The Hidden Costs of Assisted Living


Assisted living costs vary by location, but it’s also important to know how senior communities structure their fees. Many caregivers are surprised to find that services like help with bathing and dressing aren’t included in the monthly rates.

During my caregiving years, I was stretched thin between caring for multiple elders, raising my children and working. I resorted to using the services of two different home care agencies to fill the gaps in my care plans when I couldn’t be there for my loved ones. In my situation, the biggest advantage of using in-home care providers was adding only the services and hours I needed while my care recipients comfortably aged in place.

This approach usually works well for a while, but many elders eventually require a more consistent and/or higher level of care that becomes increasingly expensive in a home setting. At some point, the increasing costs of keeping a senior at home exceed the price of assisted living, especially when you factor in the expenses involved in owning and maintaining a house.

While the move to an assisted living community usually involves downsizing, seniors can still retain much of the independence they felt in their own homes. 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 a private bathroom and kitchen, but you can rest easy knowing that trained staff is on hand to help your loved one when necessary.

Location Affects Assisted Living Costs

All assisted living communities are not the same; services, apartment styles and amenities vary. Depending on what part of the country you live in, what's included at assisted living may cost more. Genworth’s Cost of Care Survey 2019 reports that the national median cost of a private one-bedroom apartment in assisted living is $4,051 a month. Compare this number to $6,950 per month for assisted living in the New York City area or $2,970 per month in Bloomington, Indiana.

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Determining Cost of Assisted Living

Geographic location plays a huge part in the costs of long-term care, but the ways in which senior living communities structure their fees is an important aspect to consider as well.

What is included in assisted living costs?

Assisted living facilities often include room and board in their “base package.” This consists of a private apartment and two or three hot meals each day. Communities are generally set up so that an elder can quickly summon help in the event of a fall or another emergency, usually via some sort of pull cord system or a wearable personal alert device. Many also offer transportation services by bus or other means for group outings or to specific locations like local stores for groceries. Basic maintenance and utilities are typically included as well.

What are the costs of additional care services?

But what about assistance with activities of daily living like eating, dressing, bathing, toileting and transferring? Many assisted living settings do not include these services in their base package. Instead, they offer personal care services, medication management, housekeeping, personal laundry services, pet care, onsite salon and barber services, companions for trips to doctor’s appointments, and health care services on an à la carte basis.

It works differently at different communities. For example, at Brookdale Senior Living in Bonita Springs, Florida, the base monthly rent is for what is called independent living. Any room could become an assisted living apartment if the resident has a health care need. A care plan is created in which a caregiver is scheduled to go to their unit to help with showering, medication management and more. The resident is then charged a fee for each of these additional services.

My Experience Comparing Assisted Living Costs for Mom

When my mom was considering the transition to assisted living, we looked at several facilities, one of which was extremely expensive. It was interesting to tour the place, even though we knew the cost was prohibitive. They offered gourmet meals as well as the option of a kitchenette in her room. The premises featured a spa, a gym, many group activities and posh surroundings.

However, after reading the contract, I realized that we’d be paying solely for the beauty of the place. Their basic assisted living package that already exceeded our budget included no more hands-on help than Mom currently received in her own apartment—care provided by me. In other words, we would have had to pay extra for basic services like help with bathing and dressing, whether we chose the assisted living staff to provide them or hired professional caregivers through a home care company to visit Mom in the community.

The one nearby facility she could afford to live in was okay, although it was not fancy. They, too, offered no real help within her apartment other than a call light in the bathroom for help if she fell. Again, I would have had to continue providing all her personal care unless we incurred additional expenses to include additional services to meet her needs.

Understanding Assisted Living Contracts

It’s very possible that an assisted living community will provide all the hands-on services that a relatively independent elder requires, but it could be at an added cost. Some facilities have their own staff for this, while others contract with an in-home care company that furnishes additional services. Going with the facility’s choice of caregivers may be cheaper, since the agency would provide care for many elders in the facility, but most assisted living contracts will let you hire independently if you so choose.

If you’re considering helping a senior move into assisted living, be sure to ask for detailed pricing information when touring prospective communities. Be aware that some offer services on an à la carte basis while others may use an all-inclusive pricing structure or feature packages of services. Unfortunately, this can make comparing total prices between communities challenging, so use care when weighing the options.

Ask about any one-time fees associated with moving in as well as the community’s history of and policies for overarching rate increases for all residents. Assisted living demand is growing and prices are climbing. Data collected from consumers by A Place for Mom, the largest senior living referral service in the U.S. and Canada, shows that assisted living rates rose 2.4 percent from 2017 to 2018.

A Care Needs Assesment May Help Estimate Costs

The better you understand the level and specific types of care a loved one requires, the easier it will be to estimate senior living costs in any setting. All long-term care providers should perform an initial needs assessment to determine whether the facility can accommodate the new resident’s needs and what services he or she will need to use to ensure their safety and wellbeing there. Inquire about how the facility assesses and accommodates a senior’s evolving needs during their residence there as well.

Read: Needs Assessment: The First Step When Moving to Senior Housing

Once you’ve decided on a community, be sure to read the contract thoroughly. You don’t want to get to this point and find that much of the care you’re looking for is not included in the base price. Keep in mind that quality is of utmost importance—even over costs, deluxe amenities and appearances. If you do your research and select the right community the first time around, it’ll relieve a great deal of stress in the long run.

Finding the best care and living environment for your loved one will free you up to be their spouse, daughter or son again instead of focusing on being their primary caregiver.

Sources: Genworth Cost of Care Survey 2019 (; A Place for Mom Releases Annual Senior Living Cost Index (

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