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Assisted living: the latest trend in senior housing.
Is it growing too quickly
without federal rules, standards, and regulations?
Assisted living is a relatively new housing concept. The United States began to adopt it in the 1980s, based on a Scandinavian model of senior housing and care. The concept quickly became popular because it offers older Americans an attractive mixture of independence and personal care.
Assisted living-complexes are home to 800,000 Americans whose average age is 84. Some of the 10,000-plus facilities in operation today (90 percent of which were built in the last decade) are stand-alone and some are part of continuing-care retirement communities that offer varying levels of help and medical supervision. They can best be described as a cross between an apartment and hotel, with services for semi-independent elderly and a nursing home for those who need more comprehensive assistance.
Most assisted living facilities include: 24-hour supervision, three meals a day in a group dining room, social and recreational activities, transportation, laundry and housekeeping services. Some also offer (for an extra charge) personal care services such as help with eating, bathing, dressing, and taking medicines. Nearly a quarter of assisted living facilities has special units for older American in the early stages of Alzheimers. According to AARP, many larger assisted living complexes offer such amenities as a library, café, beauty parlor, and chapel.
The continuing care model provides the most options, combining different kinds of care in a single setting. You can start out living independently, and when your needs become greater, you can switch to a nursing home located right on the property. This guaranteed care as you age comes at a high price. Continuing care residences usually require an entry fee as well as monthly fees from $1,500 to $5,000.
According to Consumer Reports Complete Guide to Health Services for Seniors, prices vary greatly, but on average cost $2,000 in monthly rent and fees. Rate increases can average five to seven percent annually.
The most commonly asked question is who pays for assisted living’s monthly rent and fees? Not Medicare, which only provides short-term acute care for the elderly. Ninety-five percent of residents must pay for these services out of their own pocket. Government payments have been extremely limited. Presently, thirty-seven states use the Medicaid home and community-based waiver programs to help finance some assisted-living services. Additionally, some long-term care insurance policies cover the cost of assisted living.
Assisted-living facilities are not substitutes for nursing homes. With the exception of more expensive continuing-care communities, about 36% of all residents eventually go to nursing homes because the assisted-living facility cannot accommodate their increasing needs. An additional 2% go to nursing homes because they have exhausted the means to pay for assisted living. Unfortunately, some seniors use the entire pool of their long-term care insurance proceeds on assisted living and have nothing left when the time comes for nursing home care.
While assisted-living facilities are very popular and have experienced phenomenal growth, they are not without serious problems. The main one is that, unlike nursing homes, the federal government does not regulate assisted-living communities; states do. The result: widely varying standards relating to such things as the number and training of staff, fire and safety regulations.
What you don’t know may hurt you. Most residents enter an assisted-living facility expecting to live there forever. But buried in the fine print, the contract they signed stipulates that physical or mental decline can be grounds for discharge. Facilities in many states can evict residents with little notice. Another unpleasant surprise for many assisted-living residents are hidden fees for things they thought were already paid for.
What should you look for when choosing an assisted living facility? The best guidelines I found came from The Consumer Consortium on Assisted Living:
- . Carefully assess your physical, financial, mental and life-style needs. Remember: assisted living is not for those who don’t like living and eating in a group setting.
- . Visit as many facilities as you can.
- . Narrow your choices down to two or three, return to these facilities and ask a lot of questions. Eat a meal there. Stop by several times, unannounced, near meal times, or early evening to see how the facility is managed at busy and low-staff times.
- . Ask to see the resident agreement. The contract should show fees, services provided, facility and resident responsibilities and much more.
- . Be sure to consult with an attorney, preferably an elder specialist, before signing anything.
- . Review the licensing or certification report.
- . Call the long-term ombudsman and find out if there are any complaints. To find a local ombudsman call 1-800 677-1116
For the latest and most complete information on assisted living,
I recommend Consumer Reports Complete Guide to Health Services for Seniors,
written by Trudy Lieberman and the Editors of Consumer Reports.
Other excellent sources for information on Assisted Living include:
American Association of Homes and Services for the Aging
(800) 5089422
www.aahsa.org
Assisted Living Federation of America
(703) 691-8100
www.alfa.org