Getting older brings new challenges in life. We explore what to expect with an assisted living facility, helping you to decide whether it's the right choice for you or a senior family member.
An assisted living facility, or ALF, is a community designed for those who need basic help with day-to-day activities but are still mostly independent. Around 1 million Americans currently reside in assisted living facilities, and this is set to rise. ALF’s offer a midpoint between retirement communities, where you are expected to be completely independent, and nursing homes, which offer an intensive program of care for those that need it. ALF’s are also a less expensive alternative to in-home nursing care. If you find it hard to maintain your home and keep yourself in good health – such as if you need a little help getting ready in the mornings or traveling about – then an assisted living facility could be the answer. Let’s explore further…
Communities will vary in the range of accommodation and facilities available. For example, an apartment or a studio will cost more than a room, and a shared room will cost less still. Base rates quoted usually include room, board and meals, and there may be extra charges for required services like laundry; most providers charge monthly. Many communities will offer tiered services – with the fewer services required meaning there is less to pay. This will work if you think you may only require one-off services every so often, called ‘a la carte’, and will be fairly independent. Otherwise, an ‘all inclusive’ package will offer better value for money.
The larger the facility, generally speaking, the more will be on offer. On-site amenities could include swimming pools, salons, and spas. There are themed communities based on golf or other activities, and there are also pet-friendly communities, though many ALF’s assess this on a case-by-case basis. However, don’t be fooled by a few nice touches such as flowers and luxurious carpets in the public areas: to figure out if you are getting genuine value for money, try a meal and ask about the staff ratios. Assisted living facilities can be found everywhere, from converted apartment tower blocks to former schools and suburban, purpose-built complexes. Smaller facilities usually have a more homely feel, and will be cheaper too.
According to non-profit senior living organizations, the national average for a one bedroom apartment per month is approximately $3,000, though this could increase to an average of $4,500 in depending on the area. This may sound expensive but, compared to the average cost of a retirement community and what these include, and it’s worth the extra. Retirement communities tend to offer no supporting care and in 2012 the cost was around $2,700 per month according to the private referral agency A Place for Mom. For a small difference in price, an assisted living facility offers a whole lot more care if it’s needed. Also, assisted living is generally cheaper than a nursing home or in-home help in the same area.
According to the US Census Bureau, the total population aged from 65-84 years will grow by almost 40% in the time between the last census in 2010 until 2020. As such, demand for retirement communities, nursing homes, and assisted living facilities is set to increase significantly; with this higher demand will likely come a higher price. It makes sense to plan ahead so you are not without options later on. It’s a fact that an assisted living facility will usually be paid for by the individual or their family – this is the case for approximately 7 out of 10 people, in fact. Financing is usually facilitated by selling off the family home, through personal savings, or financial assistance from children. Many ALF’s offer bridge financing for those waiting for a home sale to go through. Reverse mortgages (also known as reverse annuity mortgages) are a possibility, though these may not offer as a good a deal if you want to leave assets to family in your will. Long term care insurance is probably the best option for many, and should be considered around the age of 40 or 50 at the latest.
When it comes to finding care for the elderly, financial assistance in the US can, unfortunately, be limited. Medicare A and B do not offer cover for long term stay outside of hospital treatment. Medicaid can help, but the terms vary widely across the US and are usually limited to those on low-incomes. Currently there are an estimated 115,000 people in assisted living with the cost covered by Medicaid and, according to 2007 US Census Bureau information, Medicaid only makes up around 10% of revenue for assisted living providers. Many people may find their income and assets, even if modest, exclude them from eligibility to Medicaid. There are some provisions for veterans via the Department for Veteran Affairs, either through benefits or eligibility for veteran homes. There are also provisions for help in affording housing under Section 8. However, both of these will be limited in their scope.
As you might expect, some states are more affordable than others; particularly in the South and the Midwest. A Place for Mom, a private care referral company, performed a recent survey that looked into costs and found that the states Montana, South Dakota, Idaho, Oklahoma, Mississippi, North Dakota, Indiana, and Tennessee provided the most affordable assisted living facilities. However, it’s also important to factor in the cost of healthcare and future hospital treatment when searching for cheap assisted living facilities. CMS (Centers for Medicare and Medicaid Services) now provides data on the cost of the most common surgical procedures across the US, so you can compare price by hospital, as well as by area and state. What this research shows is that prices vary hugely even in the same locality. So, when choosing your ALF, check the local hospitals as well. As an alternative, Mexico is becoming increasingly popular because of rising costs in the US.
The most effective step in calculating how much you should pay for assisted living may be an independent medical assessment. This can help you to decide whether a nursing home or assisted living is best. Many people automatically assume that a nursing home is best, but assisted living can be a better solution in many cases. For example, many ALF’s can offer care for those with Alzheimer’s or dementia so long as the condition is in the early stages and the patient is still mobile. If this applies to your situation, then looking for a home with a specialist memory care program may work: the resident can stay in the regular accommodation for as long as possible, before moving to the specialist area (which will likely be more expensive due to the increased care requirements).
With no nationwide definition for assisted living, the level of care and the overall quality of living can vary widely from state to state. Each state and local area has its own licensing system, and it’s a wise move to check Better Business Bureau for any complaints against a particular assisted living facility. After all, reviewing feedback from people who have experienced specific ALF’s first hand is a great insight. Also, ask for the record of fines and violations – very few homes post their records online. There’s no national training standard required either, so make sure you or your relative ask questions about who is on duty and when. Having said this, all ALF’s must comply with the Americans with Disabilities Act, The Fair Housing Act and state fire and safety rules as standard procedure.
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