Consumers and Caregivers
State Licensing Agencies
National Ombudsman Resource Center – State Ombudsmen
State Information about
Assisted Living for Consumers
Frequently Asked Questions
What is assisted living?
How does assisted living differ from a skilled
care facility or a nursing home?
How can I identify a good assisted living facility?
What types of services are offered?
Who lives in assisted living residences?
What are the costs/fees?
Is assisted living covered by Medicare, other government
programs or private insurance?
What happens if I run out of money?
Do assisted living facilities serve younger people?
How is assisted living regulated?
What assisted living issues should I be aware of?
How do I choose an assisted living community that is right
for my loved one?
How can I compare different assisted living facilities to
find the right one for my loved one?
Is a facility contract (or sometimes called a Resident
Agreement) important to consider?
What is a service plan?
What is a long term care ombudsman?
Can someone help me take my medication?
Do I need an Advance Directive?
Will an assisted living community provide me with transportation
to my doctor, hairdresser, etc.?
What is assisted living?
Assisted living is a residential care option for individuals who typically
can no longer live independently. It provides or coordinates services to
meet residents’ individualized needs in ways that promote their independence
and reflect their personal choices.
There are over 26 designations that states use to refer to what is commonly
known as ‘assisted living’ and there is no single uniform definition
of assisted living. The following is the definition that CCAL and a large
number of national organizations support:
Assisted living is a state regulated and monitored residential long term
care option. Assisted living provides or coordinates oversight and services
to meet the residents’ individualized scheduled needs, based on the
residents’ assessment and service plans and their unscheduled needs
as they arise.
Service provisions must include but are not
limited to:
- 24-hour awake staff
- Provision and oversight of personal and supportive
services
- Health related services (e.g. medication management
services)
- Social services
- Recreational activities
- Meals
- Housekeeping and laundry
- Transportation
A resident has the right to make choices and receive
services in a manner that promotes dignity, autonomy, independence,
and quality of life. These services are disclosed and agreed to in the
contract between the provider and resident. Assisted living does not
generally provide ongoing, 24-hour skilled nursing care.
How does assisted living differ from a skilled care facility or a nursing
home?
Assisted living is designed to respond to the needs of individuals who need
assistance with activities of daily living such as bathing, dressing, and
grooming, but who do not need 24-hour skilled nursing care. Some states require
a nurse by regulation in an assisted living facility; others require round-the-clock
nurse availability; others do not require nursing staff at all. Because the
acuity needs of assisted living residents have increased over the past 10
years, CCAL recommends that a facility have a nurse on staff.
What does assisted living look like?
The adage “if you have seen one assisted living facility, you have
seen one assisted living facility” sums up the wide variability. There
is no one type of model or design. It could be a high-rise building housing
several hundred individuals, or it could be a small home with just a few.
Living accommodations can include a full size apartment or a single room.
In some facilities, services are limited to meal preparation, housekeeping,
medication reminders, and minimal assistance. In others, more intensive services,
including help with administering medications, on-site nurses, and regular
assistance with daily activities such as bathing and dressing are available.
How can I identify a good assisted living facility?
Regardless of the size or look of the facility, the foundation of a quality
assisted living residence lies in its philosophy, practices, administration,
and staff. You want to be sure that the administration’s philosophy
and practices are truly resident-centered. You also want to know that they
have well-trained, qualified direct care staff and have sufficient numbers
of them to meet residents’ promised and unscheduled or emergency needs.
The “feel” of the environment should be warm and inviting; with
administrators, staff, residents, and family members interacting in a caring,
respectful manner.
CCAL’s consumer publication “Choosing
an Assisted Living Facility: Considerations for Making the Right Decision” details
what to look for and what to ask when evaluating a facility.
What types of services are offered?
There is wide variability in the scope of services and care provided by
assisted living facilities. Many states set a threshold level of care need
beyond which individuals can no longer stay in assisted living. Facilities
can choose to provide any range of services up to this threshold. Some facilities,
for example, may choose to discharge a resident that becomes incontinent.
Research shows that the major reason people leave assisted living is to
receive a higher level of care. It is difficult to relocate, so you may want
to consider a facility that offers a high range of care and services to begin
with.
Who lives in assisted living residences?
There are approximately 1 million assisted living residents living in over
36,000 facilities nationwide. The majority of individuals move into assisted
living because of a significant change in health condition. Approximately
two-thirds of residents come to assisted living from home. The rest come
from hospitals, nursing homes, and other assisted living facilities.
What are the costs/fees?
Approximately 90% of individuals pay for assisted living out-of-pocket or
through other private funding. Monthly payments can range from $1,500 to
$6,000+ depending on geographic location, unit size and services provided.
Shared units, if available, generally cost less.
Is assisted living covered by Medicare, other government programs or private
insurance?
Medicare, the federal health insurance program for older individuals, does
not cover assisted living. Forty-one states currently use Medicaid waiver
monies for some low-income individuals to support assisted living expenses;
but the majority of assisted living is private pay.
Increasingly, long term care insurance policies include coverage for assisted
living. There have been some payment issues from insurance companies for
residents in states that do not have an appropriate assisted living licensing
process. Be sure to check the status of your state.
What happens if I run out of money?
As with any other consumer service, if you can not pay, then you can not
stay. A small percent of facilities (generally non-profit-based) offer funding
support if someone runs out of money, but this is not common.
Do assisted living facilities serve younger people?
The majority of assisted living facilities are serving elderly people who
can no longer live independently at home. However, some facilities do serve
younger residents with physical or neurological disabilities. Smaller, more
home-like facilities are often effective settings for younger people to develop
a sense of “community among peers” rather than the large facilities
that serve an older population. Regardless of the setting, facilities that
serve younger disabled residents should provide age-appropriate practices,
policies, and programs to reinforce residents’ sense of independence,
privacy, and control over their own lives. Staff must be trained to effectively
meet the specialized healthcare needs of these residents. The National Multiple
Sclerosis Society has created Guidelines and Recommendations for Quality
Care in Assisted Living that may serve as a useful resource for your initial
exploration (www.nmss.org).
How is assisted living regulated?
There are no federal regulations or uniform standards of operation for assisted
living. Each state develops their assisted living regulations separately
and differently. Some states began forming assisted living regulation as
facilities began operation in their state. Other states lagged in this effort
and only began addressing regulation in the past several years.
There is also great variability among states regarding the frequency of
facility inspections ranging from once a year to none. CCAL recommends that
states inspect assisted living facilities annually.
What assisted living issues should I be aware of?
The U.S. General Accounting Office’s recent report (April 2004), “Assisted
Living: Examples of State Efforts to Improve Consumer Protections,” identifies
the following as continuing concerns in assisted living:
-
Consumer information about the facility – need
for key information to assist consumers make informed decisions such
as staffing levels and qualifications, costs and potential cost increases,
and the circumstances that could lead to involuntary discharge from the
facility
-
Consumer assistance with complaints
against the provider – assisted
living residents and their families sometimes need help pursuing
a complaint against a provider, especially when faced with an involuntary
discharge. The general public typically is not aware of or knowledgeable
about long term care ombudsmen and what assistance they can provide
-
State regulation
of assisted living – unlike nursing homes which
are subject to federal regulations, assisted living facilities
are regulated by states individually. State oversight and accountability
vary widely.
How do I choose an assisted living community that is right for my loved
one?
The first step is to make an accurate and honest assessment
of what your loved one’s physical, financial, mental and lifestyle
needs are. If help is needed with this assessment, consider consulting a
private geriatric care manager. These are trained professionals in the field
of human services, experienced in assessment, and knowledgeable about assisted
living choices in the area where they practice. Their knowledge can be an
invaluable resource in helping make the right choice. Contact the National
Association of Professional Geriatric Care Managers (www.caremanager.org for referrals).
The next step is for you and your loved one to visit a number of these facilities.
Consider the proximity to those who will be visiting the most. The closer
the facility, the more likely that visits will be more frequent. Ask lots
of questions. Talk with residents about the facility. What do they like or
dislike? Talk with staff. Are they friendly and knowledgeable? Ask to eat
a meal there. Is the food good? Are there meal choices? Does the environment
feel like a “good fit” for meeting your loved one’s physical
and social-emotional needs; does it feel like a community of friends that
you’d like to visit often.
How can I compare different assisted living facilities to find the right
one for my loved one?
Some states require the use of “disclosure statements” for assisted
living facilities. These statements give consumers concise and consistent
information that makes it easier to compare across different assisted living
facilities regarding services, costs, policies, and reasons for discharge.
Click here for an example of the assisted living disclosure statement used
by the Texas Department of Aging and Disability Services.
If you are looking for an assisted living facility in Florida, check out
the Florida Affordable Assisted Living Find-A-Facility web site at faal.myflorida.com.
All facility search results are displayed in order of compatibility, based
on a formula that matches the user’s search criteria with the information
provided by the facility. The search results are intended to provide consumers
with a starting point in locating a suitable facility.
Is a facility contract (or sometimes called a Resident Agreement) important
to consider?
Yes, yes and yes. The contract is a legal document that states what services
and arrangements you and the facility have agreed to, regardless of anything
that was promoted and promised to you during tours, discussions and sales
pitches. You should ensure that key information about costs, rights, care
and services are detailed in the contract. CCAL recommends that prospective
residents have an attorney (preferably an elderlaw attorney) review the contract
before it is signed.
What is a service plan?
A resident service plan is a blueprint for their care that describes their
needs, likes and preferences and the specific manner in which this care will
be delivered. Prepared thoroughly and thoughtfully, the service plan can
help a resident achieve their highest level of function and quality of life.
A well-developed service plan uses an interdisciplinary approach and includes
the resident, the family if the resident wishes, the facility nurse and resident
service coordinator, and may also include the activity and dining directors.
Many states require that assisted living facilities prepare service plans
for each resident. Even if the state does not require it, a well run facility
will use them. CCAL recommends that service plans be reevaluated every six
months or anytime if there is a significant change in a resident’s
health status including a hospitalization.
What is a long term care ombudsman?
The federal government passed a law, the Olders American Act of 1978, that
mandates states have long term care ombudsmen for residents in long term
residential care including assisted living. These resident advocates are
authorized and required under this law to respond to complaints and concerns
made by or on behalf of long term care residents. Each state has a state
long term care ombudsman and other local ombudsmen throughout the state.
You can contact the Eldercare Locator number at (800) 677-1116 for the ombudsman
nearest you.
Can someone help me take my medication?
Many residents move into assisted living because they can no longer manage
their medications. A resident’s ability to self-administer is determined
during the admissions process. If a resident needs support, there are various
levels of medication management. Some states have strict guidelines that
require only a licensed nurse administer medications while other states allow
an unlicensed caregiver to administer medications if they have successfully
completed a state-approved course. Be sure to discuss what medication administration
services the facility provides and the fees involved before signing any contract
or resident agreement.
Do I need an Advance Directive?
The assisted living facility should disclose its policies about implementing
advance medical directives, including implementation of Do Not Resuscitate
order (DNRs) and other medical directives that require limitations on delivery
of medical services before you sign any contract or resident agreement.
Will an assisted living community provide me with transportation to my doctor,
hairdresser, etc.?
Typically, less than five percent (5%) of assisted living residents own
or drive a car. Thus, transportation is an important resident consideration.
As in all other areas of assisted living, transportation availability varies
by facility. Many lease or own their own vans. Others make arrangements with
community providers. Most facilities transport residents to recreational
outings that are part of the planned activity program. Some will transport
residents to doctors’ appointments, shopping, etc. Facilities also
vary about charging extra for this service. Facilities should disclose details
of their transportation services and charges to prospective residents in
the Resident Agreement.
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