Assisted Living Questions and Answers


When it is time for a family member to move to assisted living, caregivers and family members have lots of question. We've compiled the most common questions that caregivers have about finding and transitioning into assisted living.

What exactly is an assisted living community?

An assisted living facility is a type of senior housing provided for individuals who are no longer able to live independently because they need some assistance with activities of daily living.

Assisted living centers are appealing to seniors because within the range of senior housing environments they offer a relatively high level of independence. If your parent is in good health and doesn't require much assistance with everyday tasks, assisted living is a terrific option. In fact, residing in an assisted living center is similar to having a private apartment, complete with private bathroom and kitchen, but you can rest easy with the knowledge that trained staff is on hand to help your loved one when necessary. Assisted living communities might provide daily living care for bathing, dressing, toileting, grooming, and eating -- however be sure to read to the contract carefully. In some cases, "personal care" is an additional cost, or an outside home health care agency is required to perform these tasks.

What's the difference between assisted living and a nursing home?

Assisted living does not provide medical care, such as treatment for specific conditions or diseases like Parkinson's disease or hospice care. The assisted living facility will assess the elder to decide what kind of care his or her needs require. Nursing homes, on the other hand, are designed to house and assist individuals who have health conditions that require constant monitoring and round-the-clock availability of medical personnel.

When is it time to consider assisted living for your parents?

In the Caregiver Forum, it is often suggested that if a caregiver is asking, "When is it time?" it is a good indication that the time has come. If you are no longer able to provide the level of care a loved one needs and hiring in-home care is not an option, an elder should make the move to a higher level of care. If your parent is confused, forgetful and sometimes wanders, their safety is at risk. If your parent has severe mobility issues and cannot get around the house safely and on their own, they need assistance.

Are pets allowed at assisted living?

Many allow pets. Check with the assisted living facility.

How much does assisted living cost and who pays the bill?

Although the cost for assisted living varies by the facility, the national average is $3,500 per month for a one bedroom apartment with a private bath. The rate is significantly higher for seniors who require Alzheimer's or dementia care, with costs of $4,600 per month.

Residents of assisted living facilities use "private pay" to cover the costs of housing. The source from which they pay is up to the individual. Some people use personal savings, pensions and/or Social Security to cover the costs. Some people also use long term care insurance. Medicaid and other federal programs do not pay for the costs of assisted living. Some states offer waivers for assisted living for special circumstances. Check with your Area Agency on Aging to find out if your state offers a waiver.

An exception to private pay for assisted living is low-income or government subsidized communities. If your parent meets certain income and asset requirements, the government will subsidize the cost of the rent.

What happens if I run out of money when mom is in assisted living?

You have a few options to consider if this situation occurs. First, discuss your situation with the facility. Many times, the facility will be willing to negotiate some kind of agreement. These situations are handled on a case-by-case basis, but they may be able to reduce rent or set up a payment plan to cover past-due payments. Second, check with your state's Agency on Aging to find out if there is an available program that may help you. Finally, check to see if your parent has any funds that you may not have tapped into or if they qualify for low-income or government subsidized housing.

Unfortunately, residents in assisted living facilities do not have the same protection as those in nursing homes. Dependent upon your individual lease agreement, oftentimes the assisted living facility is required to give a 30 day notice of discharge, however the resident is not protected from involuntary discharge. Exhaust all options to prevent this from happening.

How can caregivers deal with the guilt of moving a parent to assisted living?

Guilt is a feeling that many caregivers experience when they move an elderly parent into an assisted living facility. Don't let guilt get the best of you! Always keep in mind that the move was the best option for your parent. An increased level of care provided by professionals allows you to assume the role of "overseer" when your parent moves. You can be a liaison between the assisted living staff and your parent and still make sure that your parent's needs are being met. Additionally, with daily care needs met, you can redefine your daily relationship and focus differently, like making sure their apartment has personal touches. A move that better matches their level of needs ensures that you are doing your best to provide your parent the best care possible.

What can mom or dad bring with them to assisted living?

Your parent can bring any of their personal items that can fit in the apartment. Your parents can bring furniture, too.

Can a senior be denied by an assisted living community?

It is possible. Once the facility assesses your parent's health, they will decide if he or she is a good candidate. If your parent needs more care than assisted living provides, they will most likely refer him or her to skilled nursing, also known as a nursing home. Also, you or your parent needs to be able to pay for the cost of assisted living. If you or your parent cannot afford the costs, then the elder can be denied.

Many assisted living communities have waiting lists (usually the reputable ones), so, although your parent may not have been denied, it may be a while before they can actually move into the community.

How do I know they're getting good care at assisted living?

Find a good assisted living community and make yourself a regular presence in the facility and develop relationships with the staff, if possible. Ask questions. Monitor your elderly loved one's behavior, what they say, and pay special attention if you notice any bruises or cuts on his or her body. By asking questions and maintaining communication with staff, it is easier to keep tabs on the care your parent is receiving. If you suspect elder abuse or neglect, talk to a supervisor or contact an ombudsman.

What happens when mom's Alzheimer's worsens? Will she have to move?

Usually people who are in the early stages of Alzheimer's and dementia can stay in assisted living. Again, Alzheimer's and dementia care is handled on a case-by-case basis. Many assisted living facilities offer a secure unit for experiencing cognitive challenges. If you do not want your parent in a memory unit, you can always hire a private duty nurse. Private duty nurses allow seniors with dementia or Alzheimer's to stay in their current apartment, rather than in a secure unit. Check with your parent's facility to learn its policy. Finally, when seniors can no longer function without 24 hour assistance, a move to a nursing home may be required.

How big are the rooms? Can couples live together?

Room sizes can vary. There are studio apartments and one, two or three bedroom apartments. They have private bathrooms (nursing homes usually have shared bathrooms). Some even have kitchenettes. Couples usually can live together, but it is best to check with the facility first.

Can mom or dad socialize with others? One of the benefits of an assisted living facility is that there are group activities available for residents. Everything from games to exercise classes to happy hours are offered. However, if your parent does not like to participate in group activities, social interaction can still happen at meal time, since meals are usually eaten in the community dining room.

What if they don't want to socialize? Is there privacy?

If your parent desires complete privacy they have the option of staying in their apartment and even eating meals in their apartment. Sometimes privacy cannot be given though, if your parent needs assistance with certain things. For instance, if your parent wants privacy during meal time, but he or she needs assistance eating, a staff member will need to be with them to assist. This level of assistance may require an additional charge in an assisted living setting. Assisted living communities encourage residents to socialize and engage with other residents. Staying in their room alone at all times can lead to lonliness and depression.

What will mom do all day?

A vital part of quality of life is social interaction and assisted living facilities aim to provide a means for that interaction. A variety of activities are offered to ensure that your parent has something to do that fits their interests. There are many kinds of games offered, such as bingo, board games, puzzles and cards. Depending on the facility social parties may be offered to celebrate holidays- big and small. There is usually some kind of physical exercise activity. There are movie nights, entertainers of all sorts, and a schedule full of activities seniors can pick and choose from. Good assisted living facilities offer many different activities to suit people's needs and interests. If you are concerned with a facility's activity schedule, talk to the activities director. They are open for suggestions!

Are assisted living residents kept on a daily schedule?

Yes and no. Elders in assisted living still maintain some sort of independence and can decide which activities in which they wish to participate. For example, if your parent usually plays bingo, he or she can decide not to play one day. They do not have adhere to activities schedules. Your parent will be on a daily schedule when it comes to things like meals, medication, bathing, dressing and grooming, and housekeeping.

Your parent will eat three meals per day: one in the morning, one in the afternoon and one in the evening. There is a window of time allowed for certain needs. For instance, if your parent needs assistance with bathing, he or she will know that a staff member comes to their apartment on a certain day between 8:00 a.m. and 9:00 a.m.

What if they don't remember to take their medications?

If a resident does not remember to take medication regularly, staff can assist with that. A staff member may call the resident to come to the nursing station to take medication or someone may visit the resident's apartment and administer the medication. If you feel that your parent needs assistance with remembering medication, talk to the staff at the facility. Be aware that in assisted living facilities this service may incur additional costs.

Does mom or dad need a car? How do they get to the doctor?

Many facilities allow residents to have cars if they are able to drive. It is not imperative that your parent has a car. Assisted living facilities have transportation available for residents for doctor appointments, shopping, banking needs, etc.

What happens if an elder has an emergency at assisted living?

There are a variety of ways for staff to be informed of an emergency. Many assisted living facilities have emergency pull-cord systems. A pull cord would be placed in every room of a resident's apartment and if he or she needs assistance, they can pull the cord and the receptionist will be alerted to send for help.

Another emergency device is a panic button. Residents may wear a necklace with a panic button that alerts the receptionist that there has been an emergency. Panic buttons are particularly useful for falls.

In assisted living, residents are checked on multiple times per day since they need care for different things. Often, a check in button or system is used so that if a resident has not informed staff of their status for a defined period of time, staff may pop in the room just to check on them and make sure everything is okay.

How do I know mom or dad will be safe?

Security is available in the form of emergency security and general community security. Guests are required to sign in so that the facility knows who comes in and out of the building. To ensure caregiving safety when you choose a facility, be certain to ask regarding the facility's policy that staff members pass a background check prior to being hired.

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While I love this site and spend more time on it than I should, it would be helpful to remember responses are nation wide and sometimes even world wide. I am sure some of the differences in what people have experienced is due to the state they live in. ALF, like all licensed long term facilities are regulated by state, not federal government. Every state can be a little if not a lot different. I live in the state of Missouri. In Missouri there are 2 levels of licensing for assisted living, level one and level 2. 99% of facilities are licensed for level one. 9 out of 10 of these do not take Medicaid (no one takes Medicare). Assisted living level one requires "pathway to safety" without assistance. This means if the elder hears a fire alarm they understand what that means, can transfer out of bed or chair without assistance and guide themselves to the exit. And they have no skilled nursing needs: dressing care, colostomy care, frequent assessments for heart or lung disease. Let's be honest, for most of us if our parents could do this we wouldn't be on this site. Assisted living 2 can admit patients who do not meet pathway to safety but the facility meets different state required staffing regulations. I have called every facility in the st. louis metro area. Many of the admit people don't even know their licensing status but they will only take elders who meet pathway to safety in spite of being a level 2 facility. The handful of level 2 facilities that do take more complex patients are for memory care. The cost is 6-7k a month and it is private pay only. Assisted living is a very broad term that doesn't really give accurate information for people looking for resources in a certain state/region. My other personal complaint is Adult Family Homes. These are not possible in Missouri and many other states.(but I certainly wish they were). It might be helpful if people posting with different experiences could clarify where they are located. I hope this is helpful.
Dear Aging Care Community:

We were responding to this comment in the original posting on "Assisted Living Facility Questions & Answers"

What's the Difference Between Assisted Living (ALF) and a Nursing Home (SNF)?

"Assisted living does not provide medical care, such as treatment for specific conditions or diseases like Parkinson's disease or hospice care. The assisted living facility will assess the elder to decide what kind of care his or her needs require. Nursing homes, on the other hand, are designed to house and assist individuals who have health conditions that require constant monitoring and the availability of medical personnel. "

Here in the State of Florida (the assisted living capital of the entire United States) - this is not true. Patients/residents CAN receive medical care while living in assisted living. What matters is the level of care each patient is at when ENTERING the assisted living facility - even if it is a HIGH level of care. This includes patients who are diabetic, have parkinson's disease or alzheimers/dementia, and who are on dialysis - all serious medical conditions that can be treated in assisted living. (and many others as well) If a patient can assist with transfer (even if in a W/C or bed-bound), does not have a vent/trach tube, and does not have a wound which is a stage 2 or greater - they can enter assisted living and receive the nursing care that they need.

In this day and age - few people qualify or need to go to a traditional nursing home (SNF - skilled nursing facility) - that is why assisted living facilities were created - to divert the patients who DO NOT NEED to be in a nursing home to a place where they can still be monitored, be given medication managment, receive medical care, have their medication, meals, housekeeping, physician care and transportation provided - among many other services. 30 years ago - assisted living was scarce - there was only a choice of hospital, home, or nursing home. Today ALF's give families the modernized option of a place that is much more home-like and can still provide the care that the patient needs - at many different levels - from someone who is completely independent - to someone that needs a little assistance with bathing/dressing - to someone who is on 3x weekly dialysis - who is completely incontinent and needs maximum care. ALF can accomodate all of these and many other situations.

As well as the standard license, an assisted living facility may choose to apply for an Extended Congregate Care (ECC) License. The ECC license is a specialty license that enables a facility to provide, directly or through contract, services beyond those permissible under the standard license, including acts performed by licensed nurses, and supportive services defined by rule to persons who otherwise would be disqualified from continued residence in a facility licensed under this part. This provides even more nursing care.

In large and small facilities (licensed exactly the same - regardless of size - they are held to the same standards whether they have 6 beds or 600) hospice care can be added if recommended by the attending physician. The patient can remain in the assisted living facility until death if that is their choice - they DO NOT have to move to a skilled nursing facility (traditional nursing home). Of course - if a serious medical issue occurs: ie: falling and breaking a hip, pneumonia, etc... they will go to a hospital and then short term nursing/rehab until they recover - then return to their assisted living facility (their home).

There are guidelines within each contract for assisted living in Florida which state they must "hold the bed" of a patient who has entered a short term nursing/rehabilitation facility - or hospital. It is your responsibility as an informed caregiver/consumer to look at this when signing the contract. (You have to have the power of attorney / health care surrogacy to make decisions and sign legal documents for a patient). The resident (or their power of attorney/responsible party) will be required to continue to pay the monthly fee until the bed hold is ended, as described in the written agreement; or until the resident or their legal representative tells the facility in writing that the resident will not return; or if a medical condition prevents the resident from telling the facility and the resident has no legal representative to speak for them. Yes - this means you still have to PAY for the bed in the ALF while they are in another health care facility - Medicare is paying for that other facility - or Medicaid in some instances - not the family and not the patient - so you will never be paying the ALF and the hospital or SNF.

Short term nursing/rehabilitation and hospital services ARE covered by Medicare. No ALF in the country accepts Medicare for payment - it is not covered. However, several facilities accept Medicaid programs and VA benefits based on eligibility. If someone has a long term care policy - that is also highly beneficial and is accepted at nearly every single ALF in the country.

*** of course these guidelines can be different in different states - we highly recommend checking with your individual state ***

Let us not forget the cost differences between these facility types as well. In a SNF - one here in Florida can expect to pay an approximate cost of $7000-$8000 per month - if the patient does not qualify for Medicaid benefits - this means OUT OF POCKET. Even if someone has $100K + in savings - that can quickly go in a SNF. In an ALF - you can expect to pay $3000-$4000 per month for a very nice facility - that is HALF the cost. ALF's are available below this monthly cost as well - depending on the care of the patient, private or semi-private room, geographic area, etc... Please contact us with specific questions - there is much too much information to list here.

Many families do not even know what the guidelines are or that their loved one can live in a much better situation and receive the care that they need. Assisted living is HOME-LIKE - skilled nursing will always be INSTITUTIONAL. That is why patients are afraid to go there - and they fight it until the end - because they are scared and do not want to spend their last days locked up in a hospital-like environment. Part of our job is to educate the patient and their family on the choices available to them - once they see that if they are eligible a much better choice exists today they see "this isn't so bad! this is nice! look at all the activity going on here! there are people like me!" etc... Their fear subsides and they are open to making a positive move in their life where they can get the care they need but still retain as much independence as possible. They can go out for the day or holiday with their family, or just go out to lunch - family can visit every day if they want - the choices are boundless - in a traditional nursing home they ARE NOT. You are the responsibility of the facility and you have to receive a doctor's note to even go out to lunch - which must be arranged in advance. These are just a few highlights of the advantages of ALF - we couldn't possibly write them all here - but want you to know that a much more wonderful place can exist for your your loved one - and we are here to help educate you on the choices that you as a family have.

I have a lot of guilt and anxiety for moving mom into a very nice assisted living facility, which she initially agreed to. Her house is for sale. I now am second guessing myself-----should I have let her live at home with12 or more hours of in-home aides---which charge $16-18/hr on weekdaya and $21/hr on weekends. Her money would run out much more quickly and then when she needed a nursing home, Medicaid would pay but I worry about the quality of care since I read so much about elder abuse,
bed sores, restraints in chairs most of the day, etc. The assisted living place that she is in now has promised to transfer her to their nursing home or altzeimer's home when she runs out of money and will help her apply for Medcaid. Mom has some depression and anxiety and is treated by the psychiatrist. She also has issues of back pain and foot pain. While the care is probably above average, it is understaffed with
1 RN and 1 Caregiver per shift. Mom's house has 16 residents and there are 2 other houses with the same quota. Mom gets very anxious if the medication aide is late in giving out meds. It kills me when my sister asked her if mom was happy there and m om's reply was, "I don't have any other choice." I have the space for mom to ,live with me but I work part-time and mom is very needy. When I get home exhausted from work and just want to chill before cooking dinner, it woluldn't happen and I would eventually lose my temper with her and feel even worse. I do visit her 3-4 times/week and take her out sometimes and to family events, as does my sister. She has more visitors than most of the other residents but she still is unhappy and it breaks my heart!!
Does anyone have a similar situation and words of advice? THANKS!!