Guide for Assisted Living Facilities

Opening a near chapter in your life should not be met with dread, stress, and confusion. When it comes to transitioning to long-term care, several buzz words and different terms are used – almost so that hair pulling is necessary. Is an Independent Facility and Assisted Living Facility the same thing? Is an Assisted Living Facility better for me or is a nursing home more appropriate? Can I continue living at home? 

Take a breath and relax as we coach you through understanding what Assisted Living Facilities offer, which services are offered, and monthly costs. This guide is meant to provide you with a general understanding of Assisted Living Facilities and give you the confidence to make an informed decision if an Assisted Living Facility is in fact the next chapter in your life. 

What is an Assisted Living Facility?

The several options offered when considering a transition away from your home as a senior can be a headache. Especially during a time when a significant decision is being made, your best state of mind is much needed. We’re here to help coach you through a guide in order to make things as clear-cut as possible. Let’s start with understanding exactly what an Assisted Living Facility is: 

• Assisted Living Facilities (ALF): A community aimed at serving individuals who need help with personal self-care activities and health services but do not require 24-hour monitoring skilled nursing care for long periods of time. 

If you find yourself independent in the community and can easily complete your own personal self-care activities (i.e, dressing, eating, bathing, and walking), Senior Retirement Communities or Independent Living is likely a better avenue for your transition. On the other side of the spectrum, if you find yourself requiring help for all of your personal self-care activities, needing heavy physical assistance or a mechanical lift to get up from bed, and needing close monitoring of medical problems at all times, a Skilled Nursing Facility is a more appropriate choice. 

Maintaining your independence for as long as possible is the mantra for Assisted Living Facilities, allowing seniors to age in place as safely and for as long as possible. The goal and philosophy of Assisted Living Facilities are to:

• Maximize and maintain residents’ (seniors or individuals with developmental disabilities) independence facilitated by companionship, independence, privacy, and security within a home-like environment. 
• Adapt to support the individual residents’ changing overall health needs and preferences. 
• Decrease the need for continuous relocations. 
• Incorporate family and community involvement in the resident’s new life chapter. 

In short summary, an Assisted Living Facility is a long-term environment that provides housing, limited health care support, medication administration, and personal self-care services for seniors. 

Who Belongs in an Assisted Living Facility? 

To gain a better understanding of things, it’s often helpful to compare apples to apples. Again, Assisted Living Facilities are fitting for seniors that need long-term help with personal self-care activities but do not need skilled nursing care. Specifically, common activities that seniors receive assistance for in Assisted Living Facilities include: 

1. Maintenance of personal hygiene such as bathing, brushing one’s teeth, hair grooming, and/or shaving. 
2. Getting dressed and managing clothes. This can include physical help with getting on clothes, retrieving clothing items from the closet or dresser, laundry, and maintenance of clothing items (ironing, folding, etc.). 
3. Eating. If feeding yourself or having the ability to get to the dining room is a barrier, staff personnel are available to physically help with feeding activities and getting physical help to reach the dining room. 
4. Maintaining bowel and urinary continence is facilitated by staff personnel. If you find yourself having difficulty reaching the toilet or the commode, staff personnel can help you get from point A to B with physical help along with using any necessary medical equipment (i.e., walker, cane, wheelchair, mechanical lift). Staff personnel are also available to help with cleaning up with hygiene once all is done with toileting needs. 

Still feeling self-conscious whether you’re actually requiring too much help compared to those that are currently residing in ALFs? The Assisted Living Federation of America assures future residents that Assisted Living Facilities are long-term care options that combine housing, support services, and health care needs designed specifically for those requiring help with personal self-care activities. Let’s look at some data provided by experts that can help compare your situation to current residents:

• Approximately 38 percent of residents of Assisted Living Facilities receive assistance with three or more personal self-care activities.  
• The majority of residents transitioning into an Assisted Living Facility come directly from their own homes with many residents.  endorsing that a transition into an apartment style environment was much easier. 
• The average length of stay for residents living in Assisted Living Facilities was 671 days. 
• Most residents have been diagnosed with one or more chronic conditions such as hypertension, Alzheimer’s and dementia, osteoporosis, heart disease, depression, arthritis, and diabetes. 
• 54 percent of residents in Assisted Living Facilities are aged 85 years or older. 
• Residents in Assisted Living Facilities are predominantly female. 
• As high as 42 percent of residents have Alzheimer’s and dementia. 

If you’ve questioned your own safety at some point in your home environment, perhaps an Assisted Living Facility would be a good option to consider. It’s not particularly easy to see our own faults – even more difficult to admit there’s a problem to begin with. It comes down to social support sometimes. If you’ve noticed a decline in your health living on your own, difficulty managing your medications, or physical strain getting in and out of bed, Assisted Living Facilities can offer the perfect amount of assistance while still respecting your dignity, privacy, and independence. 

Services Offered in Assisted Living Facilities

The types of services offered at Assisted Living Facilities tend to come with a mixed bag. Much like apartment hunting, some places offer more amenities than others and you’ve probably guessed it – at a price point as well. Let’s ease into it first. Services and activities that are generally included at most Assisted Living Facilities will include: 

• 24-hour supervision and assistance. Most Assisted Living Facilities have a call button system or even provide residents with a necklace call button system during moments of emergencies. 
• Provision of three daily meals in a shared dining room. 
• Personal self-care services – bathing, dressing, eating, toileting, and transfers (getting up from point A to point B)
• Medication management or administration. 
• Social services. 
• Recreational and spiritual activities. 
• Exercise, health, and wellness programs. 
• Laundry and linen services. 
• Housekeeping and maintenance. 
• Arranged transportation services. 

For residents that require more attention and supervision due to Alzheimer’s disease and variations of dementia, reserved wings and units are specifically positioned near staff personnel. If you’re unsure about having a variation of dementia or just becoming more forgetful lately, it’s highly recommended to receive a quick screen from your primary physician. A series of short questionnaires done by healthcare professionals can solidify if you are displaying forms of dementia. The results can help facilitate making an informed decision to receive the correct assistance from staff personnel at the Assisted Living Facility to improve your safety and independence. 

How will it be determined which services will be needed as a new resident? Let’s reference the steps below! 

1. Screening: Immediately or upon moving in, staff personnel will evaluate the resident’s physical, social, and memory needs through a formal assessment.  
2. Results of Assessment: The results of the assessment will help guide staff personnel in developing a service plan that is specifically tailored to meet all of the needs for the new resident’s preferences. 
3. Resident and Family Participation: The results of the assessment will establish the necessary services that will need to be provided to maintain the resident’s independence, safety, and health. The next step is participation from the resident and family for specific requests for staff personnel in order to gain a better understanding of how the resident’s privacy and dignity can better be respected. 
4. Periodic Assessments: It’s important for staff to perform periodic assessments just as it is important that many residents have periodic health changes. If a significant health change occurs for the resident, a new service plan may need to be established in order to ensure the resident is well taken care of during their daily routines. 

Ensure that you receive a copy from staff regarding the service plan that is put in place. If you have family or close friends, also share the service plan with them to ensure that you are being well taken care of. Having a second opinion always helps ensure that you’re not being taken advantage of. In addition, if family or friends are able to assist with some of the services, you can opt-out of the services from the Assisted Living Facility to help cut back on some costs as some Assisted Living Facilities charge for each specific service offered. 

Staff personnel at Assisted Living Facilities must be available 24 hours a day for all seven days of the week to ensure residents’ needs are met. Along with receiving assistance for personal self-care activities, approximately 40 percent of Assisted Living Facilities offer skilled care from licensed healthcare professionals including: 

• Registered Nurses
• Social workers
• Pharmacists
• Dieticians 
• Physical and Occupational Therapists 
• Certified Nurse Assistants and Nursing Aides 

Aside from skilled healthcare professionals, other staff personnel at Assisted Living Facilities include administrators, marketing directors, housekeepers, dining staff, maintenance workers, and activity coordinators. Residents are also allowed to bring in other healthcare professionals that are not directly part of the Assisted Living Facility just as they would in their own home. For example, a resident is allowed to bring in-home health professionals from occupational and physical therapy services after recovering from a hospital stay. 

Costs of Assisted Living Facilities

Understanding the cost of Assisted Living Facilities is the trickiest part of the transition from your home environment. A fixed price is nowhere to be found on facility websites, calling for a quote will get you nowhere, or a full assessment would need to be completed to just get a general understanding of what you will have to pay out of pocket to become a resident. In this section, we break down the costs step by step and provide data from experts that have looked at what it costs to be an Assisted Living Facility resident. 

It’s tricky to provide a set cost of an Assisted Living Facility because prices vary from region to region and from Assisted Living Facility to Assisted Living Facility. As you would imagine, Assisted Living Facilities that offer more amenities, have good accessibility, and are central to convenient locations will run up a greater price tag. Looking at a variety of data points from researchers over the past years can provide you a better perspective about the costs of Assisted Living Facilities: 

• The average costs associated with Assisted Living Facilities in the United States rose consistently between 2004 and 2011. 
• Monthly costs rose from $2,524 in 2004 to $3,500 in 2014. 
• In 2010, the average cost was $3,293 per month for a resident compared to $3,477 per month in 2011. 
• From 2010 to 2011, Assisted Living Facility costs increased by 5.3 percent. 
• Between 2004 and 2011, the costs of Assisted Living Facilities increased by 27.4%. 

The affordability of an Assisted Living Facility is the largest drawback for most seniors transitioning from their home environment. Although the costs of Assisted Living Facilities incur a substantial cost to seniors that are no longer able to safely thrive in their home environments, living in a safer environment with staff personnel to ensure residents’ safety can outweigh the cons of paying for Assisted Living Facility. 

One solution to get the best bang for your buck involves relocating to a different geographic location. Aside from the added services and amenities offered at Assisted Living Facilities, geographic regions also vary considerably with monthly costs: 

• In 2006, the monthly average cost of Assisted Living Facilities in Connecticut was $4,327 per month whereas an Assisted Living Facility in Florida was only $1,340. 
• In 2014, costs with an Assisted Living Facility in Washington DC averaged $6,890 per month, whereas the average costs in Georgia and Missouri were $2,500 per month. 

When considering an Assisted Living Facility, it would warrant the feasibility of relocating to a different geographic location if finances are limited. If the opportunity presents itself such that you have family members or close friends that reside in different geographic locations with cheaper monthly costs at an Assisted Living Facility, it would not only ensure you to save more money, but it would also allow you a new start to rekindle relationships with loved ones. 

With such a high monthly cost, how do most residents afford to live in Assisted Living Facilities? The vast majority of residents living in Assisted Living Facilities pay out of pocket with additional help from their families. A second option that is commonly used to pay for Assisted Living Facilities is Medicaid. Although Medicaid state plans vary from state to state, low-income seniors that qualify for Medicaid receive generous benefits that include: 

• A capped monthly payment that is incurred at the Assisted Living Facility. In other words, residents that qualify for Medicaid will not pay anything more than a fixed price set by Medicaid and the prices will not increase from year to year unless added services are packaged. 
• Supplemental social security assistance to cover the costs of the Assisted Living Facilities. 
• Payment of the meal services offered at Assisted Living Facilities, but not for personal grocery items. 

For seniors that do not qualify for Medicaid, some seniors opt for a “catch 22” option. In order to qualify for Medicaid to assist in paying for Assisted Living Facilities, seniors must exhaust their assets to reach the Medicaid resource limit. Meaning, seniors looking to qualify for Medicaid opt to pay out of pocket up to a certain point until they no longer have enough income and ultimately qualify for Medicaid. Once qualified for Medicaid, seniors will then receive the Medicaid state plan benefits mentioned earlier to assist in paying for their residence in the Assisted Living Facility.

Questions to Ask When Searching for an Assisted Living Facility

Use this guide as a tool to understand the basic framework of how Assisted Living Facilities work. Although understanding the ins and outs of Assisted Living Facilities certainly proves helpful, more questions tend to spur up as you learn more. With further inquiries, you will be able to narrow down all of the concerns that you have for yourself in addition to ensuring your family that you are receiving the proper care. Take a peek at a list of helpful questions to take along with you during your Assisted Living Facility tours. Make sure you take vigorous notes, ask all of the hard questions, and make sure you leave having all questions answered confidently. 

Service Planning

• Can the family and the resident be involved in the service planning process?
• How periodically are residents’ physical, mental, and psychological needs assessed? Which professionals complete these assessments?
• Do special programs exist for residents who have compromised memories or have a formal diagnosis of Alzheimer’s disease, other forms of dementia? What accommodations are made 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

• Is staff personnel available to assist residents with medication administration? What kind of training do these staff personnel receive? Is it documented each time the medication is provided? 
• Is there a pharmacy nearby that residents use or do we still have to go through our original pharmacy? Does your team communicate with the residents’ pharmacy? 
• How many professional registered nurses do you have on site? What is the registered nurse to staff ratio? During which hours of the day are nurses more or less available? 
• Can home health services be arranged if needed for occupational, physical, and speech therapy? 
• What recreational and spiritual activities do you offer to residents? 
• Is there a wellness program for residents? Is it an added cost? 
• If there is a complaint or a need for suggestion, what are the steps needed to be taken to ensure our voices are heard? 

Dining and Food Services

• Are accommodations made for residents that have special diets? 
• Are nutritionists or dieticians involved in making the menus? 
• Can families bring residents food from outside? 
• Are residents allowed to have guests for meals? 

Moving In

• Is there a written protocol outlining the move-in process? 
• What paperwork needs to be completed and what is the timeframe that they need to be turned in? 
• Is the Assisted Living Facility affiliated with other long term care services or nursing homes if the resident needs to transition out of the Assisted Living Facility due to a medical change? 
• Are there printed copies of resident rights and responsibilities? 

Costs and Fees

• What is included in the month’s cost? 
• Will there be a written schedule for the resident once planned services are put into place? 
• Will I be notified if there is a change in monthly costs? Annual costs? 
• Is there a security deposit? Is this deposit refundable? 
• Does the Assisted Living Facility participate in Medicaid state plans? 

Assisted Living Resources

• Cost of Care by Zip code: You can enter the city, state, or zip code that you plan on residing. A cost breakdown will be provided from the latest year by way of hourly, daily, monthly, or annually. This tool is great because it not only provides the average cost for an Assisted Living Facility, it provides you with other average costs as well such as homemaker services, home health aide, adult day cares, and nursing homes. 
• Understanding Costs of ALFs: A helpful guide that walks you through costs of Assisted Living Facilities, how services are priced, and how seniors pay for Assisted Living Facilities. An easy table of content is available to help navigate the handout. 
• Facts and Figures: Big into numbers and seeing data to help make an informed decision? This will be the right link to browse. Here, you can browse all 50 states and find helpful facts that will be shared regarding Assisted Living Facilities from region to region. You can find the average age of residents in each state, what percentage of residents have some form of dementia, and a percentage of Assisted Living Facilities that provide each service. 
• State by State Regulations: Also known as the compendium of Assisted Living Facilities, scroll down all the way to this link to find your state. Once you click your state, it will open up a new page that has another link on the right that opens up an extensive breakdown of all Assisted Living Facility regulations. 
• Consumer Checklist: Want to make sure you have all of your questions answered? Print out this link and it has a list of several questions to ask during your tour. You can cross out questions that are irrelevant prior to the tour or check off all the boxes for the questions that are most relevant to you. 
• Making a Successful Transition: One of the most useful links. How much prepping is too much prepping? If you want to make your transition easier make sure you use this link. This link provides what you should bring when moving in, making the emotional transition, having moving day helpers, and general advice for friends and family members. 
• Quick Fact Sheet: Short on time? No problem! This link provides useful visuals to gain a fair understanding of Assisted Living Facilities in a fast manner. Consider this your cheat sheet for the exam.