Assisted Living (AL)

Assisted living (AL) is a setting for older adults. Some centers also allow adults of any age who are living with disability. For example, AL may help with problems that affect a person's activities and movement or with problems that affect thinking (cognition). The goal of care is to maintain independence as much as possible for each resident. AL provides healthcare, housing, personal care services, social services, and 24-hour supervision. It’s focused on helping people with everyday activities such as dressing, showering, taking medicines, or eating. Assisted living generally has a lower level of care than a nursing home but more than independent senior living or a retirement community. ALs may have different levels of care based on a person’s needs and charge accordingly.

What services are provided at an AL?

Services provided in an AL may include:

• 24-hour supervision

• Onsite medical care

• Meals and snacks

• Management of medicine

• Help with hygiene and toileting

• Social activities

• Spiritual activities

• Exercise

• Laundry and cleaning services

• Transportation to medical appointments, shopping, and other activities

Some facilities offer a beauty salon, a café, and other services such as foot care clinics.

Rooms in ALs vary from semi-private rooms with a shared bath, to single rooms with a private bath, to larger apartment-style residences with kitchenettes. Bathrooms and bedrooms include handrails and emergency call devices. There is usually a large common dining room, and several common living areas with TVs, games, books, and puzzles. The facility may also include activity areas for exercise and crafts.

Who works in assisted living?

A variety of health professionals and other staff members work at the AL facility. They include:

• Nurses

• Certified nursing assistants (CNA)

• Med techs

• Activities director

• Maintenance and housekeeping staff

• Dietary and kitchen staff

Depending on the licensing requirements of the state, medicines can be handled by several different staff members including nurses, CNAs, and med techs.

An onsite administrator oversees the facility and the staff. A doctor (MD or DO) or a nurse practitioner (NP) oversees medical services, often in one or more facilities. They may be onsite, or visit the facility on certain days and be on-call on others.

Some ALs have onsite physical or occupational therapists. They may also have social workers, and other specialty care staff members. Hospice services may also be available. Other ALs may use outside vendors for these services as needed.

Questions to ask

As you and your loved ones consider assisted living, ask these questions:

• How many residents are in the facility?

• What types of units are available? Private rooms? Semi-private?

• Do the units have kitchenettes?

• Does each room have its own thermostat?

• Is there a memory care section?

• What happens if the person gets ill or their condition gets worse?

• What services are offered?

• How much does it cost to live there?

• Do they take Medicaid?

• Are there different levels of care? What are those levels and what is their cost?

• Are there laundry services?

• What is the staff-to-resident ratio?

• Are pets allowed?

• Is smoking allowed?

• Is this facility part of a chain?

During a visit, assess these things:

• Cleanliness

• Safety

• Mood of residents and staff

• Other services available and their cost (such as salon)

• Availability of food and snacks (ask to stay for a meal). Where do patients eat their meals? Can patients choose what they eat?

• Opportunities for socialization, and trips outside the facility including medical appointments

• Daily activity calendar

• Security. Are the doors locked? Are there fire sprinklers? Are there handrails?

Paying for your care

Health insurance including Medicare does not pay for assisted living. Most often, people pay for assisted living out of pocket. When that money runs out, you may be eligible for Medicaid if the facility accepts it. Some ALs don’t accept Medicaid. Other options include:

• Long-term care insurance

• Federal aid for former service members

To learn more

Eldercare Locator, 800-677-1116, www.eldercare.acl.gov. Eldercare Locator is a service of the U.S. Administration on Aging that helps connect you to services for older adults.