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Assisted Living Communities - What Can You Afford

Jul 11, 2017

What Can You Afford

 Paying for assisted living comes from private funding and your own financial resources. Other sources for paying for the long-term care include an insurance policy, Medicaid, reverse mortgage, home equity loans and other financial assistance programs.

 When meeting with senior living providers, ask for written material, including copies of the community's resident agreement that outlines, at a minimum, services, prices, extra charges, move-in and move-out criteria, staffing, and house rules.


  • Options potential residents and their families use to pay for assisted living:
  • Income from social security and other pensions
  • The sale of the family home and other investments
  • Personal retirement savings
  • Assistance from family
  • Long-term care insurance
  • VA Aid and Attendance Program
  • Settlement of a life insurance policy that is no longer needed
  • Medicaid is available on a limited basis to income-eligible seniors
  • Choosing to share your apartment with a roommate
  • Determine how much you can afford

Things To Consider When Choosing Assisted Living Facilities

Jul 4, 2017

Things to Consider When Choosing Assisted Living  

Locating a Community

When you have decided that assisted living is the right option the question becomes, "How do we find the one that best suits his or her needs?” Planning ahead, when you are not in crisis, will give you the opportunity to explore the different populations served, settings offered, and available service options. Your family member’s physical and mental needs will serve as guideposts for your decision making and discussions with admissions personnel. Seek recommendations and referrals from doctors, friends, and other community agencies. 

 Choosing a Community

When choosing an assisted living residence, you want to consider one that embraces the philosophy of consumer choice as described below by the National Center for Assisted Living and the American Health Care Association.6 

You should expect to:

Be treated with dignity and respect 

Be informed of services available and the limitations of those services

 Services and Costs

Assisted living communities usually charge a base rate which covers a certain set of the services. Other services are offered at an additional cost. The fees for services vary considerably by community size, and the number of services included in the base rate vary, impacting the overall cost of care. As residents age, they may experience a reduction in their capacities and require additional services over time that were not required when they entered the community. Check with the community to find out which of these are included in the base rate and which ones may be offered à la carte:

• Care management and monitoring

• Help with activities of daily living

• Housekeeping and laundry

• Medication management

• Recreational activities

• Security

• Transportation 

• Two meals per day or more

• Increase in frequency and time for personal care

• Incontinence care

• Laundry service beyond basic service

• Meals delivered to living quarters

• Specialized care for dementia

Find out if there are different levels of care. If someone needs more services or care, how would that be determined? Would they be able to move to a higher level of care within the same community? Would the family be notified? When and how is it determined that a resident is no longer appropriate for the community?

The cost for an assisted living community can vary dramatically by location. Most medical insurance, including Medicare, does not provide any reimbursement for assisted living. Assisted living is a covered service in many long-term care insurance policies, as it is becoming an increasingly popular long-term care service option. Many comprehensive long-term care insurance policies cover costs associated with room and board in assisted living, but there can be other charges based on the needs of the individual. Individuals who have a policy should check with their insurance company and review their plan to determine how benefits are paid for assisted living services.

Although the majority of residents pay out-of-pocket, a number of states provide subsidies or Medicaid waivers that cover assisted living for those who meet Medicaid income and asset guidelines.  Medicaid waivers enable residents of the state to receive community-based long-term care services, such as assisted living.

Be sure to ask about billing, bed reservations, refunds, and payments. Take the time to carefully review the contract. Do you understand everything in it? Does the contract specify all the services that your family member needs and how frequently they are provided? Are health services included? Which ones? Does the contract address levels of care? Take into account your loved one’s resources and the amount of time he or she is expected to be in an assisted living community. It is always good to speak to a financial professional and an elder law attorney when planning for long-term care. 

Location 

Location may be of key importance, in order to be near friends, family, and familiar, quality medical providers. If possible, consider a community within a 20- to 30-minute drive, in order to maintain contact and encourage visitors. 

 Size

Assisted living residences may have as few as three rooms or as many as 200. Most have between 25 and 120 units.9 A smaller residence may be in a traditional home in a residential neighborhood, offering residents a room. A larger residence may be a community, offering apartments with a central dining area and recreation areas. If the community is spread out, is the staff available to help accommodate individuals who may need assistance with walking or using their wheelchairs? What type of setting would your family member prefer? Bigger does not always mean better and small does not confirm that your family member will receive more care. 

Staffing 

As you are looking at different communities, you will want to compare the staff. The attitudes of the staff will tell you a lot about the residence. You may also want to look into the turnover rate of staff, and note how they interact with residents. If you visit at different times during the day you will be able to observe how the staff members balance the residents’ needs with the competing demands, and how they carry out house rules and routines. Also, you will want to know whether there is a nurse on staff for medications and assessments. If not, determine who is responsible for the process and evaluating the care needs of the residents.

Medical and Specialized Care

For individuals who have a cognitive impairment like Alzheimer’s or a similar disorder, and who require supervision for personal safety, you will need to find a setting that is dedicated to providing specialized care. You will need to consider your family member’s mental and physical health needs, and consider whether the environment will provide the needed stimulation to help him or her thrive emotionally, and with dignity. 

You will want to know what services and systems are in place to provide your loved one with adequate health care oversight, monitoring, and access to emergency medical care. What transportation is available to assist residents with getting to their doctors? Is there a therapeutic exercise or fitness program? What are the procedures for getting emergency medical attention? How often do residents get health care monitoring? If, for example, your loved one takes a blood thinner, it will be important to make sure that the staff of the assisted living community will be able to arrange for a lab to come to the residence to draw blood, and then coordinate the necessary follow-up with the doctor, and if necessary, the pharmacy. As a family member, you are the link, the one who can assure that your loved one’s health care needs are recognized and appropriately addressed.

How to Evaluate the Quality of Care

Ask whether the community is licensed in your state.  You will want to use your senses when you visit the communities. You and your loved one will be able to observe how different staff interact with the residents, whether the meals are appetizing and prepared to accommodate dietary needs, and whether there are scheduled activities that will meet your loved one’s social needs. You may also want to make one unannounced visit. Notice whether there are any disagreeable odors or high noise levels, as well as the overall condition of the community. 

Making a Successful Transition

With any move, there is always a period of adjustment. Give your family member time and stay involved and visible in his or her life. Learn the names of people to contact for giving and getting information about your family member. Be sure to praise good work and show appreciation to the staff. Find out procedures for sharing your concerns, and don’t be afraid to speak up when you see a change that concerns you. Individuals whose families are involved in a positive way generally have higher morale and receive better care.

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