Assisted living residences are aimed at helping residents remain as self-sufficient as possible with the assurance of assistance when needed. A combination of housing, meals, personal care and support, social activities, 24-hour supervision and, in some residences, health-related services is usually provided. Assisted living facilities are a great choice for those who can’t live on their own, but do not need nursing care. As needs change, these facilities offer different levels of care at different costs – and some are even associated with nursing facilities should your loved one eventually need full-time nursing care.
There is no standard for assisted living residences, which vary in size, appearance, cost, and services offered. Some residences provide only meals, basic housekeeping, and help with the activities of daily living (ADLs) such as bathing, dressing, and grooming. Others go beyond these services and furnish transportation and certain health services. Facilities range from small homes with just a few residents to high-rise apartment-style buildings with hundreds of residents. Living areas could be a single room or a full apartment with a small kitchen, with prepared meals also served in a common dining area.
If assisted living sounds like the right choice for your loved one, here are some steps to help begin your search:
Start by making a list of residences to visit. The following resources can help:
- The state or local Area Agency on Aging (AAA).
- The local yellow pages.
- The long-term care ombudsman’s office .
- The state licensing agency.
- Friends and neighbors.
- Retirement guides.
- The Assisted Living Federation of America (ALFA), which provides lists of its member residences by each state. These are mostly for-profit residences. The lists do not include all residences in each state.
- The American Association of Homes and Services for the Aging (AAHSA), which provides lists of member residences by state. These are not-for-profit.
- The Eldercare Locator helps you find the closest Area Agency on Aging (AAA) office and the state long-term care ombudsman’s office.
Keep in mind that assisted living residences are not defined or regulated by the federal government. Each state decides how they’re licensed. Be sure to find out from the AAA or state health department how the state where you are searching handles this. Make sure all the residences on your list are appropriately licensed—if one of them isn’t, cross it off and move on.
Check, too, with the state licensing agency and ombudsman’s office to see if there have been complaints filed against the facilities on the list. Don’t assume that a state license ensures quality care.
Next: Make the Call
Call each potential residence and ask for a general overview of their facilities. Remember that the person you speak with will most likely be a marketing or sales representative whose job is to promote the residence.
If you’re still interested after the call, ask that more information be mailed to you or your loved one, including:
- A price list.
- A map or floor plan.
- A copy of the residents’ rights and rules.
Copies of all the documents that will need to be signed before admittance, including, most important, the contract (sometimes referred to as residency, occupancy, or admission agreements).
Once you receive these materials, review them carefully with your loved one and write down all the questions that come to mind. Strike any residences from your list that don’t meet your criteria.
Plan to Visit
First, it is imperative that you involve your loved one in the choices about his or her care. Take them with you on the tours of each facility and let them handle as much of the talking and decision-making as possible.
Second, take these questions, along with the residence-specific questions that arose while reviewing the mailed materials, with you. As you and your loved one meet with staff and take a tour, pay attention to how you feel and your surroundings. Spend time with the staff and residents. Ask them what they like and dislike about the place. Make a second, unannounced visit on a weekend or in the evening. You may find out important information by dropping by unannounced.
Signing the Contract
After reviewing all the materials, visiting each prospective residence, and getting all questions answered, singing a contract is the final, and most important, step. This is the legal document that states what arrangements are agreed to, regardless of anything promised verbally or in marketing materials. The more specific the contract, the greater your loved one’s legal protection. Compare information in the sales brochure with that in the contract, paying close attention to fees, level of care, health care services and discharge policies. Benefits that a residence promotes in a brochure should also appear in the contract.
- Make sure you understand what the contract says. Get any and all questions you have answered before signing.
- Ask that any information not included about care, rights, costs and services be added — and don’t sign a contract until you see these additions have been made (a residence can promise anything in a brochure, but it is only bound legally by what is in the signed contract).
- Never sign on the day you visit.
- Before making a decision about a residence, take the contract home and review it with family members.
- Consider reviewing the contract with a financial adviser and a lawyer.
The Cost of Assisted Care
Assisted living can be costly. About four out of five people pay for it out of pocket. Medicare does not cover assisted living. While more states are starting to cover some services under Medicaid or other government programs, public payment is not common in the assisted living industry. State Medicaid agencies can provide information about eligibility and covered services. Before you seriously consider assisted living as an option for your loved one, decide whether you and your loved one can afford it long-term. Keep in mind that the cost will rise over time because of standard cost-of-living increases. Also, expect monthly price hikes for extra services as needs change.
Promotional materials for these residences commonly present fee information in general terms, so it’s crucial that a contract detail all of your payment obligations. Consider running the contract by a lawyer before signing.