Assisted Living Overview

­About one in every 300 Americans lives in an assisted-living facility [source: Assisted Living Federation of America]. Assisted-living facilities are designed to help the infirm, disabled or elderly with tasks such as dressing or bathing while also helping that person maintain maximum personal independence and self-reliance. The facility is designed (and appropriately equipped) to help residents primarily with the daily challenges of living that many of us are able to take for granted: reading small medication labels, preparing and eating meals, and keeping up with housekeeping and laundry.

There seem to be about twice as many descriptive terms for assisted living facilities: "residential care," "retirement residences," "personal care," "enriched housing program" and "adult foster care," just to name a few. When looking for assisted living options, be sure that what's being described is what you're looking for. Often, these terms are somewhat interchangeable with other types of personal care, such as nursing homes.

Assisted-living homes aren't nursing homes -- just because your balance isn't what it used to be doesn't mean you're ready (or welcome) to receive bedside care and near-constant supervision. Assisted-living facilities don't provide around-the-clock care -- nursing homes do. But a person who no longer is fully able to take care of himself or herself (or be given a regular helping hand by a friend or relative) may be appalled at the thought of going into the "old folks' home." Assisted living also enables people who are in earlier stages of Alzheimer's or age-related dementia to receive care as needed, and not around the clock.

With more than 20,000 different assisted-living facilities in the United States, there is no universal "look" or design [source: Assisted Living Federation of America]. There could be on-site beauty salons and barbershops, horse stables, or swimming pools. Or, the facilities could have none of those amenities. However, they do share common caregiving features. So while one facility may have rooms that resemble those of the Chelsea Hotel and another facility has rooms that are actually large multi-roomed condominiums, both will offer services -- like laundry or meal preparation -- on a per-fee basis.

We'll discuss what type of care is provided through assisted living in the next section.

What type of care is provided at assisted living homes? All homes are different, as are individual needs and service contracts (which we'll talk more about later). Generally, assisted living arrangements involve help with the following:

Assisted living is not the right choice for everyone. Also, assisted living isn't generally made available to those who need special care outside of that which a facility can provide. The following are care options not provided or medical situations that don't qualify for assisted living care:

­When choosing an assisted-living facility for yourself or a loved one, it's important to know what to look for and what questions to ask when visiting different homes. As we've learned, assisted living comes in many different forms, and, like about everything else in life, some are better than others.

Some questions to ask yourself or your guide when visiting:

If you're considering a roommate so that you can cut costs (or simply for the camaraderie), check the size of the rooms and the design of the living arrangements. It'll be harder to get off on the right foot with your new roommate if you're constantly stepping on his or her toes.

Think about these matters before you start your search, and you'll be more likely to know you've found the right facility when you see it.

If you think haggling over the contract for a new car is stressful, imagine signing a contract that determines how much you'll pay for your loved one to receive specific caregiving services. You'll definitely want to go into the contract phase of entering assisted living with a clear idea of what you want and what you can expect.

Many assisted living residences are for-profit businesses, and even nonprofits need to delegate their resources carefully. What this means to you or your loved one is that every service requested on top of the basic package included in the base monthly housing payment will have a cost attached. Some facilities may include laundry and meals in the base rate, and others may not.

Contracts tend to fall into three categories:

There are typically three different ways to pay for assisted living care: Medicaid, long-term care insurance and out of pocket. Medicare won't cover the cost of care facilities unless the care is medically necessary. Usually, assisted living situations aren't medically necessary, in that the type of help provided in assisted-living situations is considered "custodial care."

Most facilities in the United States do accept Medicaid. Medicaid is government assistance for health costs that is available to limited-income or asset-depleted elderly Americans. Regulations for Medicaid's payment for assisted living vary from state to state, but more than 100,000 people receive Medicaid assistance toward the cost of assisted living [source: National Center for Assisted Living].

Those who don't qualify for Medicaid are in danger of outliving their resources (and eventually qualifying for Medicaid). Those who don't actually outlive their funds end up spending so much on their ongoing care later that they have little if any to bequeath to surviving family members, churches or charitable causes when they die.

Long-term care insurance works like other forms of insurance: You qualify for it, pay for it before you need it, and it pays for your needs when they arise. If you wait until your health is beginning to give way, you may find it is too late to qualify for this type of insurance. Insurers know how much long-term care costs can accumulate and won't put themselves on the line for a high-risk applicant. Of course, you don't want to get prematurely insured and pay years and years of premiums for a policy you may not ultimately even need. The premiums aren't cheap -- a retiree who applies for long-term care insurance at age 65 may pay as much as $3,000 a year on premiums [source: AARP]. Some premiums will increase according to inflation or a pre-arranged staggered payment schedule that increases after a set number of years. The upside is that this insurance kicks in before you need to move to a facility, as it oftentimes will cover at least part of the costs of adult day-care or home-based care in the form of visiting nurses.

The benefits (or payout) of long-term care insurance may be calculated on a per-day or per-month basis. Once that amount is reached in your care, additional costs won't be the responsibility of the insurer.

Veterans and military personnel should contact their nearest Veterans Affairs (VA) hospital to find out if free assisted living will be available to them at a VA facility.

Prior to being admitted by an assisted living facility, potential residents will be required to have a medical examination and other assessments. The physical exam will serve to establish that the applicant's needs can be met by the facility. People with serious health problems won't be admitted.

Additionally, people at the facility will assess the resident's ability for himself (or herself). This helps determine what services the resident may need and which ones are unnecessary. Behavioral screening may be provided to guarantee that extreme cognitive issues commonly associated with dementia, such as violent outbursts or confused wandering, aren't present.

While in care, residents may have regular checkups (how often this occurs varies state by state, and even within states). If these exams uncover new or advancing health issues, the resident may be required to leave and seek more advanced care elsewhere.

Residents must also frequently update their service contracts. This may occur once every three, six or 12 months, depending on the facility. If a physical exam reveals the resident will need a greater level of care, the contract must be reassessed to reflect the change in circumstances.

Assisted living care is rarely a permanent living situation. Most residents, as they age, will need higher levels of care. Many facilities are grouped together on a shared campus with nursing homes and independent retirement communities so the transition from one care provider to another will be as easy as possible.

These are known as continuing care retirement communities, or CCRCs. By grouping these facilities, residents are able to remain in the same location for the latter stages of life instead of moving from one part of town to another. CCRCs allow the retirement community resident to switch to a different level of care. Many CCRCs are maintained or operated by nonprofit organizations, such as religious groups.

Other times, a resident or the resident's family may run out of money to pay for care, requiring the resident to leave. When the decision isn't the patient's, state laws determine the amount of notice and method of notification needed to "evict" a resident. Typically, a 30-, 60- or 90-day notice must be given in writing, to both the resident and to the resident's family contact listed on the contract. If a resident becomes a danger to himself or others, the notification period of imminent eviction may be as short as three days.

Once a family or individual is satisfied that the right assisted-living arrangement is available, there are steps that must be taken to place a person in that facility's care.

For more articles on aging, try the links on the next page.