Assisted-Living Options and Added Services
Assisted living is an intermediate step between independent living and skilled nursing care. Residents typically require some personal or custodial care, but limited or no medical care. They cannot be permanently bed-bound or require extensive medical care. In some instances, assisted-living facilities can apply for a waiver from state licensing agencies to allow hospice to provide end-of-life care to a resident who arranges for a private primary caregiver.
Assisted-living facilities currently house about 1 million Americans. They typically house 25–150 residents in small, one-room studios or one-bedroom efficiency apartments or units with scaled down kitchens. They provide communal meals three times a day. In some facilities, these meals are served restaurant style, with menus and salad bars. Others are cafeteria style or sit-down, with a fixed menu with variations to accommodate special nutritional needs. Most will provide meals to the resident's room, but not for long periods of time. Residents have to be able to get to the central dining area with or without assistance.
Assisted-living facilities provide twenty-four-hour supervision; assistance with personal care such as bathing, grooming, dressing, and eating; some assistance to and from the dining room or to and from transportation; and minor medical care such as assistance with medications. They also provide housekeeping and laundry services; transportation services to local shopping, medical centers, adult day care and senior centers; and some social engagements such as theater outings.
All of these services are usually included in the monthly fees, but some facilities charge extra for anything beyond twenty-four-hour supervision and meal services. Be sure to discuss services and fees up front and get it all in writing. If ownership or management changes, you may need to renegotiate.
For additional fees, some facilities can provide personal supervision and assistance to residents in their rooms on an hourly or shift basis. Most assisted-living facilities charge extra for those who need special supervision such as Alzheimer's patients who require a locked unit to avoid wandering. Most also charge extra for diapering and toileting services. For Alzheimer's residents, these toileting/incontinence fees are usually included.
Some facilities have a nurse on duty to assist with taking pulses and blood pressures and addressing first-aid issues, but assisted-living facilities aren't licensed to provide medical care to residents. As with the board-and-care homes, home-health agencies can provide intermittent nursing or therapy to assisted-living residents.
Assisted-living facilities usually have community cultural, social, and educational activities and may provide health and exercise programs. Some of these may be at additional costs.
Typical costs for assisted-living facilities range $850–$4,000 per month depending upon the location, amenities, and services. These fees are usually out-of-pocket expenses, but there may be some government assistance to those who qualify for SSI.
