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Learn how to review your loved onesí mental, physical, and environmental conditions to see if they can remain safely at home on their own.

Learn more about what long-term care insurance covers.

Assisted Living Facilities: Weighing the Options

As your loved one's health declines, his or her independence may follow. At this point, people will consider alternate living arrangements. Assisted living is aimed at helping residents remain as self-sufficient as possible with the assurance of assistance when it's needed. These residences usually provide a combination of housing, meals, personal care and support, social activities, 24-hour supervision, and in some residences, health-related services. Itís all conveniently gathered in a homelike setting.

There is no standard for assisted living residences, which vary in size, appearance, and the types of services they offer. Some residences provide only meals, basic housekeeping, and help with the activities of daily living (ADLs) such as bathing, dressing, and grooming. Others go beyond these services and furnish transportation and certain health services. Costs vary widely, and the monthly fee can change depending on the services provided.

An assisted living residence could be a small home with just a few people or a high-rise apartment-style building with hundreds of residents. Living areas could be a single room or a full apartment with a small kitchen, with prepared meals also served in a common dining area.

These residences offer a great choice for people who canít live on their own but do not need a nursing home. Older people have many different needs. As those needs change, assisted living facilities offer different levels of care at different costs. Clients who live in an assisted living residence associated with a nursing home may have easier access to additional services when needed.

If an assisted living residence sounds like the right choice, visit several to make the most informed decision.

An assisted living residence could be a small home with just a few people or a high-rise apartment-style building with hundreds of residents.

The FacilityóHow Does It Stack Up? Start by making a list of residences to visit. The following resources can help:

  • The state or local Area Agency on Aging (AAA)
  • The local yellow pages
  • The long-term care ombudsmanís office
  • The state licensing agency
  • Friends and neighbors
  • Retirement guides
  • The Assisted Living Federation of America (ALFA) provides lists of its member residences by each state. These are mostly for-profit residences. The lists do not include all residences in each state.
  • The American Association of Homes and Services for the Aging (AAHSA) provides lists of member residences by state. These are not-for-profit.
  • The Eldercare Locator helps you find the closest Area Agency on Aging (AAA) office and the state long-term care ombudsmanís office.

Assisted living residences are not defined or regulated by the federal government. Each state decides how theyíre licensed. Be sure to find out from the AAA or state health department how the state where you are searching handles this. Make sure all the residences on the list are appropriately licensedóif one of them isnít, cross it off and move on.

Check, too, with the state licensing agency and ombudsmanís office to see if there have been complaints filed against the facilities on the list. Donít assume that a state license assures quality care.

The Call Equipped with your list of residences to visit, make a telephone call to each. Think about whatís most important in a new home: location, size, and types of services, to name a few. Remember that the person you speak with will most likely be a marketing or sales representative whose job is to promote the residence.

If youíre still interested after getting all your questions answered, ask the staff person to send information: brochures, a price list, a map or floor plan, a copy of the residentsí rights and rules, and copies of all the documents that will need to be signed before admittance. This material includes, most importantly, the contract. Some residences refer to their contract as residency, occupancy, or admission agreements. Once you receive the materials, review them carefully and write down all the questions that come to mind.

The Visit Take these questions with you on your site visit. As you meet with staff and take a tour, pay close attention to how you feel and what is going on around you. Spend time with the staff and residents. Ask them what they like and dislike about the place. Make a second, unannounced visit on a weekend or in the evening. You may find out important information by dropping by unannounced.

The Contract It's showtime. After all the materials youíve collected and all the questions youíve asked, the contract remains the most important partóitís the legal document that states what arrangements you and the residence agree to, regardless of anything promised. The more specific the contract, the greater your legal protection. Compare information in the sales brochure with that in the contract, paying close attention to the fees, level of care, health care services, and discharge policies. Benefits that a residence promotes in a brochure should also appear in the contract. Make sure you understand what the contract says. Ask that any information not included about care, rights, costs, and services be added. Remember that a residence can promise anything in a brochure, but it is only bound legally by what ends up in the signed contract. A good residence would want a possible client to review the contract in advance. Never sign on the day you visit. Before making a decision about a residence, take the contract home and review it with family members. Then consider reviewing it with a financial adviser and a lawyer.

The Money Assisted living can be costly. About four out of five people pay for it from their own pockets. Medicare does not cover assisted living. While more states are starting to cover some services under Medicaid or other government programs, public payment is not common in the assisted living industry. State Medicaid agencies can provide information about eligibility and covered services. Before you seriously consider assisted living as an option for your loved one, decide whether you and your loved one can afford it long-term. Keep in mind that the cost will rise over time due to standard cost-of-living increases. Also, expect monthly price hikes for extra services as needs change.

Promotional materials for these residences commonly present fee information in general terms, so itís crucial that a contract detail all of your payment obligations.

See the article ďAssisted Living: What to AskĒ for nuts and bolts about what to ask on a site visit or when reviewing a contract.

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© 2003, 2004, 2007 AARP. Reprinting by permission only.

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