Assisted Living Facilities
Tips for Choosing a Facility and Making the Transition
If you’re having more and more difficulty with everyday activities such as showering, dressing, getting around the house, and running errands, an assisted living facility may be the answer. You can get the daily support you need, while remaining as independent as possible. Making the decision to leave your home can be difficult, but by taking time to find the right fit and being honest about your needs and concerns, you can you can make the choice that’s right for you and ensure your senior years are happy and fulfilling.
What is assisted living?
Assisted living is a residential option for seniors who want or need help with some of the activities of daily living—things like cooking meals, getting to the bathroom in the middle of the night, keeping house, and traveling to appointments.
What’s in a name?
Other common names for assisted living include:
- Residential care
- Board and care
- Congregate care
- Adult care home
- Adult group home
- Alternative care facility
- Sheltered housing
An assisted living facility may be a good choice if you need more personal care services than you can get at home or an independent living retirement community, but you don’t need the round-the-clock medical care and supervision of a nursing home.
Assisted living facilities offer the safety and security of 24-hour support and access to care. Day or night, help is only a phone call away. However, privacy and independence are encouraged. A good facility will develop a personalized plan that meets your needs and accommodates your disabilities, while giving you the freedom to do what you can for yourself. In general, assisted living is in a residential type facility, ranging from converted homes or apartment complexes to renovated schools. Some provide apartment-style living with scaled down kitchens, while others provide rooms. In some, you may need to share a room unless you're willing to pay higher cost. Most facilities have a group dining area and common areas for social and recreational activities.
In the U.S., each state has its own specific licensing requirements for assisted living, so you’ll want to check to see what services can be provided.
Services at a typical assisted living facility
Is an assisted living facility right for you?
If you’re trying to decide whether assisted living is right for you, ask yourself the following questions:
- Do you need more help than family and friends are able to provide? Are the activities of daily living becoming stressful or overwhelming? If family or in-home help is not able to bridge the gap, assisted living is an option.
- Do you feel lonely or isolated at home? Having an active social life is vital to your health and happiness. Being alone much of the time is a recipe for depression. The social aspect of assisted living is a huge benefit. Good facilities offer a range of social and recreational activities. And the community environment also gives the opportunity to make new friends.
- Do you worry for your safety? Perhaps your mobility is limited, making it difficult to get out of bed by yourself, for example. Maybe you’re afraid of what might happen if you fell and couldn’t get up, or experience another problem and couldn’t get help.
- Are you tired of maintaining a home? There are a lot of responsibilities that come with living in your own home. Assisted living facilities can provide a home-like atmosphere, without the work of cooking, cleaning, shopping for groceries, and doing laundry.
- Is transportation an issue? Perhaps you’re having trouble driving or can no longer drive. If public transportation or another alternative isn’t easy and convenient, you may be increasingly housebound. Assisted living facilities offer transportation, so you can get where you need to go without having to rely on friends and family.
Signs that a parent or loved one might need assisted living
It’s not always easy to tell when your parent or another family member or loved one needs more help. The following warning signs may indicate that it’s time for a talk about assisted living.
- The refrigerator is empty or filled with spoiled food or your parent is losing weight. These may be signs that he or she isn’t eating well because shopping or cooking is difficult.
- You notice frequent bruises, although your parent may try to cover them up. This may be a sign of falling, or mobility and balance problems.
- Your parent wears the same clothes over and over again or neglects personal hygiene. This can indicate that doing laundry and bathing is physically challenging.
- The house and yard isn’t as clean and tidy as it used to be.
- Your parent forgets things, including doctor’s appointments and when to take medication. This may be due to memory loss.
- Your parent seems depressed. Depression is common in seniors who are isolated and alone.
- You notice strange or inappropriate behavior. For example, your parent may dress inappropriately for the weather. This can be a sign that he or she is experiencing confusion.
Making the decision to leave home: What you may be feeling
No matter your situation, moving is always stressful. But when you’re contemplating leaving your home for an assisted living facility, stress is just the tip of the emotional iceberg. You may associate grief with the death of a loved one, but grief is a natural response to any loss. And the loss of your home, neighborhood, and community is a big one.
The thought of leaving everything you know can make you feel very vulnerable. You may feel like you’re losing your independence or a big part of your identity. It’s important to realize that all of these feelings are normal. Take some time to acknowledge these feelings of loss. Sometimes talking to someone who is sympathetic can help. Counseling and therapy can be an option too. Give yourself time to grieve and get used to the change.
Tips for making the transition to assisted living easier
Life in an assisted living facility is an undeniable adjustment. In addition to a new living environment, you are meeting new residents and getting used to the staff. This can feel stressful in the beginning. But there are things you can do to make the transition easier.
- Pack well in advance of the move. Don’t add to the stress of the actual move by putting yourself in a position where you’ll need to make hasty decisions about what to take and what to discard.
- Know what to expect. Do your homework on the facility. It will be less stressful if you know what to expect. Read all the materials before you move in and make sure all of your questions are answered ahead of time.
- Stay busy. You may be tempted to stay in your apartment or living space, but you’ll feel comfortable much quicker if you get out there to meet the residents, participate in activities, and explore the facility.
- Go easy on yourself. Everyone adjusts to change differently, so give yourself a break, no matter what you’re feeling. However, if you feel like you’re taking longer than you think you should to adjust, it may help to talk to your family members, the director of the facility, or a trusted friend.
Choosing the right assisted living facility for you
There is a huge variation among assisted living facilities. While this can make the process of choosing seem daunting, the plus side is that you have a good chance of finding a facility that is perfectly suited to your preferences and needs.
As you start your search, try not to get overwhelmed by all the options. Remember, amenities matter much less than the residents and staff. It’s the people that truly make any place, including an assisted living facility. You can tell a lot about a facility by the people who live and work there. You want a facility with an active social atmosphere—where the residents are friendly and the staff is caring and warm. Make sure that, overall, you feel the facility is a place where you will fit in and develop new relationships.
Ask about staffing patterns
To feel confident that you or your loved one will be well taken care of, it’s important to ask questions about the staffing levels and workload at an assisted living facility. For example, how many staff members are actually involved in residents’ care? How many people are working at any one time? What are their duties during those times—do they have time to interact with residents? Are there registered nurses on site? How do staffing patterns differ at night? What happens when a staff member is sick or otherwise unable to be at work—is there enough cover?
Choosing an assisted living facility
Visit a facility at different times—during activities and meal times, for example—and seek feedback from residents and their families or via online reviews.
What to look for in the staff:
- Do they have time to speak with you or does it feel rushed?
- Do they appear genuinely friendly and interested in you?
- Do they interact warmly with current residents? Or do they seem stressed or overwhelmed?
- How do they handle emergencies?
What to look for in the residents:
- Do they appear happy?
- Do they enjoy interacting with one another?
- Do they seem like people you’d enjoy getting to know?
- Are there hobbies or groups on site that look interesting to you?
What to look for in the facility:
- Do the different areas seem clean and fresh?
- How often is housekeeping provided for your room?
- Does the facility seem safe and secure? Are the bathrooms easily accessible and have grab bars? How do residents contact staff in an emergency?
- How is the food? Sample a meal and ask about menu options.
Other things to consider when choosing an assisted living facility
The most important factor when choosing an assisted living facility is that it feels friendly, safe, and comfortable to you. While the facility should be clean and well maintained, don’t place too much emphasis on surface appeal, such as designer furnishings, gourmet meals, and impeccable grounds. The facility you’ll be happiest at won’t necessarily be the most fancy or expensive. The bottom line is that the right facility for you is the facility where you feel most at home.
Does it feel homey to you? This is a personal preference. Do you prefer a smaller, cozier environment, or would you rather be in a larger, bustling place with more activities? Is outside design, such as gardens or other greenery, important to you?
Does the facility offer activities you’re interested in? Are there hobbies or activities on site, or transportation available to outside ones? Does the facility have amenities that are important to you such as a gym, recreation center, library, or a chapel?
Is the food appealing to you? Do you have the option of eating in your room if you would like to? What kinds of food are served? Is it nutritious and appetizing? Are their different food options available?
How are health problems handled? How does the facility handle both emergency and non-emergency problems? If you develop a medical condition, will you be able to remain at the facility? At what point would you be required to move elsewhere for medical care?
Is the facility in compliance with state and local licensing requirements? In the U.S., each state has different standards, so you will want to check with your local regulatory agency to make sure that the facility is licensed and in compliance. You can also check the Better Business Bureau to see if any complaints have been lodged against the facility.
Assisted living vs. other types of senior housing
Assisted living may be considered an intermediate between independent living and nursing home care. If you only need minimal assistance, independent living might be a better choice. If you have a lot of medical needs, you would need to consider nursing homes or other facilities with skilled medical care. For more information, read Senior Housing Options.
Supporting a loved one as they move to assisted living
A move to assisted living, even if all parties are in agreement, can be a stressful time. Here are some of the ways you can support a loved one:
- Acknowledge your loved one’s feelings of loss. Even in the best of situations—where your loved one willingly chose assisted living—grief and feelings of loss are to be expected. Leaving one’s home is a huge upheaval. Don’t minimize their feelings or focus excessively on the positive. Sympathize and respect feelings of loss and give them time to adjust.
- Call and visit as often as you can. Regular contact from friends and family will reassure your loved one that they’re still loved and cared for. Continue to include your loved one in family outings and events whenever possible. If your loved one lives far away, regular calls or emails can make a big difference.
- Work through concerns together. While your loved one will likely go through a period of adjustment after moving into an assisted living facility, don’t automatically assume that complaints are just part of the transition process. If your loved one has concerns, take them seriously. Talk about what steps you can take together to resolve the issue. And if the problem turns out to be a big one with no apparent solution, be prepared to look at other facilities.
- Help your loved one personalize their living space. Help your loved one choose and bring over the meaningful possessions and decorations that will give the new living space the feeling of home. But be careful not to take over. Let your loved one take the lead. He or she is going to be the one living there, after all.
|Suggestions For Friends and Relatives|
Source: National Center for Assisted Living
Planning and paying for an assisted living facility
In evaluating assisted living, cost is often a major consideration, especially since the majority of the costs will most likely come out of your own pocket. Assisted living facilities are owned and operated by both for-profit and non-profit organizations and can range in cost from approximately $800 to $4,000 a month or more, depending on where you live. This is a big investment, so taking time to develop a budget and prioritize your needs will really pay off in the long run.
Paying for an assisted living facility
You may be wondering if health insurance or governmental programs will cover any of the costs of assisted living. If you have purchased private long term-care insurance, check the provisions of your plan to find out how much assisted living is covered.
In the United States, Medicare, government health insurance for older adults, does not cover the costs of assisted living. In some cases Medicaid—government health insurance based on financial need—may provide a limited benefit. Additionally, there are some board and care homes that will accept Supplemental Security income as payment. However, a limited amount of assisted living facilities accept these programs because of the lower rates they receive. Special populations like veterans may have access to VA-approved board and care homes, or veterans’ homes which provide a continuum of care.
Evaluating the costs of an assisted living facility
- Don’t assume that expensive always means better. Focus on what the facility has to offer specific to your wants and needs, and the quality and responsiveness of the staff.
- Make sure you understand how the facility bills. Is there a flat fee, or do additional services require additional costs? For example, say you start to need a higher level of care at the facility. How will that be managed? It is your right to have access to this information. If a facility balks or is vague, find another facility.
- Get a sense of rate increases. You don’t want to be unpleasantly surprised by sharp rate increases. While you can’t completely predict the future, try to get a sense of how rates have risen in the past.
If you want less stress and more connection in your caregiving, read FEELING LOVED.
More help for senior housing
- Senior Housing Options: Making the Best Senior Living Choices
- Home Care Services for Seniors: Services to Help You Stay at Home
- Independent Living for Seniors: Choosing a Retirement Home or Retirement Facility
Resources and references
General information about assisted living
Stepping Stones in Care Needs – How assisted living facilities combines help with an increased social life. (ElderCareLink)
Moving to Assisted Living Care – Guide for new residents and families on how to ease the transition from home to assisted living. (Care Conversations)
Comparing and choosing assisted living facilities
Assisted Living Facilities Checklist – A handy checklist of questions to ask when evaluating and choosing an assisted living facility. (CarePathways.com)
Guide to Choosing an Assisted Living Community (PDF) – Explains assisted living and what consumers can expect from an assisted living community. Also includes a checklist to use when visiting and evaluating a potential new home for yourself or for a loved one. (Assisted Living Federation of America)
Choosing an Assisted Living Residence: A Consumer’s Guide (PDF) – A comparative checklist for consumers and prospective residents, including starting ideas to find facilities. (American Health Care Association / National Center for Assisted Living)
Finding an assisted living facility in the U.S.
Helping a loved one transition to assisted living
Ten Questions To Consider when Moving a Parent into Assisted Living – Helpful tips on how to help a parent through the process of moving into an assisted living facility. (Golden Years Changes)
Transition to Care – Covers what you can do to make your loved one’s transition smoother. Written specifically for nursing home transitions, but most of the tips also apply to assisted living. (Care Conversations)
Cost of assisted living facilities
Costs and How to Pay - LongTermCare.gov – Explore how to pay for long-term care, including long-term care insurance, personal income and savings, life insurance, annuities and reverse mortgages. (U.S. Department of Health & Human Services)
Long-Term Care: Paying For Long-Term Care – A guide from the National Institutes of Health on paying for long-term care. Includes information about Medicare and Medicaid. (NIH SeniorHealth)
Long-Term Senior Care Costs: Medicare & Medicaid – Covers assistance programs from Medicare, Medicaid and the U.S. Department of Veteran Affairs that can help pay for eldercare. (A Place for Mom)