We spend quite a bit of time discussing nursing home care and the legal obligations of facilities to provide skilled nursing care under federal and state regulations. While nursing homes are medical facilities with very specific obligations set forth under the law, assisted living facilities are a completely separate entity that needs to be clearly distinguished form nursing homes.

The department of Health and Human Services estimate that close to one million people currently live in the more than 38,000 assisted living facilities scattered across the country. According to some experts, the number of assisted living residents may soon surpass the number of people living in nursing homes over the next decade.

Because assisted living facilities are an quickly evolving segment of the senior care market, their role remains somewhat of a mystery to many. I came across Dave Carpenter’s article “Assisted living options: What you need to know” which does a great job enumerating responsibilities and information about assisted living facilities in a clean and articulate manner. Below is an except from Dave’s recent article.

What they are

Assisted living facilities are residential communities that offer different levels of health or personal care services for seniors who want or need help with some daily activities — anything from cooking to transportation to dressing and bathing.

What they’re not is nursing homes that address major medical needs. They are designed to provide a home-like setting for residents who want to live independently with minimal assistance.

Who lives there

The average age of residents in assisted living facilities in 2009 was about 87, according to the National Center for Assisted Living, an organization representing long-term care providers. Three-quarters of the residents are female. They stay at the assisted living residence for an average of about 28 months, and the majority then move on to a nursing facility.

Services provided

Services offered vary widely but typically include 24-hour emergency care, some medical services and help with medications, limited assistance with personal care, meals, housekeeping, laundry, transportation and recreational activities. Large facilities may have private apartments as well as shared and private rooms.

First steps

AARP suggests checking with a state or local agency on aging, the yellow pages, the Assisted Living Federation of America and the American Association of Homes and Services for the Aging, as well as with friends, neighbors and books on retirement.

If looking on behalf of your parents, check your own local neighborhoods first. Most residents of assisted living facilities in urban areas who have children live within five to seven miles of them, according to Eichelbaum.

Finances

The cost of assisted living facilities varies greatly depending on size, location and services. The median rate for a private room is $3,261 a month, or just over $39,000 a year, according to Genworth Financial Inc., which compiles an annual costs survey among long-term care service providers. If you need a home health aide on top of that, the median cost nationwide is $19 an hour.

Neither Medicare nor health insurance policies pay for assisted living. Medicaid covers only some services, and not in every facility or every state.

Long-term care insurance may cover most of the costs, depending on your policy. But if you haven’t bought coverage well ahead of time, you may not be eligible and able to afford it.

AARP says four out of five residents pay for assisted living out of pocket. Veterans who need assistance can qualify for up to $1,949 a month if married, $1,644 if single or $1,055 for surviving spouses through the Aid and Attendance Pension.

Alternative option

There are three basic types of living options for seniors as they age: independent living, assisted living and skilled nursing. To avoid needing to move every time more assistance is needed, continuing care retirement communities are worth considering. They offer a variety of services for all three levels within one community. But this tiered approach is expensive. Entrance fees can range from $100,000 to $1 million, and monthly charges can range from $3,000 to $5,000, increasing as needs change.

Advance preparation

Do the research before you have an immediate need. Having an idea of the cost and availability of options in your community is essential. If local facilities aren’t appropriate or affordable, it may be worth considering relocating to a community with one that fits you or your parents better.

It’s probably too late for your elderly parents to obtain long-term care insurance, but getting it for yourself in your 50s or early 60s is an important step to finance your own future care in an assisted living facility or elsewhere.

Getting siblings to agree ahead of time to a plan for an aging parent and how to finance it is important too, says Amy Goyer, AARP’s family expert. “If you wait until the crisis time, often the burden just falls on who’s closest,” she says. “That can be much harder and unfair for some family members.”

Glenn says:

November 15, 2011 at 5:22 am

In addition families need to be careful that assisted living facilities abide by HIPAA. Many of these organizations are very loose with sharing information online about their residents. They often post names of residents and birthdays online. This exposes residents to identity theft too.
The HITECH act of 2009 pushed out the HIPAA regulations for privacy and security to assisted living since they are considered a business associate. So even using email is considered a violation in some cases.

ron says:

November 15, 2011 at 8:39 am

I’ve worked in this field for two decades – ALFs have changed and people need to be aware of this. Be sure to find out if there is a licensed nurse onsite 24/7 or just “on call.” In my opinion having an LPN 24/7 “onsite” is a must. Are activities planned for evenings s/weekends? Many facilities “appear” to have activities at these times but the activity person leaves at the end of the day so who is conducting them during these times? Observe a meal and note if there is additional staff to help accommodate those with special needs – do not eat in a private dining room becaue you will not be able to observe this; ask to be seated in main dining area. Mealtimes are the best time to visit/tour – assisted living facilities have become the nursing homes of yesteryear wtih many very sick residents. If you visit then you can see the health of residents and if this will be appropriate for your loved one. The best tip of all – ask other family members, most of whom will tell it like it is! Are there any entrance fees or move-in fees? Most assisted living facilities have this fee ranging anywhere from $500 to $1,000 and up and it’s usually not refundable. That fee is used mainly to pay the bonus of the salesperson. If you stand your ground, this fee is negotiable and in some cases may be waived. Times are tough for these places and a bed in the head is worth more than a bonus for the salesperson. Be sure to negotiate this with the director, not the salesperson.