Assisted living homes are a type of senior housing designed for older adults who need help with some activities of daily living (ADLs), such as dressing, bathing and meals, but who don’t require continuous medical care and monitoring.
Residents typically live in their own private rooms or apartments, with staff working on site for a blend of independent living, support and supervision.
Although people often use the term “nursing home” as a catchall phrase for all types of senior housing, there’s a distinct difference between assisted living and skilled nursing facilities.
Assisted living homes provide a greater level of independence than skilled nursing facilities, but they do not provide continuous onsite medical care or round-the-clock nurse monitoring.
|Assisted Living||Nursing Homes|
|Living Area||Apartments with private bathrooms and small kitchens.||Semi-private or private rooms with shared bathrooms.|
|Communal areas and outdoor space||Yes / Varies||Limited|
|ADLs assistance (help with dressing, bathing, eating, etc.)||Yes||Yes|
Registered nurse on site 24/7Specialist care available (physical and occupational therapy, speech therapy)
|Non-medical transportation||Yes||Limited / Varies|
|Medical transportation||Not covered||Covered|
|Cost||$3,750/month on average*||$7,148/month on average*|
|Payment options||- Medicaid (if eligible)
- Veteran’s benefits (if eligible)
- Personal funds (if required)
- Long-term care insurance (if you have it)
|- Medicare (if eligible)
- Medicaid (if eligible)
- Personal funds (if required)
- Long-term care insurance (if you have it)
Assisted living services vary from facility to facility, but generally include:
Assisted living care does not typically include 24/7 nursing supervision, ongoing medical care or specialist rehabilitative care, such as occupational, physical and speech therapy. It also doesn’t cover the cost of ambulance transportation to/from the hospital if required.
In 2018, the average cost of assisted living care in the United States was $3,750 per month*. However, costs differ greatly based on where you live, the facility you choose, and level of care required.
Some assisted living homes charge a one-time entrance fee, also known as a “community fee,” to reserve your place. These fees vary depending on the facility and the type of unit you’ve selected, but they’re usually close to the cost of one month’s rent. In the event that the resident is unable to move into the facility due to declining health, your entrance fee may be refundable.
Entrance fees are negotiable, with many facilities willing to waive the fee completely in order to secure you as a customer – This is especially true if you contact the facility directly, without using a referral or placement company that charges the facility thousands of dollars. For the best rates, always conact facilities directly.
There are three main pricing models used by assisted living facilities and adult family homes.
The all inclusive pricing model bundles all services into a single monthly fee, regardless of whether you use each service or not. Each facility defines “all inclusive” differently. Certain services, such as toileting and incontinence assistance, may be considered extra and charged separately. Other add-ons may include pet fees, cable/TV bills, and in-facility purchases, such as a haircut at the onsite barber shop.
The levels of care model has different price tiers based on the amount of care required. Prior to moving in, the facility assesses the resident to determine which level of care they’ll need. Residents who require very little care beyond room and board will fall under the lowest, least expensive tier. Those who require more care, including those with Alzheimer’s or dementia, will be placed in higher price tiers. Facilities routinely reevaluate the needs of residents to see if they need to move into a higher care level.
Under a fee for services or “a la carte” pricing model, residents pay a fixed monthly fee for rent and meals, with all other services charged separately. You pay for only for the services you use. Certain services may be charged at an hourly rate, while others may be based on a flat weekly or monthly rate.
People use the following methods, or most often a combination of the following methods, to pay for assisted living care.
In most states, financial assistance for assisted living care is available through Medicaid for people with limited income. However, the amount of funding provided and the eligibility requirements differ greatly from state to state. Coverage is typically provided through Medicaid waiver programs, and wait-lists are common. Some assisted living homes may require a Medicaid spend-down period where private pay is required for X number of months before Medicaid is accepted.
Many families can’t rely on government assistance to cover the cost of assisted living entirely. People cover the remaining costs through personal savings, retirement funds, and income, often through the sale of their home.
Certain insurance policies, such as long-term care insurance or whole life insurance with a long-term care rider, provide funds for assisted living. However, in order to be cost-effective, these plans are best purchased when young and healthy. Another option is to sell a life insurance plan in order to create a long-term benefit plan. Others may choose to “surrender” their life insurance plan for cash value in order to pay for assisted living care.
If a person moves into an assisted living home while their spouse remains living at home, they may be able to get a reverse mortgage to cover the cost of care. Another option is to apply for a Home Equity Line of Credit (HELOC), in which you borrow against the value of your house.
There are also loans designed specifically to cover short-term assisted living costs. These assisted living loans are primarily used by families who need immediate financial assistance while they wait for another funding source to become available (e.g. VA Aid and Attendance approval, funds from the sale of a home, etc.).
Veterans and their spouses who meet certain eligibility requirements can receive funding for assisted living care via the U.S. Department of Veteran Affairs Aid and Attendance Benefit.
Many states have their own, non-Medicaid programs designed to assist older adults with the cost of assisted living. Programs vary by state and are typically managed by the state’s Aging Services Division—visit the HHS.gov to view a directory of resources by state.
Make a checklist of your needs. Compare your list to the services and amenities offered at each facility. For example, are pets allowed? Is there a store in walking distance? Can I bring my own furniture?
Find assisted living options near you. When visiting your loved one in an assisted living home, it can be helpful to have a community that’s nearby your residence or on your commute. Sharing time with your loved one is invaluable and there are oftentimes many available options near you.
Avoid large online referral brokers. These companies receive thousands of dollars in referral fees in exchange for passing on your information. Instead search for assisted living homes near you and send care requests via Care Listings.
Visit the facilities multiple times. In addition to touring the facility, stop by for an unexpected visit to make sure it meets your standards even when they aren’t expecting you.
Speak to staff and residents. Talking to people who work and live at the facility is one of the best ways to get a feel for the place and determine whether it would be a good fit.
View state records and speak to your long-term care ombudsman. Some states allow you to view inspection reports and complaints online. You can also call your state’s long-term care ombudsman for advice on finding quality care and for help understanding the often-complex records.
Consider the costs and negotiate. Review the pricing models available at each facility and don’t be afraid to ask for a discount, especially if you are contacting facilities directly (without using a referral or placement service). Assisted living homes want your business and prices aren’t always set in stone.