What You Need to Know About Assisted Living

It's never easy when an aging loved one needs to move to a residential facility. But understanding the basics in advance can help ease the transition when the time comes. As you and your loved one prepare for the future, refer to this Frequently Asked Questions guide provided by the national nonprofit Consumer Consortium on Assisted Living (CCAL).

What Is Assisted Living?

Assisted living is a residential care option for individuals who typically can no longer live independently. It provides or coordinates services to meet residents' individualized needs in ways that promote their independence and reflect their personal choices.

There are more than 26 designations that states use to refer to what is commonly known as assisted living, and there is no single uniform definition. The definition that CCAL and a large number of national organizations support is as follows: "Assisted living is a state-regulated and -monitored residential long-term-care option. Assisted living provides or coordinates oversight and services to meet the residents' individualized scheduled needs, based on the residents' assessment and service plans and their unscheduled needs as they arise."

Service provisions must include but are not limited to:

  • 24-hour awake staff.
  • Provision and oversight of personal and supportive services.
  • Health-related services (e.g., medication management services).
  • Social services.
  • Recreational activities.
  • Meals.
  • Housekeeping and laundry.
  • Transportation.

A resident has the right to make choices and receive services in a manner that promotes dignity, autonomy, independence, and quality of life. These services are disclosed and agreed to in the contract between the provider and resident. Assisted living does not generally provide ongoing, 24-hour skilled nursing care.

How Does Assisted Living Differ from a Skilled Care Facility or Nursing Home?

Assisted living is designed to respond to the needs of individuals who need assistance with activities of daily living such as bathing, dressing, and grooming, but who do not need 24-hour skilled nursing care. Some states require a nurse by regulation in an assisted-living facility, others require round-the-clock nurse availability, and others do not require nursing staff at all. Because the acuity needs of assisted-living residents have increased over the past 10 years, CCAL recommends that a facility have a nurse on staff.

What Does Assisted Living Look Like?

The wide range of assisted-living facilities available doesn't adhere to a single model or design. One facility could be a high-rise building housing several hundred individuals, or it could be a small home with just a few. Living accommodations can include a full-size apartment or a single room. In some facilities, services are limited to meal preparation, housekeeping, medication reminders, and minimal assistance. In others, more intensive services, including help with administering medications, on-site nurses, and regular assistance with daily activities such as bathing and dressing are available.

How Can I Identify a Good Assisted-Living Facility?

Regardless of the size or look of the facility, the foundation of a quality assisted living residence lies in its philosophy, practices, administration, and staff. You want to be sure that the administration's philosophy and practices are truly resident-centered. You also want to know that they have well-trained, qualified direct care staff and have sufficient numbers of them to meet residents' promised and unscheduled or emergency needs. The environment should be warm and inviting, with administrators, staff, residents, and family members interacting in a caring, respectful manner. For more information on choosing a facility, check out the CCAL's Choosing an Assisted Living Facility: Considerations for Making the Right Decision.

What Types of Services Are Offered?

There's wide range in terms of the scope of services and care provided by assisted-living facilities. Many states set a threshold level of care need beyond which individuals can no longer stay in assisted living. Facilities can choose to provide any range of services up to this threshold. Some facilities, for example, may choose to discharge a resident that becomes incontinent. Research shows that the major reason people leave assisted living is to receive a higher level of care. It is difficult to relocate, so you may want to consider a facility that offers a high range of care and services to begin with.

Who Lives in Assisted-Living Residences?

There are approximately 1 million assisted-living residents living in more than 36,000 facilities nationwide. The majority of individuals move into assisted living because of a significant change in health condition. Approximately two-thirds of residents come to assisted living from home. The rest come from hospitals, nursing homes, and other assisted-living facilities.

What Are the Costs/Fees?

Approximately 90 percent of individuals pay for assisted living out-of-pocket or through other private funding. Monthly payments can range from $3,100 to $6,000 and up, depending on geographic location, unit size, and services provided. Shared units, if available, generally cost less.

Is Assisted Living Covered by Medicare, Other Government Programs, or Private Insurance?

Medicare, the federal health insurance program for older individuals, does not cover assisted living. Forty-one states currently use Medicaid waiver monies for some low-income individuals to support assisted-living expenses, but the majority of assisted living is private pay. Increasingly, long-term-care insurance policies include coverage for assisted living. There have been some payment issues from insurance companies for residents in states that do not have an appropriate assisted-living licensing process. Be sure to check the status of your state.

The Consumer Consortium on Assisted Living educates consumers, trains professionals, and advocates for assisted-living issues. It is currently the only national consumer education and advocacy organization focused on the needs, rights, and protection of assisted-living consumers, their caregivers, and their loved ones.