Assisted Living: A Beginner's Guide

Quick Summary

Assisted living is regulated (and defined) by each state rather than by the federal government, so you can expect a wide variation in what each community offers. Make sure you know exactly what the one you've selected provides before your parent moves in.

What is assisted living?

An assisted-living community provides communal living, often with planned activities, housekeeping and laundry, transportation, meals, exercise and wellness programs, opportunities to socialize with other residents, assistance with activities of daily living, and some medical care.

An assisted-living facility could be an apartment building, a campus-like setting, or even a large converted house. According to the Assisted Living Federation of America (ALFA), most have between 24 and 120 units that vary in size from a single room to a full apartment. Residents generally have a lot of freedom in terms of what they do and when they do it, but they should also get plenty of support from trained caregivers.

Who's a good candidate for an assisted-living community?

Assisted living falls somewhere between an independent living community and a skilled nursing facility in terms of the level of care provided. If your parent is beginning to need help with the basic activities of daily living (bathing, dressing, grooming, walking, managing medications, toileting, and eating) -- or expects to need that help down the line -- she may find this support at a good assisted-living community.

If your parent has a serious medical condition that requires specialized care, assisted living may not be the right choice, although some assisted-living communities do have specialized wings that provide skilled nursing or Alzheimer's care.

How can we find a good assisted living facility?

Newlifestyles.com has a searchable nationwide database of senior communities of all types, included assisted living. ALFA maintains an online database devoted exclusively to assisted living communities.

Your local Area Agency on Aging can help you find communities in your area, and your state or regional long-term care ombudsman may also be able to help. You can also consult with an expert in transitioning, such as a geriatric care manager or a senior move manager, who will be familiar with communities in your area.

What will it cost?

Costs and payment plans will vary, but most assisted-living communities charge a flat fee to enter and a monthly rate after that. In many, the monthly rate may increase as your parent's need for hands-on care and assistance with activities of daily living increase. Some, however, have a fee structure more like that at a continuing care retirement community, where your parent would pay a significantly larger entrance fee but the monthly rate is set and shouldn't go up even if her needs change.

Most communities will start with a monthly rate of at least $2,000, and some can go as high as $10,000, says Donna Quinn Robbins, CEO of Ultimate Moves and author of Moving Mom and Dad. According to ALFA, the median monthly rate for assisted living is $2,350, about two-thirds of what it would cost to stay in a skilled nursing facility.

Make sure you ask whether (and how much) costs will rise if care levels increase, advises Robbins, and whether the monthly rate is all-inclusive or there are additional fees for particular services. Also find out how much the annual cost-of-living increase has been for the past few years, and whether they will refund your deposit if you change your mind or things don't work out.

Do government programs cover any of the cost of assisted living?

Government support for the cost of assisted living is very limited, and the great majority of residents pay for their care themselves (or with family support).

How do we choose the right assisted-living facility?

Once you've narrowed down your choices, you and your parent should ask to visit the community several times, share a meal, and meet staff and residents. If your parents have friends or acquaintances who have moved into assisted-living communities, try to arrange visits with them, ideally at mealtimes, and find out what their experiences have been.

Ask to look at the weekly menu, the list of activities, and the residents' agreement, which should outline both services and costs. Look for emergency call systems in each room, and make sure staff are available to support your parent around the clock.

ALFA has created a consumer checklist that can help guide you through the process of checking out various assisted living communities. ALFA also provides a list of state agencies that oversee assisted living, which you can contact to see whether there have been any complaints about a community you're considering.

In the end, there's no substitute for going with your gut. "Talk to residents," suggests Robbins, "and look at how they are. Is it a place where people are sitting around with their heads hanging down, or is there activity? How does it feel? Walking into a community will tell you whether you want to live there."