Intro
Assisted living is usually the first step in long-term care once you or a loved lone leave home. It offers a balance between independent living and long-term care (you are assisted with your living).
The choice of assisted living can be a big part of your LTC goals: Learn about options, Talk with family, and Create a plan. This post can help you decide if it's the right choice.
When you see ALF, you may be reminded of that super weird TV show from the 80s. Assisted living is different.
Post jargon
ADLs (activities of daily living): basic tasks like bathing, dressing, eating, transferring, toileting, and continence
ALF: assisted living facility
LTC: long-term care
MedicAID: healthcare public assistance
Medicare: health insurance for 65+ adults and disabled
nursing home: like a hospital, but with fewer doctors and for LTC
ombudsman: an advocate for residents' rights
skilled care: continuous care by a nurse, such as administering IV antibiotics
➡️ Explore all the LTC jargon
What is it?
To help understand assisted living, a comparison to other care options is helpful. Assisted living falls in between independent living and nursing homes.
| Features | Independent living | Assisted living | Nursing home |
|---|---|---|---|
| Independence | ✅ | ✅ | |
| Home-like | ✅ | ✅ | ❓ |
| Help with ADLs | ✅ | ✅ | |
| 24/7 care staff | ✅ | ✅ | |
| Skilled care | ✅ |
Facilities
Most assisted living facilities are cozy, with around 39 beds, offering private apartments and a homey vibe. Shared meals, housekeeping, laundry, transportation, and social activities are all included.
Check out this 90-second video of an assisted living facility by Brookdale, the largest senior living provider in the US.
Residents
Most assisted living facility residents are over 75 years old, and 70% are women. Why? Because women live longer.
Yep, residents are older, but that doesn't mean they're sitting around watching TV all day. Check out this 30-second clip of Ed, an assisted living resident who helps his friends stay active.
Other notes on residents:
- Residents typically stay for about 2 years, with many transitioning to a nursing home afterward.
- ALFs allow couples to stay together, even with varying care needs, by offering customized care for each partner.
Care
People move to assisted living for more than just ADL assistance. Residents receive basic medical support from 24/7 staff, including help with ADLs (bathing, dressing, etc.), medication management, and physical/occupational therapy.
If more extensive care is needed, transitioning to a nursing home or memory care may be the next step.
When to join
Many begin their long-term care journey at home, supported by unpaid caregivers, such as family and friends. However, a move to assisted living is often necessary to meet the needs of both the care recipient and the caregiver.
Watch for these signs to move to assisted living:
- From care receivers - As health or hygiene declines, help with daily activities, like bathing, dressing, and household tasks become necessary.
- From caregivers - Juggling care duties with work and life leads to fatigue, burnout, and poor mental health.
Recognizing these signs early ensures that both the caregiver and the care receiver can maintain their well-being in a safe, supportive environment.
Costs
The cost of assisted living has risen significantly since COVID. The national average is now $64,000/year.
Yes, prices are high, but at least now you won't be taken by surprise.
Costs have risen steadily, but it helps to put this inflation in context—they've increased at a rate similar to household staples like eggs over the last few decades.
| Last 3 years | Last 19 years | |
|---|---|---|
| Assisted living facility | 7.6% | 4.3% |
| Eggs | 19.3% | 4.0% |
Check out this cost calculator to get a sense of local costs. For example, the median cost in Denver, Colorado, in 20 years is forecast to be $108k/year.
Assisted living facilities are often criticized for high costs, extra fees, and confusing pricing systems. Some use points instead of dollars.
During a visit to a facility in 2024, I was provided with a pricing sheet where care is charged by these "points."
For example, needing medication 3x/day would cost 44 points x $16, adding up to an extra $704/month. It felt a bit like converting tickets at Chuck E. Cheese.
Payment options
Most assisted living is covered by personal savings or long-term care insurance.
- 🔴 Private health insurance doesn't cover assisted living.
- 🔴 Medicare doesn't pay for assisted living.
- 🟡 MedicAID only helps if you have a severe financial hardship or a disability. If you qualify, it covers care but not room or board.
- 🟢 Long-term care insurance covers assisted living.
Oversight
Unlike nursing homes, assisted living facilities (ALFs) are not regulated by the federal government. Instead, each state sets its own standards for oversight, leading to significant differences.
Some states require rigorous oversight, while others have minimal standards, leading to concerns about staffing, training, and neglect. For example, Kansas requires workers to complete 90 hours of training before starting in assisted living, while Tennessee requires none.
Even though over 850,000 people live in ALFs, it's kind of weird that the rules can be looser than, say, the ones for bananas.
ALFs vs. Bananas
| ALFs | Bananas | |
|---|---|---|
| Federal oversight | None | FDA and USDA |
| Inspections | once per year or less | Many times per year |
| Penalties | Reactive, fines | Proactive, recalls |
Surprisingly, bananas get more oversight than ALFs, but that doesn’t leave you powerless.
In fact, the most important authority is YOU or your care advocate.
Many ALFs provide great care—you just need to research to find the right one. Even if you find a great fit now, facilities can change quickly, so it’s wise to reevaluate options when the time comes.
Think of it like shopping for produce: review your options and choose the best.
Online research
Start by reviewing inspection reports from your state’s Department of Public Health. Then, move on to these options.
- Review sites: US News, Caring.com, Yelp, and Google (reviews can be limited, so compare across multiple platforms)
- Directories: Community Resource Finder and Senior's Blue Book
- Employer reviews: Glassdoor and Indeed
- Senior placement agencies: Search for local options and check chains like Care Patrol, Assisted Living Locators, or Caring.com. They offer free guidance and support, but since advisors are compensated by the facilities, it's important to do your own research.
Personal visits
Choosing an assisted living facility is a big decision—financially, emotionally, and health-wise—so take your time and shop around. Remember, they want your business. 😄
- Prep: Read online reviews and explore their website.
- Observe: Look for cleanliness, safety features, and accessibility.
- Talk: Chat with staff and residents—do they seem happy? Speak with visiting family members to get their insights.
- Evaluate: Ask about personal, medical, and specialized care options.
- Activities: Check out the social calendar and try a meal in the dining room.
- Check costs: Review the contract in detail and get a clear breakdown of all costs.
Wrap up
Assisted living can be a great option, but you need to do your homework. Take your time and commit to research to make an informed choice.
In a world where bananas might get more attention than ALFs, it’s up to you to find a place that stands out. With some effort, you’ll find the right fit. 🍌
