Assisted Living Facilities: When Home Isn't the Place to Be

Your mother just can't live in her home any longer. She forgets to take her medication and has stopped cooking for herself. She is having difficulty getting around because of her arthritis and is cut off from her friends and activities. She refuses to consider a nursing home. What can you do?

One alternative is an assisted living facility (ALF). Assisted living facilities go by many names: domiciliary care facilities, personal care homes, residential care facilities, adult congregate housing, community residences, and sheltered care facilities. Assisted living, by any name, provides care for elders who need help with daily activities but want to retain as much independence as possible. Most facilities offer 24-hour supervision and an array of supportive services with more privacy, space, and dignity than many nursing homes - and at a lower cost.

What Is An Assisted Living Facility

Assisted living facilities are a middle ground between independent living and nursing home care. These homes follow a philosophy of personalized care that allows a resident as much autonomy as s/he wants or needs. Assisted living facilities attract people who require help in activities of daily living but do not need the skilled medical care provided in a nursing home. Residents can choose the level of care they require and define their own lifestyle needs. Most facilities provide housing and personalized support services to meet the daily needs of residents. The staff of ALFs generally encourage the involvement of residents and their families, neighbors, and friends in planning programs and creating a supportive environment. The advantage of assisted living is that elders can receive substantial care in a more residential (and less restrictive) environment than a nursing home or long-term care facility. Since the 1980's, thousands of assisted living facilities have sprung up in response to the need for a place where elderly and disabled people can receive care but retain their independence. Residences might be provided in a large house in a community, in a newly built free-standing structure, or in connection with independent apartments or a nursing home.

What Assistance Do ALFs Provide

Although services vary greatly, residents typically enjoy their own room or apartment, three meals per day, assistance with personal care, laundry service, transportation and medical supervision. Some facilities also arrange for residents to receive senior services in the community such as adult day care, transportation, and recreation. Facilities may also include these elements:
  • safety features such as grab bars and wheelchair ramps
  • social work assistance to coordinate services
  • health and exercise programs
  • nurse or a medical clinic in the building
  • housekeeping and laundry
  • community areas for social activities
  • security and emergency call systems

What Are The Costs?

Residents or their families generally pay the cost of care for ALFs because few susidies are available. In some cases, health insurance or long-term care insurance may reimburse certain costs of the facility. Some state and local governments offer subsidies for low income elders in ALFs. Depending on state regulations, your elder may be eligible for Supplemental Security Income (SSI) or Medicaid payments.

Experts expect more states to begin offering benefits to pay for assisted living homes because they are less costly than long-term care and serve the needs of elders who want more independence. ALFs are owned and operated by both for-profit and non-profit organizations and can range in cost from $800 to $3,000 a month. Fees may be inclusive or there may be additional charges for special services. Costs are generally lower than home health services or nursing homes.

Who Lives In ALFs?

The typical resident is 75 years or older, female, and widdowed or single. However, residents may be young or old, affluent or low income, frail or disabled. Older residents come to assisted living facilities from nursing homes, hospitals, or their own homes or apartments. Many older people, with a wide range of conditions, continue to live in assisted living programs even when they become more disabled. The number of residents living in a facility can range from several to 300 persons, with the most common size from 25 to 120 individuals.

Are These Facilities Licensed?

All U.S. states license ALFs, but they are regulated under various names, and requirements vary from state to state. Most ALF providers and their staffs must take special training and follow specific fire and safety codes. Some states require a nurse on duty or on call at all times.

How Can I Choose The Best Facility For My Older Relative?

After receiving a list of facilities, consider the location and services your elder requires. You may find that types of accommodations and fees vary greatly from one facility to another. Call ahead to schedule a tour for you and your elder of homes that seem appropriate. Ask if you can stay for a meal as well as speak to residents.

Consider these points when touring each facility:

  • Do you and your elder like the location and appearance of the residence?
  • Does the staff greet you and your elder warmly? Do they call the residents by name?
  • Do residents socialize with each other and appear happy?
  • Is the community well-designed for residents' needs? Does it include safety features?
  • Is the food nutritious, appetizing, and prepared according to dietary restrictions?
  • Do residents have a choice of eating in common dining areas or their own units?

When speaking with the facility director or other staff member, ask these questions:

  • Does the facility meet local and state licensing requirements?
  • What public transportation, shops, and places of worship are nearby?
  • Do volunteers from the community or residents help conduct programs?
  • What are the costs, including any additional fees for extra services?
  • Is government, private, or corporate assistance available?
  • What types of units are available and how much does each cost?
  • Are residents given a written service plan that is reviewed and adjusted periodically?
  • What professionals are on staff? What are their qualifications and availability?
  • Who coordinates home care visits (nurse, occupational therapist) if needed?

When considering whether a facility is right for your elder, consider:

  • Does it fit the budget of you and/or your elder?
  • Will facilities and rules fit your older relative's lifestyle?
  • Are current residents satisfied?
  • Do you and your elder feel s/he will fit in here?
  • Does it provide all the services that your elder currently needs or may need in the future?

Because accommodations, services, and fees vary so greatly from one facility to another, you'll need to be sure that the ALF you choose matches the needs of your older relative. Consider the reputation, staffing, services, and costs of each facility. It's a good idea to ask your state long-term care ombudsman about the licensing and reputation of any home that interests you and your elder.

Caring And Independence

Without the supportive care of assisted living facilities, many older people would be forced to enter nursing homes, often at a higher cost. ALFs provide the independence that your older relative may want, while offering a range of services to help him/her manage daily needs. Such a home will also allow your aging parent or relative the chance to remain involved with the community and socialize with other residents. If your elder does not require 24-hour skillled medical care, an assisted living facility may be just right for him/her.

Resources For Further Information

Carlin, Vivian F., Ph.D., and Ruth Mansberg
Where Can Mom Live?
Free Press, 1987, 206 p., $14.95. Call 1-800-223-2336 to order.

Down, Ivy M.
Between Home and Nursing Home: The Board and Care Alternative.
Prometheus Books, 1991, 216 p., $18.95. Call 1-800-421-0351 to order.

Gold, Margaret
Housing Alternatives for Older Citizens.
Consumer Reports, 1985, 184p., $11.95. Call 1-515-237-4903 to order

Salamon, Michael J., Ph.D., and Gloria Rosenthal.
Home or Nursing Home: Making the Right Choices.
Springer, 1990, 128p., $23.95. Call 1-212-431-4370 to order.

Assisted Living Today, a quarterly magazine for elders, families, and providers, can be ordered through the Assisted Living Facilities Association of America.
Send a check for $12.00 to ALFAA, 9402 Lee Highway, Third Floor, Fairfax, VA 22031

Kane, Rosalie and Keren Brown Wilson.
Assisted Living in the U.S.
AARP Policy Institute, 1993. To order this free booklet, write AARP Fulfillment, 601 E Street, Washington, DC 20049.

For more information or a list of other Heritage Planning educational materials on helping your parents, contact:

Richard Smith or Roger Erickson
Professional Educators Benefits Company
Post Office Box 37102
Tallahassee, Florida 32315-7102

Telephone: Richard Smith: 850-385-2627, Roger Erickson: 850-385-5135
In Florida, outside Leon county, call: 1-800-260-6573