Assisted Living

A Home Away from Home

More like a bed-and-breakfast or an apartment complex than a medical institution, assisted living communities are making a comeback in the senior housing landscape. They offer privacy and independence, as well as 24-hour assistance for people who need some help with their own personal care.With their focus on creating community and building warm bonds between residents and their neighborhood, many assisted living communities think of themselves as “communities” rather than”facilities.” A fireplace and big armchairs in the common room, a laughing game of bridge, a family celebrating a resident’s birthday with a big cake–assisted living communities offer friends and family a homelike setting to visit and provide a variety of recreational and social activities as well as supervised housing.

The Resident Community

Most residents find they have a lot in common: the majority are women in their mid-eighties, and most are coping with some aspect of aging–hearing or vision loss, memory problems, Alzheimer’s disease, incontinence, or trouble getting around safely by themselves. About a third of ALF residents move in after a hospitalization of some kind. Assisted living is also ideal for younger people who are disabled and need the supportive, cost-effective services these communities can offer.

 The Unique Services of Assisted Living

Assisted living offers three unique components. Housing units are often a room or small apartment in a facility with 25 to 120 units, with security services and groundskeeping provided. Trained staff help residents with personal care like bathing, dressing, toileting, and walking, as well as reminders to take medications. Other services, such as housekeeping, meals, and laundry, are also provided. It’s an ideal social care model for older people who can no longer live safely at home but who don’t need specialized, expensive nursing care. Average assisted living facilities tend to be about 20% less expensive than a nursing facility.

Specific names and definitions of ALFs vary from state to state: they may be called board and care homes, congregate living facilities, residential care facilities, personal care homes, and foster care homes. It’s an old idea with a new name, really. After all, people have been offering help with the everyday needs of older people for generations.

What Does Assisted Living Offer?

Some ALFs offer equity ownership in the facility; others have cooking facilities in each unit and amenities like a cafe, pool, or beauty salon. Every facility offers a unique set of services, but as a baseline to qualify for assisted living, most provide:

• housing in a double or single room or apartment
• housekeeping, laundry, and linen service a meal service
• transportation service security services and grounds upkeep
• an emergency call system in each room
• staff available 24 hours a day
• health promotion and exercise programs
• social and recreational programs

Philosophy

The staff and management at an assisted living community work to foster dignity, choice, and independence during the aging process, and believe that their residents’ living space plays a big role in how well they adapt to the changes of aging. Toward that end, ALFs are designed to encourage group living over isolation, social activity over boredom, a sense of vital well-being over unnecessary dependence, and normal home living over institutional care.

Each assisted living community has its own personality, but all offer personal care services, a choice of lifestyle balancing privacy with social interaction, and an atmosphere that nurtures individual residents while seeking to involve their families and friends in their daily lives. Residential design typically includes a reception desk rather than a nursing station and unobtrusive handrails and other safety features. Whether free-standing or as a wing of a nursing home, assisted living facilities offer ongoing supervision of residents to assure their health and wellbeing.

The Cost of Assisted Living

The average cost of an assisted living facility is $1,000 to $7,500 per month, which includes the apartment or room, meals, and support services. ALF fees vary widely, depending on geographic location, amount of private space in the unit, and the number and quality of personal services that are offered. Most residents are private-pay residents: they pay for their care with personal assets. Medicare doesn’t cover assisted living; a few states are trying out new Medicaid arrangements to help cover care.

Most assisted living facilities charge a monthly fee; a few may require a longterm contract and one-time entrance fee (called an “entrance,” “endowment,” or “lifetime lease” fee). Be sure to ask whether the fee at the facility you’re considering covers all services or if some–like laundry,medication management, or recreational programs–cost extra

Licensing

Each state regulates and licenses assisted living communities based on its own rules; there are currently no federal regulations on assisted living. Some states require that fire and building codes be met;others treat ALFs more like medically based nursing homes and require specific training for staff.

You can ask the admissions staff at specific communities whether they are currently licensed by the state, but remember that licensing in any community just means that the property met minimal requirements on test day. You’ll want to judge a community’s quality of care yourself, when you visit and talk with its staff and residents.

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