Factors to consider
Assisted living homes continue to spring up, with owners hoping to attract the highest paying residents to the nicest facilities. After all, Medicare does not cover assisted living and residents must pay out of pocket. If you are considering this for an aging parent, cost is a primary factor in the decision. The price of such a home varies widely from state to state depending on the cost of real estate in any location. The better amenities in an assisted living home also cost more. Before a family chooses a place based on costs of care, explore all options in the area. Notice what you/your aging parent will be paying for and what actual value you will get for the monthly cost the home charges.
If it looks nice and has expensive furnishings, it will cost more than a more modest living situation. The targets the salespeople look for are the adult children of the elder. They want Mom or Dad to be in a place that looks nice. Never mind that good furniture and art is no measure of quality of service in such a place. It’s a selling point. It may matter to an elder who is still completely “with it” and will notice pretty, well arranged things. But if the aging parent is confused, has dementia or has limited vision, those lovely details important to the family may not be of any consequence to the elders themselves. Consider what your aging parent notices and likes and what they don’t like. Of course, elders usually don’t want to move into these homes. It is typically their family who encourage them to move and give up living alone or from an environment the family sees as unsafe. Safety concerns are a legitimate reason to consider assisted living.
Who is a good fit for assisted living?
Assisted living is a social environment, a group setting, and a place where interaction with others is emphasized. For example, some of these homes have a policy that the resident can only have so many meals a week in one’s own apartment. The idea behind is this that the facility wants to prevent isolation by requiring that residents eat some of the time in the dining room interacting with other residents. It’s good in theory and can work well, but it’s not for everyone. If your aging loved one is truly a loner, doesn’t make friends much, won’t join things and prefers to be by herself, assisted living will not give such a person her money’s worth.
Isolation isn’t good for most people and from some studies, it is connected to poor health. As humans evolved, we did so in groups. That influences how well we do or don’t do all by ourselves as we age. Generally, social isolation should be prevented so people can rely on others, make satisfying connections, and above all, get help when it’s needed. Those healthy interactions can take place in a variety of environments, including high end assisted living as well as the more modestly priced homes. Even the small “board and care” homes with only a few residents can prevent isolation. One of the great appeals of assisted living is the fact that there is someone on staff all the time (far more limited at night) and that there is a way to call for help at any hour.
An elder in your life may be reluctant to go, but willing to adapt to a new living situation out of necessity. Someone needs to be available to help 24/7 and family is unable to meet that need. That is a reasonable consideration in the decision process. There is typically a variety of activities offered in these homes, entertainment, outings, and someone to talk to every day. That works when an elder, sometimes with a little gentle prodding by staff, learns to engage. It can work well and some folks are happy in these environments. Romances can bloom too!
Who is not a good fit for assisted living?
Some families have a vague notion that assisted living will take care of whatever the aging loved one needs. After all, they are paying a pretty penny and want good care in exchange. “Care” can involve the need for skilled, licensed nurses. Assisted living, administered by the state’s social services department, is not a nursing care facility. Because skilled nursing homes are regulated by the states departments of health, overseen by the Federal government’s Center for Medicare/Medicaid Services, they need a different license from an assisted living facility. No licensed nurses are required to be on staff at assisted living facilities. These homes are not allowed to provide nursing care and do not deliver it. Rather, they offer help with “activities of daily living”, which means eating, walking, bathing, dressing, toileting, and transferring into and out of bed. If your aging loved one needs more than that, even in the highest priced assisted living homes, you need to find out if the facility allows you to have a licensed nurse visit and administer skilled care for a brief time, such as changing dressings on a wound, or whether the facility does not allow this. Some homes will insist that the elder in need of skilled care, however brief it may be, must go to a nursing home to receive it
If you have a confused elder who has dementia, a typical, ordinary assisted living home is not going to meet their needs. Demented elders need better safety protocols and more supervision than those who are not so impaired. Memory care, as the industry calls it, is designed to better address the needs of cognitively impaired elders. And inevitably, it will cost more than assisted living without memory care.
An important factor families must consider is the high cost of any of the choices of assisted living available. Some families place an aging parent in assisted living, knowing that their assets are only going to cover the cost of the place for a year or two. They like the look of the place, people are nice and kind and the elder is willing to live there. But there is no plan for what happens when the elder runs out of money. There is no magical source of income to pay for it. Medicare, as mentioned, does not pay for it, and neither does Medicaid, the government source of healthcare for those with low incomes.
What happens when an elder runs out of money after living in assisted living for a year or several years? They can’t live there rent-free. Family either must pay the out-of-pocket costs or the elder has to move out to something affordable. If there is no more money, the family can’t afford the rent, or the elder’s income is too low to cover the cost of that kind of facility, they may have to get Medicaid and live in a nursing home. That is a sad choice.
At AgingParents.com, where we offer advice to families of elders about age-related issues, running out of money is a recurring problem we see. People do live longer sometimes than anyone thought they would. If the family or the elders themselves chose an expensive and lovely assisted living home that takes all their assets within a year or two, they are shocked to find that they don’t get free rent and amenities just because they are a long term resident there. These facilities have to make their own profits and they do that only from the dollars they take in from residents. They do evict residents who cannot pay, just as any landlord would. When an elder has limited assets and no wealthy relatives available to support them, it makes good sense at the outset to choose an assisted living place that is at the low end of the cost spectrum. You do not want your elder to experience getting moved out for lack of funds to pay rent.
A move to assisted living is a major event in an older person’s life. It changes dramatically from what it was before such a move. Family members usually help with the choice of where to go. If so, consider what is a fit and what may not be. Cost is a major concern for many. Bear in mind that this arrangement could go on for a long time and adequate resources are essential to prevent having to move twice. Find more detail on the subject here.
Related: Are Aging Parents In La-La Land About Their Health?