?
Staffing: What is the caregiver to resident staffing ratio for each shift? Does this include nurses and medication aids? What does the staffing look like on the weekend compared to the weekday? What is the turnover rate for staff?
Survey: Ask to see the latest survey, a detailed report of the State’s last regulatory inspection for compliance that happens every one to two years. The survey results are public information and should be easily accessible to anyone who requests them. If a facility will not share with you the most current survey results, run away. Far, far away. Look for an open and transparent facility regarding any issues they have had and how those infractions or citations have been corrected.
Transportation: Is transportation available? Is there a fee for transportation? Is the bus/van able to transport residents to doctor’s appointments? Are there specific days that transportation is available? What is the radius that the bus can transport residents?
Depending on your geographical area, there may be options that range greatly in size. Keep your loved one in mind when considering the size of a community. Would they prefer a large setting with lots of activity and people to meet? Or would they prefer more homey intimate surroundings?
The Stuff: What to Bring, What to Let Go
Once the difficult decision of WHERE to go is made, the overwhelming task of deciding WHAT to bring quickly follows.
The move to a care community means downsizing in every way. Square footage, closet space, and outdoor living space is greatly decreased compared to living at home.
Bed Generally, beds are not furnished (the exception would be an adult care home), unless your insurance is paying for a hospital bed. Depending on the size of the bedroom, a twin, double, or full sized mattress is best. You want to make sure there is plenty of room around the sides of the bed to maneuver safely, especially if other furniture is in the room. A footboard and headboard may be desired, depending on the space.
Bedspread, blankets, and pillows Chairs and sofa, if space permits
Clock, personal photos, and decorative items familiar items in your new home, like curtains, artwork, and houseplants can make a world of difference to make your new accommodations feel more like home.
Clothing Garments that are washable commercial washing machines can be very hard on clothing. I would limit dry clean items and bring clothes comfortable for everyday use. Perhaps a few dressy items for special events. Label Clothing!!!
Dresser/ Nightstand/ Lamp if you are tight on space, the dresser may fit in the closet.
Garbage cans In a retirement or assisted living setting, a small garbage in the bathroom(s) and kitchen area are handy.
Personal Items & Toiletries toothpaste, toothbrush, denture products, comb/brush, soap, shampoo, shaving products, incontinence supplies*, glasses, hearing aids.
Sheets At least two sets, unless the bed is changed frequently, most housekeeping is weekly that includes laundering sheets.
Shower curtain and rings Most communities supply the rod.
Telephone or cell
Towels Several (23) complete sets of towels. If housekeeping is done weekly, this should be plenty.
*Some communities will assist in ordering incontinence supplies as they may be able to purchase in bulk at reduced prices
Large Furniture dining room tables, coffee tables, TV units, and King sized poster beds can all be left behind. Not only are they difficult to move, but they will take up considerable living space. If these items are meaningful treasures, this may be the time to hand them down to family, place in storage, sell, or consider donating.
Kitchen Items you will no longer need the crock pot, Dutch oven, and countless pots and pans that have accumulated over the years. A few dishes, silverware, cups, and Tupperware may be appropriate, but anything else will go unused and take up valuable cupboard space that can be used for other necessities. Cleaning Supplies If housekeeping is included (and it usually is), you will not need to bring chemicals, mops, or the vacuum. Perhaps a small broom for quick clean ups, but that’s it.
I recommend working with a professional organizer or move manager when the time comes to consider a move. These wonderful folks will help you with organizing your belongings and guiding you through the tedious task of deciding what to keep, pass on, donate, sell and what to simply throw away.