The Basics Of Assisted Living

What are assisted living facilities? What services do they provide? Should your loved one consider a move to assisted living? Here are the answers.

Assisted living facilities—also known as congregate housing, residential care, adult congregate care, boarding home, or domiciliary care—are suitable for individuals who need very little daily care. In terms of medical needs, little care might be considered assistance with medication or intermittent skilled nursing care.

Currently, nearly 1.2 million individuals live in the nearly 30,000 assisted living facilities in the U. S. In general, the average resident of an assisted living facility is an 80-year-old mobile female who has moved from a private living arrangement to the facility and has an average annual income of approximately $30,000. Individuals who require a wheelchair for locomotion, have a severe cognitive impairment, or show behavioral symptoms such as wandering are discouraged from becoming residents of an assisted living facility.

The typical resident lives in assisted living for two to three years, and many then move to nursing homes. Other reasons that a facility discharges an individual include:

  • To return home
  • For a hospital stay
  • Financial problems
  • To move to another assisted living facility.

Resident Rights

Assisted living facilities allow individuals to remain independent as long as possible in an environment that maximizes the person’s autonomy, dignity, privacy, and safety, as well as emphasizes family and community involvement. This means that in cases of temporary incapacity, the care recipient should be allowed to remain in the facility or should be readmitted after needed outside services have been provided. Even when death is imminent, the facility often allows the patient to remain as long as the facility can provide any necessary services. In general, resident rights in assisted living facilities include:

  • Being treated with dignity and respect
  • Continued practice of or abstinence from religion
  • Freedom from neglect or abuse
  • Freedom to interact with individuals inside and outside of the facility
  • Privacy
  • Receipt of all evaluations of medical needs and health-related services
  • Representation in residential councils
  • Retention and use of personal possessions
  • Self-control of personal finances

Additionally, most assisted living facilities continue to allow residents to use tobacco and consume alcohol, to keep small pets or to interact with facility-owned pets, to allow visitors at any time during the day, and to allow overnight guests at the discretion of the resident.

Living Arrangements And Services

Assisted living residents usually live in their own semiprivate or private apartments, which include a furnished or unfurnished bedroom, kitchen area, and bathroom. Various types of apartments are available such as private studio apartments, one-bedroom private apartments, one-bedroom shared apartments, and dormitory-style bedroom arrangements.

Although assisted living facilities differ by state, services offered can include:

  • Assistance with daily living activities (bathing, dressing, eating, toileting, etc.)
  • Central dining programs that include three meals a day
  • Educational activities
  • Emergency call systems in private and common areas
  • Exercise activities
  • Health services and medication administration
  • Housekeeping and maintenance
  • Organized recreational activities
  • Personal and/or nonpersonal laundry services
  • Social services and religious activities
  • Transportation arrangements
  • Wellness programs
  • 24-hour security

The majority of assisted living facilities also contract with home health agencies to provide skilled nursing care and with hospice providers for hospice services.

Regardless, the care recipient and his or her family should receive an initial orientation of the services provided. Additionally, an assisted living service coordinator should make an initial evaluation to determine which services your loved one needs. Your loved one should also be reevaluated on a regular basis and modifications should be made to his or her service program to reflect any services no longer needed or any additional services required. The care recipient should have access to these evaluations at all times and should be given a copy of each evaluation for his or her own records.

Fees And Payment

Most assisted living services are included in the facility’s basic service costs, but some may be offered for additional fees. Generally, fees charged for an assisted living facility pay for the facility and some services. Because specific assisted living facilities differ greatly, the fees also differ between facilities and may be offered as an all-inclusive monthly price, tiered pricing based on required services, pricing based on individual services requested by the resident, or some combination of these.

Overall, fees for assisted living fall tend to between those for board and care, which are generally lower, and nursing homes, which are generally higher. On average, monthly fees are approximately $2,000 in an assisted living facility, but can range from $500 to more than $3,500 depending on availability, location, and size.

Most residents pay for assisted living without assistance, although some states provide public assistance with payment in the form of Medicaid, Supplementary Security Income, or Social Services Block Grant programs. Private long-term care insurance and some managed care programs may also assist with costs incurred while living in this type of facility. Medicare does not cover assisted living facility expenses.

Those states that do subsidize assisted living services, especially personal care services, do so using Medicaid 1915c waivers. Participation in these state programs is limited because such waivers are only available to individuals meeting the state criteria for nursing home care. Some states also use alternate strategies to help lower the costs of assisted living, including Low-Income Housing Tax Credits (LIHTCs), taxable and tax-exempt bonds, and other programs.
 
Quality Of Care

When searching for an assisted living facility, it’s important to find out as much as you can about the regulations governing these facilities in your loved one’s area. At present, no federal regulation policy exists for assisted living facilities, but as the need for assisted living grows at an increasingly rapid rate, many states are hurrying to create regulatory systems. Currently, approximately two out of every five states have assisted living licensure regulations in place, one out of every five states has drafted or revised assisted living regulations, and 20 percent of states have begun studying assisted living.

It is also important to check the qualifications of the administrator as well as the service providers for an assisted living facility. When evaluating the residence administrator, look for:

  • An adequate education
  • Experience in the field
  • Ongoing training to meet residents’ health and psycho-social needs
  • Management ability that meets those required by the setting

In general, the number and type of staff employed in an assisted living facility will depend on the size of the facility, the services offered, and any special requirements of the residents. Typically, a staff will include activity directors, administrators, certified nurse assistants, food service managers, health/wellness directors, maintenance personnel, nurses, and personal care attendants, as well as contracted services from beauticians, dietitians, nutritionists, physical therapists, and physicians. When evaluating the care staff, look for:

  • A sufficient number to meet the 24-hour scheduled needs of the residents
  • A sufficient number to meet any unscheduled needs that might arise
  • A sufficient number to meet any needs the care recipients’ families might have
  • Individuals with the education, skills, and ongoing training to serve residents’ needs

Finding The Right Facility

If you have assessed residential facilities and feel that your loved one would be comfortable in assisted living, you should contact a case manager, clergy member, financial planner, hospital discharge planner, physician, or social worker to inquire about facilities in the area. You can find additional information about assisted living by investigating one or more of the 16 publically traded assisted living companies, including Alternative Living Services, American Retirement Corporation, Assisted Living Concepts, Atria Communities, Balanced Care Corporation, Brookdale Communities, Capital Senior Living, CareMatrix Corporation, and Sunrise Assisted Living. Better yet, ask more than one of these individuals and learn about more than one of these companies, and when you have gathered all the information that you can about facilities in your loved one’s area, be sure to visit more than one facility. This way you can get a good feel for what different assisted living facilities can offer.

When visiting an assisted living facility be sure to ask the following questions:

  • What is the entire range of services offered at this facility?
  • How is the payment plan set-up?
  • Which services are included in the base monthly plan?
  • How do you identify which care services my loved one needs, and how often will he or she be reevaluated?
  • Who conducts these evaluations?
  • What is your policy regarding use of outside services?
  • Is there a deposit, and is it refundable if my loved one needs to move?
  • If my loved one’s needs increase or decrease, will the fees reflect these changes?
  • How much notice will my loved one be given if or when fees change?
  • Can my loved one’s fees increase even if his or her needs do not?

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