Assisted Living — How to Find the Right Facility
Most older adults don’t need continuous skilled nursing care. But, many do need help with various activities of daily living, including bathing and dressing — sometimes even reminders to eat. They, including many people with early-stage Alzheimer’s disease, can benefit substantially from assisted living, many of which are part of continuing care retirement communities.
Assisted living facilities vary greatly in their services and philosophy of care. As a result, it is important to find the right facility for your loved one. It will have a profound impact on their dignity, quality of life and sense of well-being.
Assisted living facilities vary widely in size, from a few residents to hundreds. They typically offer private rooms or small apartments, common areas for socializing and recreation, planned activities, 24-hour staffing and controlled access.
Most assisted living facilities offer personalized care and support services, including meals served in a common dining area or taken to a resident’s room, shuttles for errands and appointments, housekeeping, help with medication management and emergency call monitoring. They also offer some resident supervision.
Step One — Determine what your loved one can afford
Many older adults who need help with their activities of daily living will never have to go to nursing homes — if they can afford assisted living. Unfortunately, Medicare pays nothing for assisted living, and Medicaid pays very little, although that’s gradually changing in some states. Instead, virtually all expenses must be paid out-of-pocket by residents and/or their families.
The good news is assisted living is not as expensive as it first seems. Instead, to an extent that varies from person to person, it simply involves a shift of expenses from one living arrangement to another.
After someone’s capabilities decline to the point where they need assistance, their move into a facility is usually permanent. When their former home is sold, most of the expenses associated with it can then be used to help pay facility-based expenses. And, the money from the sale of their home can be used, for example, to purchase a CD or annuity that pays monthly interest to boost income.
Also, since a facility’s fees usually include all meals, no groceries are needed, thereby freeing up even more money. To help you evaluate your loved one’s financial situation, we’ve included a worksheet, Worksheet: Assisted Living Expenses — Finding the Money to Pay for Care.
The worksheet assumes no assets are spent down — that they’ll remain intact with the interest/dividends they produce used to supplement your loved one’s income. But, if your loved one is short on funds, some or all of their assets will have to be spent down. That is, the principal value will have to be converted into a stream of monthly income payments.
However, several factors need to be kept in mind …
- Your loved one’s income needs will increase from month-to-month due to inflation. The cost of long-term care has been increasing 4.5% per year, faster than inflation in general.
- You need to decide how many years the income should last (the longer the period, the lower the income). Some people might use remaining life expectancy in a retirement calculator to estimate monthly payouts, but that would be a mistake. By definition, life expectancy is an average for all people; therefore, half of us will live longer than our life expectancy.Instead, you want to be as certain as possible, without overdoing it, that your loved one won’t outlive their income. To accomplish that, we recommend you select a payout period based on a 90% probability that they won’t. The following pull-down menus, based on the current age of your loved one, show our recommended payout periods1 for ages 65 through 90.
- Work with a trusted financial advisor to assist you in converting each financial asset into a stream of monthly payments.
Step Two — Determine your loved one’s needs
The types of care available varies widely from one assisted living facility to another. To be certain that a facility can provide the care necessary for your loved one, first determine what your loved one’s needs truly are (they may be different than you think). Use our checklist How to Tell if Your Elderly Loved One Needs Help.
When you compare assisted living facilities, some factors matter more than others. No perfect facility exists. Finding one that meets your loved one’s needs is Goal Number 1. But don’t underestimate Goal Number 2, that is, getting the facility to accept your loved one. When you tour a facility and interview its staff, be thorough, clear and professional. Show them that you’re part of the solution and will work closely with them to achieve the best care possible for the new member of their community.
Be ready to:
- Explain the type of care your loved one needs. Ask the facility to describe how it will meet those needs, for example, assistance with dressing, taking medications, incontinence, or general supervision. An assisted living facility should provide enough care and support to meet your loved one’s needs while encouraging and allowing them to remain as independent as possible. And, don’t forget that your loved one may need more care as time passes; ask questions that don’t apply now, but may in the future.
- Visit several facilities; services and fees will vary greatly. Our checklist will help you compare facilities and organize your impressions of different homes.
Step Three — Select a general location
After you’ve determined how much your loved one can afford to pay for assisted living, select the city or region where their facility should be. (Many assisted living facilities are part of retirement communities that offer a wide variety of living arrangements from completely independent living to 24-hour skilled nursing care.)
Be sure to include your loved one in the selection process. After all, it is their future home you are selecting. The goal of assisted living is to allow the person to retain as much independence as circumstances permit. And, it is your role as a caregiver to help them maintain as much control over their lives as feasible, not take it away. This includes allowing them to make their own decisions whenever possible. And, be prepared to accept the fact that your loved one may have strong preferences about where they want to live even though their choice may not be the one you would prefer.
Step Four — Go
Make an appointment for a tour. Ask to see more than the public areas. Visit several residents’ rooms. Ask if both you and your loved one can join the residents for lunch or dinner. And, if possible, stroll through the facility on your own. This will allow you to experience it without an official interpretation. Talk to the residents; ask them what they like most — and what they feel could be improved.
Take a deep breath and clear your mind. You’re ready. Here’s our Assisted Living Checklist. (Take a blank checklist with you for each facility you visit.)
1Based on United States Life Tables, 2010, National Vital Statistics Reports, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Volume 63, Number 7, November 4, 2014.