To begin, assisted living is a type of residential living for persons who can no longer live independently in their homes, but do not require a level of care as great as provided in nursing homes. In addition to room and board, assistance with daily living activities (personal care assistance, light housecleaning, and homemaker tasks), supervision, activities (social, educational, and recreational), limited medical services, and transportation assistance may be provided.
When considering assisted living facilities, it is important to be aware that there are both non-profit and for-profit facilities. While both types of assisted living residences charge residents a monthly fee, there are several distinct differences between the two types of residences.
Non-profit assisted living residences are run by “non-profit” organizations, or charitable groups, many of which are faith-based, and some of which are city- or state-run. Commonly, non-profit facilities have a mission statement, which states their purpose, values, and direction. While admittance to a non-profit assisted living residence is not tied to involvement with the group that is running it, activities associated with the group and their mission statement are common. For instance, a residence run by a religious group will most likely offer activities that are religious based, such as mass or church services, confessionals, bible studies, and prayer groups.
Stated very clearly, non-profit assisted living facilities are not run to generate a profit. Rather, any money left over after paying all expenses is reinvested into the residence, or stated differently, stays in-house to meet the needs of the residents.
On the other hand, the end goal of for-profit assisted living residences is to make money. For-profit residences are often run by individuals and private companies, including chains, both regionally and nationally. Often times, there are investors to whom these residences must answer. At the time of this writing, the majority of assisted living residences are for-profit. In fact, they account for approximately 80% of assisted living residences.
Generally speaking, non-profit assisted living residences are usually smaller than for-profit facilities. This is partially because with for-profit residences, the more residents, the greater financial return. That being said, there are some advantages to smaller assisted living residences. The fewer the residents, the greater opportunity to develop deeper, more meaningful relationships with the staff and other residents. Also, smaller residences can equate to a better staff to resident ratio.
Essentially, there may be fewer residents and more staff at non-profit communities, which means each resident may get more individual care attention than in for-profit residences.
While staff to resident ratio was touched on above in regards to the size of the residence, the number of staff may be unrelated to the size of the facility. Since the goal of for-profit residences is to generate money, and the higher the level of expenses, the lower the bottom line, for-profits may keep their staff to the bare minimum.
On the other hand, non-profit assisted living residences are not concerned with the bottom line and reinvest the profits into the facility. This means non-profit residences may have a higher staff to resident ratio, which leads some people to believe the level of care provided is greater. However, it cannot be assumed that the level of care is always greater in non-profit assisted living. There are both non-profit and for-profit residences that offer superb care.
Of course, the differences mentioned above should be considered when deciding between the two types of assisted living residences, but there are also a lot of other considerations. When choosing between a for-profit and non-profit assisted living facility, it is very important to do your research, including visiting the facilities.
It is very important that an assisted living resident feels comfortable in his / her new living environment. When visiting the residence, consider if there is a warm and inviting ambiance. Are the staff friendly and caring? Do they seem rushed? Are the other residents receptive to new residents? Will it be easy to make new friends? Will the potential resident feel like he / she belongs there? If the facility has a mission statement, it is also important to consider if the potential resident is in agreement with it.
Determine how many staff are on duty at any given time (day and night) and what roles they serve. For example, how many of the staff provide direct-care, and are there registered nurses available on-site? Another consideration is if there are replacement staff members in the event an employee is sick or cannot make their shift. Also, what is the average length of employment for persons employed at the facility? Is there a high turnover rate?
Cost is a big factor when considering assisted living residences. The average monthly cost depends on the state, and even the geographic region within the state. That being said, Genworth’s 2018 Cost of Care Survey indicates that the nationwide average cost is $4,000 / month.
When considering the cost, make sure to ask the facility what activities and services are included in this price. For example, persons who require a higher level of care due to Alzheimer’s or dementia may need to reside in a memory care unit, which has an additional cost above and beyond traditional assisted living.
There are a number of questions that should be asked, such as:
One should also consider the amenities, which may include the following:
Please keep in mind, some of these amenities may include an extra fee, and all amenities will not be available in every assisted living residence.
Fortunately, there is funding available to help with the cost of assisted living. However, the sources will vary based on the circumstances, the state, and the assisted living residence. For instance, most assistance programs are needs based, which means an applicant must have a financial need, in addition to a functional need. In addition, not all assisted living residences accept all types of financial aid.
One source of assistance may be the non-profit assisted living residence itself. Since non-profit facilities are often charity-based, money may be set aside for resident financial assistance. Therefore, when considering facilities, ask if funding is available for this purpose.
Medicaid, a state and federal program for low-income persons, is one source of funding for assisted living. Each state has the freedom to run its Medicaid program within the federally established parameters, so the available programs and eligibility requirements are not consistent across the states.
To be clear, Medicaid will cover the cost of care services and supports in assisted living facilities, but not room and board. This is often done through Home and Community Based Services (HCBS) Medicaid Waivers. These waivers are not entitlement programs, which means program participation is limited, and there may be a waitlist to receive services.
In addition, some states will cover personal care assistance in assisted living residences via their regular state Medicaid plan. State plan programs are an entitlement, which means that meeting the eligibility requirements ensures one will receive services, and there is never a waitlist. Not all assisted living facilities accept Medicaid, so this is another important consideration when choosing a facility. There are several Medicaid-funded options for financial assistance for assisted living. Click here for a list of available programs and eligibility requirements.
There are also non-Medicaid state-funded programs that will help cover the cost of assisted living. While some provide care services, others will help with the cost of room and board. Click here to find programs by state.
For veterans and their surviving spouses, there is the Aid & Attendance (A&A) pension, which is an added monthly cash benefit to the basic VA pension. A&A helps eligible persons who require assistance with their activities of daily living to pay for long-term care, which includes assisted living. To learn more about this pension, including eligibility requirements, click here.
Long term care insurance is insurance that is specifically intended to help pay for long term care. While it helps to cover many types of long term care, including home care services, home modifications, adult day care, nursing home care, and hospice care, it also helps to cover the cost of assisted living and Alzheimer’s care units. While this type of insurance is pricey, compared to the monthly cost of assisted living, it can save a lot of money in the long run.
There are a number of ways in which persons can find assisted living residences (both non-profit and for-profit) in the area in which they reside. Persons can contact their local Area Agency on Aging (AAA) office, their local Long-Term Care Ombudsmen Program, look on the National Center for Assisted Living website, ask friends and family for referrals, and search online by state, city, and surrounding areas.