Assisted Living Facility

An assisted living facility provided is as the term implies, assistance with activities for daily living (ADL's). The arrangement entail some assistance from hired help. The hired help assistance may be provided by experienced but unlicensed healthcare workers to take care of all the needs of the residents or it may be a combination of personnel including a director, licensed nurse, certified nurse aide, cooks, wait-staff, housekeepers and a maintenance worker.

When an elderly person is having problems with activities of daily living or starting to have memory problems as well as some control of bowel and bladder function, an assisted living facility may be appropriate. These ADL’s include but are not limited to such services as bathing, dressing, laundry, housekeeping, activities, and assistance with meals and medications. Some facilities will also provide transportation to medical appointments and other outside services.

How to Get Admitted to an Assisted Living Facility

Each assisted living facility will vary in their admission policies and some clients will not be accepted for admission to certain facilities based on the level of care they require and whether that level of care conforms to the facility’s care policy. For example, many assisted living facilities (ALF’s) will not accept people who do not have control of their bowel and bladder functions. Some will allow a resident to use pads or briefs but will not provide incontinent care. The resident must be able to do that for himself/herself. Other ALF’s will not admit clients who require a wheelchair to get around or are not able to walk unassisted. On the other hand, hard economic times and competition have compelled some companies to make compromises and push the envelope on their admission policy so that they may admit residents who might be more appropriate for nursing home placement.

Types of Assisted Living Facilities 

The most common type of assisted living facility is one built and operated by a chain organization that operates several facilities. These facilities may be in the same city or may be spread throughout the continent. The buildings and the policies by which they operate are usually standardized so that if you’re familiar with an assisted living facility in your town owned by XYZ corporation and you go to another facility owned by the same company, you will find the two to be very similar and the main differences will be the personnel. This is a cookie cutter type of operation.

There are some organizations that build their business through purchasing existing facilities that are already in operation. They may change the name to reflect the change in ownership or they may keep the existing name, especially if the name is well established in that community. The change of ownership can be done seamlessly so that most of the residents and their families would not even notice.

There are a few entrepreneurs who will buy a facility and operate it themselves. This is what some call a mom and pop operation. Even though it may have a down-home connotation, it can be a very sophisticated, caring and expertly run operation.

Each of the above examples can be relatively small facilities with a census of 30 or so to a large facility with a census of over 100 residents. There are also small facilities that call themselves assisted living centers. They may have from 3 to 30 residents that they assist. Many of these are usually owned and operated by someone who has had experience in assisting the elderly in some way. They may be licensed nurses or perhaps a nurse aide who decided to start her own business.

Some of these smaller facilities are called group homes. These group homes are usually owned by an individual or a family and are usually located in a residential community. They may have a house attendant who lives there part time or they may have shifts like larger facilities. I have seen 4 bedroom homes that converted the garage into a nice living space for an elderly couple.

As you can see from what I’ve written above, there are many variations of what is called assisted living. I have tried to write about the most common types of facilities that provide assistance with ADL’s. To learn about nursing homes or retirement facilities, click on the appropriate link.

A Brief History of Assisted Living Facilities

In the years preceding the 1990’s, nursing homes were a place for the elderly who could no longer live alone and needed assistance with activities of daily living. Some people referred to them as rest homes or The Home. These facilities admitted residents who ran the gamut as far as the level of care that they required.

There were the ladies with the blue hair that you saw in the front lobby visiting with their fellow residents and watching who came and went through the front door. These residents needed minimal care and did well with having a clean bed, 3 square meals a day and an in house hairdresser. But there were also residents with dementia and Alzheimer’s who required constant supervision and other residents who were wheelchair bound or bedfast with multiple health issues that required the care of a licensed nurse.

Assisted Living Facilities arose to fill a need in elder care when hospitals started discharging patients with higher acuity levels to nursing homes. It became apparent that there was a niche for residents who did not require the skill level of care that a nursing home provides but just needed minimal assistance. Some families turned to group homes to admit their loved ones and enjoyed more comfortable and home-like surroundings at a fraction of the cost of nursing homes.

Soon, entrepreneurs were responding to the demand for larger facilities with better amenities and services and the assisted living facility designation was born. Soon after came licensing and state regulation.

How to pay for Assisted Living?

Most assisted living facility residents pay for services out of pocket. In most cases this means drawing out of savings, a trust fund or dividends from investments. There are many financial advisors available to provide the resident or family care-giver with sound financial advice on how best to use your financial resource.

Some residents rely on financial assistance from relatives such as sons and daughters where the children foot the bill entirely or it can be shared by several members of the family including the resident.

Still others bought Long Term Care Insurance with the thought that they may need it some time in the future to cover such costs. Long term care insurance can be a wise investment if you have the funds to pay for it while you’re still relatively young and in good health. It can easily pay for itself if you reside in the facility long enough and it certainly is better than paying the full amount every month.

Another form of financial assistance is Medicaid. This is a State program for people who fall below a certain income and resource limit. Each state has differing rules for eligibility and for the amount of financial assistance. If you feel you may qualify for Medicaid assistance, call your State’s Medicaid office and inquire or go online at to see if you would qualify for Medicare and Medicaid benefits.

Cost of Assisted Living

The costs for living in an assisted living facility can vary widely depending on some of the following factors.

1. Geographic location – some parts of the country may have higher rates and large cities tend to have higher rates than smaller towns or rural areas.

2. Semi private or private room. A private room will cost you more, especially if it comes with certain amenities such as a kitchenette, a balcony, or a patio.

3. The furnishings of an assisted living facility – some facilities may have luxurious accommodations while others will have very modest furnishings.

4. Services provided – some facilities will have a fixed monthly rate but will charge additionally for certain services such as outings, transportation, meals, medication administration and housekeeping services, .

5. The amount of care the resident requires- Most facilities charge a flat monthly rate while others will charge a monthly rate based on levels of care. Obviously, the higher the acuity of care required, the higher the rates.

Third Party Payers

A third party payer is an entity that pays the facility on your behalf such as long term care insurance or Medicaid. Long term care insurance can be a very valuable resource if you can afford the premiums. Most long term care insurance plans have very affordable rates and offer financial assistance when you need long term care services. I will cover long term care insurance on another page in this website. For more information, click on the Long Term Care Insurance button of this website.

Medicaid is also covered in other sections of this website, however, I will tell you that most assisted living facilities do not participate in the Medicaid program and will take only personal out-of-pocket payments or private insurance payments. Each state has different rules for how that state will cover through Medicaid. You need to ask the assisted living facility you are considering if they are Medicaid certified and will take Medicaid reimbursement.

Another option for you is to call your state’s Medicaid office and ask for a list of assisted living facilities in your area that are Medicaid certified and will take Medicaid reimbursement.

The past ten years have seen a dramatic increase in the number of states whose Medicaid programs provide financial assistance for residents of an assisted living facility. Forty-six states now provide some level of financial assistance and the trend is expected to continue until all 50 states and D.C. are included. 

Unfortunately, many facilities that do take Medicaid recipients will have a waiting list for any new admissions. In many cases, once you do get accepted for admission, you may have to pay for part of the expense of your monthly stay. This is a question that you will need to ask your state Medicaid case worker. They should be able to tell you what your portion of the cost will be, if any, or can direct you to the office that handles assisted living facilities.

I have purposely omitted any dollar figures because they can vary so widely according to what I just listed above. You will just need to call or visit each facility and ask about their rates. Most facilities will have an admissions representative or an administrator that will be eager to assist you with any questions you may have.

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