Liz Weston, NerdWallet
If you or a loved one can no longer live safely at home, assisted living may be the answer. Residents typically live in their own rooms or apartments and get housekeeping services, meals and help with personal care.
But facilities can vary enormously, and people’s expectations about assisted living often clash with reality, elder care experts say. Here are some important things to know.
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1. Medicare doesn’t cover the cost
Medicare does not pay for “custodial” care, which is what assisted living facilities provide, including help with daily activities such as bathing, dressing, getting in and out of bed, and using the toilet. Most people pay for assisted living out-of-pocket if they don’t have long-term care insurance, says Amy Goyer, AARP’s national family and caregiving expert.
Nationwide, the cost of assisted living facilities averaged $4,500 a month in 2021, according to the latest figures from long-term care insurer Genworth. But costs range enormously depending on the area and the services provided, Goyer says.
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2. There may not be a medical professional on staff
Assisted living is considered residential rather than medical care, says elder care expert Kate Granigan, president-elect of the Aging Life Care Association’s board of directors and CEO of LifeCare Advocates in Newton, Massachusetts. Some facilities bring in doctors or other medical professionals to provide routine care, she says. But if there is a medical professional on staff, it’s often a nurse who can assess people’s needs rather than provide hands-on care.
“They’re not there to change bandages and to administer medical assistance,” Granigan says.
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3. You may need more care than you’ll get
The key word in assisted living is “assisted,” Goyer says. While facilities can provide help around the clock, they aren’t designed for people who need one-on-one, constant care. That’s the function of a nursing home. If someone requires medical care in addition to help with daily living, they would need a skilled nursing facility.
Residents or their families often expect help on demand, but assisted living facilities aren’t staffed for that, Goyer explains.
“They may wait half an hour for someone to help them go to the bathroom,” Goyer says.
Assisted living facilities typically offer tiers of care, with each tier increasing in price. The first tier may include medication reminders and help getting in and out of the shower, while the next tiers offer increasing levels of hands-on care, she says.
Prospective residents or their families need to ask what’s included in each tier and what exactly bumps the resident up to the next level of care, Goyer adds.
Another important question to ask is whether private caregivers can be brought in if the resident needs more care than the facility provides, Granigan says. Not all facilities allow outside help, which could mean the resident has to move to a nursing home if their needs increase.
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4. You can get kicked out
Scrutinize the admissions agreement — the legal contract that outlines the services, costs and other terms of admission —and ask questions about what can trigger an eviction. Assisted living facilities can kick people out if they have behavior problems, need more care than the facility provides or can no longer pay the bill, says Jaclyn Flores, consumer and policy advocate for the nonprofit California Advocates for Nursing Home Reform.
Assisted living facilities also can raise rates with sufficient notice, and many have been doing so, Flores says.
“They’re increasing rates at an astronomical rate and people find themselves stranded because they can’t afford it anymore,” she says.
Flores recommends prospective residents have a Plan B long before their savings are exhausted. Options might include moving to a less expensive facility or exploring public benefits such as the aid and attendance benefit available to veterans or Medicaid, the federal public health insurance program for people with low income and few assets.
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5. There’s no ‘one-stop shop’ for getting advice
AARP has a checklist for evaluating assisted living facilities, and advocacy groups such as CANHR and Consumer Voice can provide additional information. If you’re looking for assisted living, you’ll likely come across online marketplaces, placement agencies and consultants who offer to help. You may get valuable information, but the guidance may not be objective or comprehensive, Goyer says. Facilities pay these sources for referrals, so you may get steered to one that pays a commission rather than the one that’s the best fit.
For personalized advice, consider a consultation with an aging-life-care professional, also known as a geriatric care manager, who is paid only by your fees. For a cost that often ranges from $100 to $250 an hour, the pro — who is typically a nurse or social worker — can evaluate the aging person’s needs, recommend resources and help find appropriate facilities, Granigan says.
Finding the right place can take time, and the pro also can recommend ways to keep the current home safer while you search, she adds. You can get referrals for an aging-life-care professional from the Aging Life Care Association.
Genworth’s “Cost of Care” survey was conducted by CareScout, a Genworth company, that contacted 67,742 providers by phone from June through November 2021 to complete 14,698 surveys of nursing homes, assisted living facilities, adult day health facilities and home care providers.
