• Assisted Living Residences

The level of health care offered by assisted living is lower than the level of care offered by a skilled nursing facility. Assisted living residents generally are able to move about the residence independently, but some may use a walker or wheelchair. If an assisted living residence can accommodate individuals who use wheelchairs, those residents must generally be able to get in and out of the wheelchair independently, to transfer from the chair to bed or a toilet independently and to use the chair to move about the facility by themselves. The needs of residents tend to vary. Some will be quite mobile, but find the prepared meals and housekeeping assistance helpful. Some residents may be very alert and independent, but may have problems with mobility, bathing or dressing. Some residents may have some early dementia (such as Alzheimer's disease) and would not be safe at home alone, but do well in a community with some supervision and direction from the staff. Spouses sometimes enter assisted living when the healthier spouse is unable to provide enough care for the more ill spouse; they can live together in an apartment and receive the appropriate level of care for each.

If a resident in assisted living should become terminally ill, he or she could bring hospice care into his or her assisted living apartment.

LICENSING: Residences are licensed by the state as assisted living facilities. Some assisted living facilities may also be specially licensed to provide care for individuals with Alzheimer's disease. Those residences licensed for Alzheimer's disease care can have residents who dementia is fairly advanced and who require larger amounts of assistance as a result. Those types of residences will have staff trained to assist Alzheimer's patients and will generally have "secured" areas, meaning that the areas are locked to prevent residents from wandering out and becoming lost. Assisted living facilities that are not licensed as Alzheimer's facilities cannot keep residents whose dementia progresses beyond the point where they are safe with only limited supervision; at that point, the assisted living staff will try to help the resident's family find a residence that offers a higher level of care.

WHAT DOES ASSISTED LIVING LOOK LIKE? Most newer assisted living residences offer small private apartments, with private baths, and large, cheerful community areas for residents to enjoy. They often have lovely landscaped grounds or courtyards where residents may enjoy being outside, perhaps to garden a bit or simply to take a stroll. Most apartments are private, or larger apartments might be shared by spouses or siblings. Some older buildings will occasionally have semi-private rooms (two residents per room).

Some assisted living facilities may be what are also called "residential care homes." These are generally small residences that take a very limited number of residents (less than 10) and operate in what would otherwise be considered a single-family home in a residential neighborhood. These residential homes may have a cozier feel than larger assisted living communities and may be a better fit for some residents. Some residential homes may have shared bedrooms and baths, others may have private rooms. When touring a private residential care home, ask if the home is licensed and, if so, for what. Some may be licensed by the state as assisted living, some as Alzheimer's care. Very small residences are not required to be licensed, but keep in mind that no license means no inspection or oversight by the state. Some residential care homes may be less expensive than larger assisted living facilities; others are quite comparable in price.

When you tour an assisted living residence, the apartments may look small, but remember that one of the important goals of assisted living is to provide social interaction for residents. They are encouraged to spend a great deal of the day in common areas, such as sitting areas, the dining room, the library, crafts areas, game rooms, or other areas where residents congregate for fun, meals and conversation. Optimally, the time a resident spends in his or her apartment will be limited.

Most newer assisted living residences will have only mini-kitchens in their apartments, perhaps with microwaves or small refrigerators. A resident's monthly fee includes three meals per day; residents do not need to prepare their own meals. In a residential care home, the residents will share a communal kitchen.

Assisted living residences may be stand-alone buildings or may share grounds with independent living or skilled nursing care. Some will be found in a continuing care retirement community. Residential care homes are found in all types of neighborhoods; there could be one on your own street and you couldn't tell from the outside.

TRANSPORTATION: Some residents in assisted living still drive and will bring a car to their new home. The assisted living community typically offers transportation for medical appointments, shopping and group activities and residents do not need their own cars.

PRICING: Some assisted living communities charge each resident a flat rate per month, based on the size of the resident's apartment. Others may offer several levels of care and, depending on the needs of a resident, he or she will be billed for that level of care in addition to the base rent for the apartment. Many residents will need increasing care over time and their rates will increase accordingly. Some communities charge per resident, so a husband and wife will pay twice the single rate. Others charge per apartment, with an extra small fee for the second spouse.

When touring facilities, ask how billing charges are determined and ask for a rate sheet. A resident signs an agreement upon moving to an assisted living facility. The contract is generally considered as month-to-month, with a specified notice period to the facility before the resident leaves, which some facilities will waive if the move is caused by a decline in the resident's health.

The cost of assisted living is less than the cost of skilled nursing care, although high level assisted living services, especially high level dementia care, may approach the cost of low level skilled care. The level of care provided, the size, age, condition and location of the facility and the size of the resident's apartment all factor into assisted living pricing. You sign a contract before admission for an agreed-upon price, which may change if the resident's level of care changes or if monthly fees increase periodically for the entire facility. It is not unusual in the Dallas - Fort Worth area to pay $3,000 to $4,000 per month on average for one person in assisted living.

Make sure your service agreement spells out what services will be provided for the agreed-upon fee and what extra costs might also be incurred. Does the facility charge for supplies (for example, a wound dressing or adult diaper)? If a resident isn't feeling well and requests a meal be delivered to his apartment, is there a charge for that service? Medications will probably have to go through the facility's pharmacy and be packaged in individual doses (to prevent medication errors); this will increase the cost of medications. Are there charges for transportation? Is there a beauty salon and, if so, what do they charge for services? Are there fees for housekeeping or laundry? For items that are billed as an additional charge, family members may sometimes be able to provide supplies or labor (such as doing the resident's laundry) to keep costs at a minimum.

PAYMENT: Where does the money to pay for care come from? Medicare does NOT pay for assisted living. Most assisted living residents pay their fees from their monthly income and/or from savings or investments (called "private pay"). Some assisted living facilities will accept Medicaid payments for those of their residents who qualify medically and financially for the program, but this is the exception, rather than the norm. If a resident has a long-term care policy, the policy may pay benefits at the rate set by the policy (at a full or reduced daily rate, depending on policy terms) directly to the facility or to the resident. With most long-term care policies, the person who is insured does not have to continue paying insurance premiums while receiving benefits under the policy. Read the policy to see what conditions are required for the policy to begin paying benefits. Some policies also have dollar or time limitations, meaning they will pay up to a certain dollar limit (for example, a maximum of $100,000 in benefits) or for a certain length of time (for example, up to three years). Most have a waiting period before they will begin to pay benefits (most often 90 - 100 days).

WHAT TO LOOK FOR: When considering a move to assisted living, visit several facilities before making a decision, including residential care homes. Does the individual making the move prefer a large or a small community (the smaller communities feel more like home; the larger communities offer more activities and amenities)? Does a facility look clean and inviting? Does it SMELL inviting? Do residents seem happy and active? Is the neighborhood convenient for the resident to frequently see friends and family? Is the neighborhood safe for the resident to go shopping or out for a walk? Does the potential resident like the food (ask to try a meal and to see a sample menu)? Would the resident keep her own doctor or does the facility offer a physician who visits? While touring, talk to residents and family members you encounter and ask how they like the community. You should see groups of residents socializing throughout the facility; if no one is out and about, how will a new resident find companionship? Can the potential resident afford to live there? Can the potential resident easily get from the apartment you are considering to the dining room and other popular common areas or is it too far for her to walk comfortably? Does it have activities that the potential resident enjoys (cards, crafts, pool, a fitness center, etc.)? Does it have a personal response system in each apartment (a pendant that a resident pushes to summon help in an emergency)? And MOST IMPORTANTLY, what is the staff to resident ratio (and weekdays vs. nights and weekends)? Compare these items for the communities you are considering. Base your decision on which community is going to have the fastest response time if your loved one falls or has a care need. Knowing a care aide will appear quickly to assist is better than a crystal chandelier in the lobby any day of the week.

HINT: Sometimes individuals wait too long to start in-home services or to move to assisted living. They struggle at home, sometimes eating poorly, lonely and depressed, or at a high risk for falls from stairs or other dangers. By the time they finally seek help, they are injured or so debilitated that they need a high level of care and must enter a skilled care facility (such as a nursing home). Early assistance from in-home services or assisted living can keep an individual safer, healthier and more independent longer, which not only improves his or her quality of life, but is also cost-effective as it avoids or delays the need for higher levels of care. Be smart -- don't struggle alone, get the help you need.