What is Assisted Living?

As defined by the Assisted Living Federation of America, Assisted Living is a long-term care option that combines housing, support services and health care, as needed.These needs may include assistance for Memory Care disorders including Alzheimer's Disease. Assisted Living Facilities can act as a bridge for those individuals requiring more assistance than what is provided at home or at an independent living facility but not needing the round the clock supervision or care of a nursing home.

Also commonly called a residential care facility, assisted living is in a residential type facility, ranging anywhere from converted homes or hotels to high-rise apartment complexes. As a result, they range in size from as few as 10 residents to 120 or more. Residents typically live in there own private apartments, equipped with private kitchens and sitting areas. Although, shared apartments, rooms, and studios are available based on the residents preference and care requirements.

The range of amenities and services vary by facility but commonly include:

  • Transportation
  • Personalized care plans
  • 24-hour security
  • Exercise and wellness programs
  • Personal laundry services
  • Weekly housekeeping
  • Three meals a day in a common dining area
  • Availability of a training clinical staff
  • Availability of a licensed nursing staff

It's important to note that assisted living is not regulated by the Federal Government. In the U.S., each state has its own specific licensing requirements for assisted living. For additional questions regarding regulations in the State of Illinois, please call the Illinois Deparment of Health, Office of Health Care Regulation at (1-800-252-4343) or visit http://www.idph.state.il.us/about/ohcr.htm.

Costs and Payment

Assisted Living can be very costly. The overwhelming majority of residents pay for assisted living out pocket, with costs that vary by your desired type of room, amenities,level of care required, and location. Residents can typically expect to pay more for a private room and/or a higher level of care than other residents. It's important to note that costs will rise over time to accommodate for standard cost-of-living increases and extra services as individual care needs change.

According to the 2012 MetLife Market Survey of Nursing Home, Assisted Living, Adult Day Services, and?Home Care Costs, the average monthly base rates for assisted living in Illinois were $3,858 per month. Base rates started as low as $1,700 per month and went as high as $5,880 per month. Costs in this base rate included at least two meals per day, housekeeping, and some personal care assistance.

Personal Funds

About four out of five people pay for assisted living out of pocket. They may use personal savings, a pension or other retirement fund, income from stocks and bonds, or proceeds from the sale of a home. As a result, residents should ask the facility about financial assistance programs which may include grant programs or internal move-in incentives.

Long-Term Care Insurance

Long-term care insurance pays for several types of long-term care, including assisted living. The exact coverage depends on what type of policy you buy and what services are covered. It's important to check the provisions of your plan to find how much assisted living is covered. For those interested in buying long-term care insurance, we recommend that you plan in advance as costs go up with age and increased care requirements.

Government Assistance

Medicare does not cover most long-term care costs and does not pay for assisted living. Over half of the participating facilities in the 2013 Overview of Long-Term Care Services in the United States were authorized or certified to participate in Medicaid so make sure to ask prospective facilities if they accommodate Medicaid. However, Medicaid is not available for everyone. To be eligible you must meet certain financial and health requirements. For some individuals with financial resources above a certain limit, they may not qualify unless they first use up their own resources to pay for care, which is called "spending down."

Veterans'Benefits

Veterans' benefits are another source of government funds where veterans may have access to VA-approved board and care homes, or veterans' homes which provide a continuum of care. Veteran's Aid and Attendance Pension Benefit provides a Tax-Free pension that will help offset the costs of assisted living. Qualified veterans are eligible up to $2,085 per month for a married couple, $1,758 per month for a single or widowed Veteran, and $1,130 per month for the widow/er of a Veteran. To determine your eligibility, please contact your nearest veteran service officer.

Before moving into an assisted living facility, make sure you have a clear understanding of the following questions provided by the American Health Care Association.

Service Planning

  • Are the family and the resident involved in the service planning process? How often are residents' needs assessed? Who completes the assessment?
  • Are there special programs for residents who have Alzheimer's disease, other forms of dementia or memory impairments? Are there accommodations for memory-impaired residents to be outside and exercise?
  • Are there special programs for residents with disabilities?
  • How are emergency medical situations managed? What is the protocol for such events?
  • What happens if the health care needs of a resident change? Under what conditions are residents asked to move if there is a change in health status?

Services and Activities

  • Does staff assist residents in administration of medication? If so, what kind of staff and what type of training did they receive?
  • Does the residence generally use a particular pharmacy? If applicable, does that pharmacy participate in the individual's Medicare Part D prescription drug plan?
  • Does the pharmacy provide a yearly review and consultation services?
  • Are there professional nursing services on site? If not, do staff members assist residents and families in making arrangements through a home health agency?
  • Are the services of a physical, occupational or speech therapist available or arranged?
  • Does the residence provide bed linens and towels?
  • Does the facility provide laundry service?
  • Are there beauty shop services available on site?
  • What recreational and spiritual activities are available? (Obtain or review a copy of the activities calendar.)
  • Is there a wellness program?
  • Are the activity supplies available for resident use outside of scheduled programs?
  • How are individual activity interests and preferences accommodated?
  • Is transportation provided for medical appointments and recreational purposes? Is there a fee?
  • Are there resident and family councils? How often do they meet? What are the suggestion, complaint, or grievance procedures?
  • Can hospice care be offered? If so, does the residence coordinate that care with the physician and family?

Staff

  • Ask about the residence's staffing levels and philosophy about staffing.
  • What training and qualifications are required for staff? Are there on-going training programs provided for staff?
  • Do staff members receive special training in care for residents with Alzheimer's or dementia?
  • (Observe staff and resident interactions.) Are they positive? Courteous?
  • Do staff members handle resident requests in a timely way?
  • What is the residence occupancy level?
  • Can private duty companions be hired? What is the procedure for that type of service?
  • Does the residence have a volunteer program? If yes, what types of activities do the volunteers perform?
  • Does the administrator/director practice an "open door" policy?
  • Who owns the assisted living community?

Dining and Food Services

  • Does the residence accommodate special diets?
  • Does a dietician or nutritionist review the menus? (Request or review copies of the menus.)
  • How often do the menus rotate? Are residents and families involved in the menu planning?
  • Are residents allowed to have guests for meals? Is there a separate guest dining room?
  • Are there separate fees for guests?
  • What are the criteria for residents to eat meals in their rooms? Are there separate fees for having meals delivered?

Living Space and Accommodations

  • Are there adequate residence areas for resident use?
  • Are the residents' rooms furnished or unfurnished?
  • What is the policy about personal belongings?
  • What is the policy for overnight guests? Are there guestrooms available?
  • What are the guest fees?
  • Is additional storage space available? Is there an extra fee?
  • Does the residence meet the rules for people with disabilities?
  • Can residents have automobiles? Is there assigned parking? Is there an extra fee?
  • Are there patios and courtyards available for resident use? Is there an area for resident gardening?
  • Does the residence provide security?
  • Are pets allowed to reside in the residence? If so, are there additional fees and or deposits? If not, are pets allowed to visit?

Licensure and Certification

  • Is the residence licensed? (Ask to review the last licensing or certification report.)
  • If the state requires the administrator to be licensed or certified, is it current?
  • Do staff members actively participate in a professional association, such as a state long term care association affiliated with National Center for Assisted Living?

Safety

  • Does the residence have a fire sprinkler system throughout the facility?
  • Where are smoke detectors located?
  • How often does the facility have fire drills?
  • Does the facility have an emergency preparedness plan?
  • How are emergency and evacuation plans reviewed with residents after admission to reinforce their memory?
  • What systems are used to keep residents with dementia or Alzheimer's secure from leaving the residence on their own?

Location

  • Is the location of the residence convenient to shopping, medical services, and entertainment areas?
  • Can family members and visitors easily locate the residence for visiting?

Moving In

  • What does the move-in process entail? What are the paperwork requirements and the timeframes involved?
  • How is the initial assessment managed? Who completes the assessment?
  • Is the residence affiliated with a hospital or nursing home should acute or long term care be needed? If so, is there a priority admission process?
  • If you need hospital or nursing home care, is your room held? What are the associated fees? Is there a discount for unused services (e.g. meals)?
  • Does the residence subscribe to a set of resident rights and responsibilities? Are printed copies of resident rights and responsibilities available?

Costs and Fees

  • What is included in the basic monthly cost? Ask for a written copy.
  • Does the residence have a written schedule of fees for extra services? If so, request a copy.
  • Under what circumstances might the fees change? How much notice is given if there is a fee increase?
  • Is there a security deposit and/or an entrance fee? What is the refund policy?
  • Can service agreements and or contracts be amended or modified?
  • Does the assisted living residence participate in Medicaid?
  • Can the residence provide a list of services and activities that cost extra?

Choosing an Assisted Living Residence: A Consumer’s Guide: A comparative checklist for consumers and prospective residents, including starting ideas to find facilities. (American Health Care Association / National Center for Assisted Living)

Assisted Living: Weighing the Options: AARP Caregiving Resource Center

A Helping Hand, Paid on Commission: New York Times article discussing the practice of long-term care referral agencies recommending facilities to consumers based on earned commissions.