We all want our parents to live as long as possible, but seeing them deteriorate can be heartbreaking. I didn’t have the benefit of watching my mother age, as she passed away at the age of 49 from complications of leukemia. I would have loved to have more time with her as she grew older. On the other hand, it was difficult watching my dad age. He went from being an independent, sociable retired police officer who enjoyed traveling and attending Washington Redskins games to a dialysis patient who struggled to keep up with his medications, didn’t eat properly, and seemed to prefer his bed over family gatherings. As his physical and emotional health deteriorated, it became clear that he could no longer live alone. Moving him into an assisted living facility was a difficult decision, but one that my sisters and I felt would provide the socialization and support he needed. Within a couple of weeks after he moved in, we knew we had made the right decision.
Assisted living facilities are a great option for seniors who are able to live independently but require assistance with meals, medications, or activities of daily living, such as bathing, dressing, or toileting. Residents live in their own apartments and share common spaces. There are staff members on-site 24 hours/day, 7 days/week. Meals are offered in a central dining room, which provides both nourishment and opportunities for socialization. There are scheduled activities and outings, and most facilities offer transportation to local grocery stores, churches, and other businesses. Some facilities also provide skilled nursing care, which can be very helpful if your loved one’s health declines but they are not ill enough to require a nursing home.
Assisted living can be very pricey. There is a base price that covers the room, meals and basic services, which can range from an average of $2500-$3500/month depending on the geographic location. Additional fees are incurred for skilled nursing care based on a tiered system, depending on the severity of the resident’s illness and the amount of nursing care they require. In my home state of Maryland, assisted living facilities are licensed to provide three levels of care (low, moderate, and high). An example of level one is a patient with a chronic illness who can live independently but needs some assistance with bathing and dressing. Someone with dementia who requires assistance with all activities of daily living and is on multiple medications would be classified as a level three. As my father’s health declined, his level of care increased several times and the additional fees were in excess of $1000. Facilities may charge additional fees for incontinence care, on-site personal services (such as hair styling services), and transportation. Generally, residents will be responsible for their own monthly phone and cable television bill.
Some assisted living facilities offer specialized services, referred to as “memory care” services, to residents with dementia. These services typically include a modified staff: resident ratio, qualified staff who are trained to communicate and engage with dementia patients, safety precautions to address wandering behaviors (including secured units, alarm devices, and enclosed outdoor areas), and special programming activities. The cost for these services is exorbitant and can be upwards of $2000/month in addition to the fees for basic and medical services.
As discussed in the post about paying for nursing homes, the fees associated with long-term care are not covered by health insurance and are generally paid for with personal funds. Long-term care insurance benefits may partially cover the cost of assisted living care. Some individuals will rely on the sale of a home or a reverse mortgage to cover the expenses. Medicaid assistance varies by state and is usually provided by a variety of Medicaid waiver programs. These waivers require the participant to have “nursing home level of care needs” and there are income limits that also vary by state. Of note, Alabama, Kentucky, Louisiana, and Pennsylvania do not offer Medicaid waivers for assisted living. Medicare does not cover fees for long-term care. The Department of Veterans Affairs (VA) provides assisted living benefits for veterans and spouses of veterans who have served at least 90 days on active duty and at least one day during wartime.
When choosing an assisted living facility, you will need to do your research. Unlike nursing homes, there are no federal regulations that govern assisted living facilities. Each state has its own laws, regulations, and licensing standards for these communities. You will want to inquire about the following items:
- Levels of care provided (which will be important if your loved one’s condition deteriorates)
- Staffing (number and qualifications)
- Health status, age, and gender of the residents
- Services offered (bathing, dressing, medication management, meals, housekeeping, laundry, transportation)
- Daily schedule (meals, bedtime, visiting hours)
Be sure to visit as many facilities as possible. Take note of the way you are greeted by the receptionist, how residents are treated by staff, whether there are bad or unusual odors, the cleanliness of the facility, and whether residents appear cared for and happy. Get recommendations from friends, family members, and healthcare providers. Referral services like A Place For Mom can be extremely helpful.
Approximately 70% of individuals 65 years of age and older will need long-term care at some point in their lives. If you are unable to care for your aging parent or loved one in your home, an assisted living facility may be an appropriate option. These facilities provide a sense of independence and privacy while offering valuable support and services. Researching your options ahead of a crisis can make this transition less stressful.
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