Assisted living: What it is and what to consider when looking for a facility

What is assisted living?

Assisted living is a long-term residential option for older people that combines housing with medical, nursing, personal, and other supportive services under one roof. It is for older adults who are independent, but need help doing daily activities in a safe environment. Residents typically have their own room or suite, with a bathroom, but take meals communally in a dining room.

Staff who work at assisted living facilities include doctors, nurses, social workers, and therapists. Although the staff will help residents take medication, assisted living is not for people who have serious medical conditions that need a skilled nurse on a regular basis; for this type of care, you would need to choose a nursing home or skilled nursing facility.

Unlike nursing homes, assisted living facilities do not operate under a federal regulatory standard. Each state has its own licensing guidelines so the standards and costs vary from state to state and facility to facility.

Services provided

Some of the basic services provided by an assisted living facility may include:

  • Assistance with daily life activities, including bathing, dressing, taking medication
  • Daily meals
  • Housekeeping, laundry
  • Exercise programs
  • Recreational activities
  • Social services
  • Medical, health, therapeutic services (physical, speech and occupational)
  • Transportation arrangements
  • Security

Cost and how to pay for it

The 2018 estimated national median cost for an assisted living facility was $4,000 per month, or about $48,000 per year, for a private one-bedroom, according to the Genworth Cost of Care Survey. But the actual cost can vary widely from state to state; for example, the monthly cost in Yuma, Arizona is about $3,625 while in northern New Jersey you could pay $7,230 per month.

Many facilities break down costs into various tiers:

  • The all-inclusive model will bundle monthly rent, meals, housekeeping, laundry, activities, services, transportation, and security. But exactly what services are bundled, again, differs at each facility.
  • Next, the level-of-care model will group costs into different tiers: An individual who doesn’t need help getting dressed, bathing, or taking medication will be in a lower-cost tier than someone who needs all of those services.
  • Finally, there’s the fee-for-services plan, where room and board will be a monthly set price, but each service rendered will be billed à la carte.
  • Note: Some facilities will also charge a one-time entrance fee.

Most assisted living facilities are paid for through private funds. Low-income adults may be able to use Medicaid to help pay for some costs, but the coverage depends from state to state. Some Medicaid plans can help pay for home and community-based services (HCBS), and in some states Medicaid can pay for assisted living communities, but the communities that accept this payment are becoming few and far between. Services that may be covered under Medicaid for HCBS include dietary management, skilled nursing care, personal care, and various therapies, like speech, occupational, or physical. In states where Medicaid doesn't cover room and board,  Medicaid programs may help with those costs through supplemental assistance or other ways of defraying those costs. 

Medicare does not help pay for long-term care, including assisted living. Medicare is a health insurance program, so it covers various medical and nursing services, if you qualify for them. Assisted living is considered custodial care, which is not covered by Medicare. That said, individuals can use Medicare to help pay for certain prescriptions and therapies while living in an assisted living facility.

What to look for in an assisted living facility

It can be daunting to try to figure out which assisted living facility your loved one will enjoy and find the necessary services all under one roof. You can start by asking for recommendations from trusted family members and friends or consulting an aging life care manager, social worker, elder law attorney or financial planner. 

“When choosing a facility, it’s important to go visit and talk with the staff,” said Rachel Reeves, NCAL communications director. “Go a couple of times. Go during lunch or dinner. Talk with residents. Really get a feel for what the facility is like. There’s no one formula, everyone is different. Listening [to your parents] is so important. Give them as much autonomy as possible.” 

It’s best to visit several residences, both during the day and, if possible, at night, so you can get a sense of the vibe at different times. Generally speaking, you should consider these questions:

  • What kind of services do you want and/or require and how may they change over time? You might not need a reminder to take your medication or help getting dressed now, but you may in a few years.
  • How much will each facility cost, and which services does that cost cover? Get the specifics in writing.
  • How will you pay for it? Can Medicaid help cover certain costs?
  • When you visit the residence, consider: Is it bright? Is it clean? How are the staff? How do the residents look? How are the meals? Can you see your loved one living there?
  • Is the location convenient for friends and family to visit?
  • Are the offered services things you need or care to participate in?

How to find assisted living near you

Each state has an agency that oversees these communities. It’s either the Office on Aging or the Department of Health, depending on the state. You can also visit NCAL State Affiliates for information in your area or search on Care.com.

By Kaya Laterman with contributed reporting by Dana Klosner-Wehner

Read next: Choosing an assisted living facility

Tips and stories from parents and caregivers who’ve been there.

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