1. What is Assisted Living?
2. What services are offered by an Assisted Living Facility (ALF)?
3. How much do assisted living facilities cost and how are prices determined?
4. How does an Assisted Living Facility differ from a nurscing facility?
5. People with what types of health concerns are appropriate for placement in an assisted living facility
6. How do I know whether a nursing facility or an assisted living facility is the best for me or a family member?
7. How are assisted living facilities regulated?
8. Is there financial assistance available if I run out of money?
9. Will I have to move when my health deteriorates?

What is Assisted Living?

Based on a Scandinavian model for senior living, assisted living began emerging in America in the mid-1980s. A type of long-term care for people who are unable to live alone or who cannot maintain an enjoyable quality of life without some assistance. Assisted living was developed to meet the personal care needs of people, in a homelike setting, without the institutional feeling that is found in most nursing facilities.

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 at least some degree, independence and privacy. In most facilities, there are no shared apartments (except by choice), all apartments have private bathrooms, and most have a kitchenette. In addition, each apartment has a lockable door, individually controlled heat, and, in most locations, air conditioning. Residents generally furnish their own apartments to suit their lifestyle and taste.

In short, the main goal of assisted living is to provide as normal an atmosphere as possible, while providing all the care a person may need assisting to enable continued living.

What services are offered by an Assisted Living Facility (ALF)?

The services offered by an ALF can 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 offer three meals a day plus snacks, special diets, housekeeping services, personal care assistance, such as bathing, dressing, personal hygiene, medication administration or assistance, and health monitoring. Some assisted living facilities go beyond this set of standard care options and provide routine nursing care, hospice care, injections, catheter care, and incontinence training.

A newer type of option, known as catered living, has also become quite popular in recent years. It is important however to differentiate this type of housing from assisted living. A good way to understand it is as the name suggests: catered living offers many convenience services whereas assisted living offers more genuine needs assistance. Additionally, if catered living is selected, many individuals are likely to need to relocate again, or be faced with having to arrange some outside support to come in down the road. In assisted living, many individuals may not need to move again and additional support is usually available or arrangable within the building. Thus, the term .aging in place. is often associated with assisted living.

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

Here again, there can be considerable variation among different facilities. Generally though, total charges will average twenty to thirty percent less than a nursing home.

Different operators will establish different rate structures. Some may appear very straightforward and all inclusive while others appear to be overly complex with many extra fees. Several competing facilities in an area can further confuse due to advertising strategies and limited-time special offers. It is therefore very important that you take care when comparing rates between facilities. In example, one operator may advertise a low base rate for rent, meals, housekeeping, and activities, but then add fees for personal care services used; another may offer a single fee no matter how many services are used. Between these, there are also many other variations.

It is important to get accurate pricing for all of the services you or your relative are going to want or need before deciding on the facility. Do not accept a low base rate only to have the facility substantially increase rates after a month or two. A low base rate may not be the rate you will pay and until you know how much you will pay, it is advisable not to commit to taking a unit. It is also important to know when and how often the facility might increase rates.

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

A few ways that assisted living differs from a nursing facility:

Assisted living facilities 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 his or her care than is true in nursing facilities. Because assisted living is a cooperative effort between the resident and the facility, the resident in assisted living 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 onerous regulations found in nursing facilities.

People with what types of health concerns are appropriate for placement in an assisted living facility?

Assisted living is designed to serve people who are no longer able to live without support, and can serve many of the same types of people who have, traditionally, been served by nursing facilities. While individual facilities vary in their admission and retention qualities, most can serve people who are quite frail, have cognitive impairments, are incontinent, require mobility aids (walkers, wheel chairs), require special diets, require monitoring and/or assistance with medication, and those who require frequent monitoring of health conditions.

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 facility or a nursing facility, here are some issues to consider:

Assisted living facilities, will almost invariably require much more involvement from the resident and/or his or her family in determining just how much is going to be done by the facility and how much will be done by the resident. For example, an assisted living facility may do personal laundry or the resident may do the laundry; where the resident is capable of doing the laundry, 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 has extensive medical care needs, you would also be better served by a nursing facility. For example, people who are ill, recovering from major surgery, bedridden, require transferring at all times, a danger to self or others, or are cognitively impaired to the extent that they require constant supervision.

How are assisted living facilities (ALFs) regulated?

In most cases, assisted living facilities are regulated by the state and there is a great deal of variation among the states. In Oregon, the Senior and Disabled Services Division regulates assisted living and only licensed facilities can call themselves an assisted living facility. In other states, an ALF may be licensed as a residential care facility, a boarding home, or a personal care facility and available services may significantly differ. With the exception of Oregon, a facility that calls itself an assisted living facility may not have to meet specific requirements so it is important that you understand what can and cannot be accommodated.

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

In Oregon and Washington, Medicaid is available for people who meet 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.

In other states, financial assistance and amounts available vary greatly. In many states, financial assistance in not available or, if available, is usually too little to assure adequate care.

Usually the resident and/or their families pay for the cost of care from their own financial resources. However, some individuals may have long term health insurance 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. The goal of assisted living is to provide an environment for all residents to be allowed to .age-in-place.. 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 facilities licensing restrictions.

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