Common Questions about Assisted Living

January 07, 2011

Common Questions about Assisted Living


What is Assisted Living?


Assisted living is a relatively new type of long term care for people who are unable to live alone or cannot maintain an enjoyable quality of life without assistance.

Assisted living was developed to meet the personal care needs of people in a home-like setting without the institutional feeling that is found in most nursing facilities.

The Assisted Living Federation of America (ALFA) defines an Assisted Living resident as a special combination of housing, personalized supportive services, and health care designed to meet the needs, both scheduled and unscheduled.

In essence, assisted living consists of a private apartment with an extensive array of services available to the person or persons that live in the apartment.

All assisted living facilities emphasize to some degree, independence and privacy. In most facilities there are no shared apartments, except by choice and all apartments have private bathrooms. Most come equipped with a kitchenette and each apartment has a lockable door, individually controlled heat and air conditioning. In most cases, the residents furnish their apartments to suit their own lifestyle and taste. In short, the goal of assisted living is to provide as normal an atmosphere as possible, while providing all the care a person may need.


How do I know whether a nursing facility or an assisted living facility is the best for me or a family member?


When thinking about an assisted living vs. nursing facility, here are some issues to consider:


·         Assisted living facilities will almost always require more involvement from the resident or their family in determining just how much is going to be done by the facility and how much will be done by the resident. Where the resident is capable of doing personal laundry, for example, they are encouraged to do so. If a resident wants to have all needs met without having to be involved in care decisions, a nursing facility is probably a more appropriate choice.

·         If you or your relative requires extensive medical care, (recovering from major surgery, require transferring at all times, are a danger to themselves or others, cognitively impaired to require constant supervision or who are ill) you would be better served by a nursing facility.

How are assisted living facilities (ALF’s) regulated?


In most cases, ALF’s are regulated by the state and there is a great deal of variation among the states. In Oregon, the Dept of Human Services & Seniors and People with Disabilities, regulates assisted living. In Oregon, a facility must meet specific structural and program requirements before it can call itself Assisted Living.


Is there financial assistance available if I run out of money?


In Oregon and Washington, Medicaid is available for people who met income requirements. Assessment and placement is done by the state and all Medicaid eligible residents must go through the state to qualify for placement.

The ability of a facility to utilize Medicaid waiver programs to help pay for assisted living varies from state to state. Contact your local Medicaid office for more information.

Assisted Living facilities are not required to accept Medicaid clients; therefore it is important that you ask about a facilities policy.

In other state, financial assistance and amounts available vary greatly. Often financial assistance is not available or is usually too little to assure adequate care.

Generally, the resident and their families pay for the cost of care from their own financial resources. However, some individuals may have long term health insurance or veteran’s benefits that may reimburse them for the cost of assisted living.


Will I have to move when my health deteriorates?


Many residents experience chronic and progressive health conditions. As needs change, services are negotiated to meet the changing needs of the resident. If needed, Home Health and Hospice agencies, family members, or private care providers can provide services outside the facility’s licensing restrictions.

Researching the availability and variety of services in your area, and coordinating those services with the director of the facility is the best way to plan for possible extended are needs. However, state agency mandates may not allow certain skilled nursing services to be provided in an assisted living setting.

Facilities vary in their acceptance and retention policies and it is important to clearly understand the policies regarding how decisions are made to move a resident out and about Medicaid before deciding on a particular facility. Do not rely on what the facility representative tells you. Request a copy of the resident agreement, Disclosure statement, or lease and read it carefully. If you have any questions, make sure they are answered.


What services are offered by an Assisted Living Facility?


The services offered by an ALF may vary to a great extent. State regulations usually provide some limitations on the services that can be offered and most operators have specific criteria on the kinds and amounts of services they will provide. Some assisted living facilities provide an extensive array of services while others offer a more limited menu of services.

Most facilities offer 3 means a day plus snacks, special diets, housekeeping and laundry services. Personal care assistance such as bathing, dressing, toileting and personal hygiene are standard services. In addition, medication assistance and health monitoring are generally provided.

Some assisted living facilities go beyond this set of standard care options and provide routine nursing care, hospice care, assistance with injections, and catheter care. Types of service offered are limited by state regulations.


How much do assisted living facilities cost and how are prices determined?


In general assisted living facilities usually charge from 20-30% less than a nursing home. However, there is considerable fee variation among different operators of assisted living. You must be very careful when comparing rates among operators. Because of increased competition some facilities advertise a low base rate for rent, meals, housekeeping and activities, but add fees for personal care service used.

Others have a single fee no matter how many services you use. Between these two, there are many variations. It is important to get accurate pricing for all of the services you or your loved one want or need before deciding on a facility. You do not want to accept a low base rate only to have the facility increase rates after a month or two. A low base rate may not be the rate you will pay and, until you know exactly how much you will pay, it is advisable not to taking a unit. It is also important to know when and how often the facility might increase its rates.


How does an Assisted Living Facility differ from a nursing facility?


·         ALF’s tailor services to the specific needs and wishes of the tenant and are not required to provide a specific set of services to all residents as is true of licensed nursing facilities.

·         The resident is much more involved in their care than is true in nursing facilities. Assisted living is a cooperative effort between the resident and the facility, and the resident is encouraged and even expected to do as much as he or she is capable of doing.

·         Assisted living is less expensive than nursing facilities because they are not required to meet many of the heavy regulations found in nursing facilities.


What types of health concerns are appropriate for placement in an assisted living facility?


ALF’s are designed to serve people who are no longer able to live without support, and can serve many of those who have been served by nursing facilities in the past. While individual facilities vary in their admission and retention criteria, most can serve people whom:

·         Are quite frail

·         Have cognitive impairments

·         Are incontinent

·         Require mobility aids (walkers, wheelchairs)

·         Require special diets

·         Require monitoring and/or assistance with medication

·         Require frequent monitoring of health conditions