For seniors who need extra care, yet want to maintain some degree of independence, assisted living has emerged as a popular option. Data suggests that about 800,000 older adults resided in assisted living facilities in 2024, and about half of these residents are 85 and older; these numbers have no doubt only increased over the last few years.
The ideal candidate for assisted living care is a senior who is in reasonably good health, yet who needs some help with so-called activities of daily living, often abbreviated ADLs. These ADLs include bathing, eating, dressing or moving from a bed to a chair. Assisted living facilities can vary widely in size, amenities, and range of care – not to mention cost.
Analyzing Modern Senior Housing Options
There are plenty of articles out there about choosing an assisted living facility, including this past Blog article. But today we’re taking a more “wide-angle” look at your assisted living options, guided by this NerdWallet article from late 2023 written by senior writer and certified financial planner Liz Weston.
Her point: there are several essential but often misunderstood facts you definitely need to know about assisted living. Her clear message is also a familiar one: it’s essential that you make your housing choices carefully. Otherwise, you might not receive the care you need – with potentially dire consequences.
The article may be a few years old, but the content is highly relevant, and the topic is extremely important to seniors and their families. We first brought you Weston’s insights on assisted living two years ago. Let’s revisit the article to review what Weston has to say.
Understanding the Reality of Assisted Living
For many seniors and their loved ones, assisted living is the logical answer when they can no longer safely live at home. Assisted living feels like the best of both worlds: residents live in their own independent rooms or apartments while receiving help with housekeeping, meals, and (often) personal care.
But Weston and the elder care experts she consulted warn us that “facilities can vary enormously, and people’s expectations about assisted living often clash with reality.” Here are some vital things to keep in mind, if you’re considering assisted living as an option for your next chapter.
Fact #1: Medicare Does Not Cover Assisted Living Costs
First, some important brass tacks: assisted living is not cheap, and Medicare does not pay for it. Weston explains, “Medicare does not pay for ‘custodial’ care, which is what assisted living facilities provide, including help with daily activities such as bathing, dressing, getting in and out of bed, and using the toilet.”
Because of this, according to AARP caregiving expert Amy Goyer, most people pay for assisted living out of pocket if they don’t have long-term care insurance. And the expense can add up rapidly.
The cost of assisted living nationally averaged $5,900 a month in 2024, according to numbers from long-term care insurer Genworth. At time of writing, it was $6,900-plus here in Washington State, home to Life Point Law and AgingOptions; numbers may have adjusted since. Goyer also adds that costs can range widely, based on the area and the services provided.
Fact #2: Most Facilities Lack Full-Time Medical Staff
Elder care expert Kate Granigan notes that assisted living is considered residential care, not medical care. This is an important distinction to consider as you age.
She says that some facilities do bring in doctors or other medical professionals to provide routine care, but most of the time the only medical professional on staff will be a nurse who will do assessments of people’s needs rather than hands-on care. That means there will likely be no medical provider on site for immediate response to your particular need.
“[Staff members] are not there to change bandages and to administer medical assistance,” Granigan adds.
Fact #3: Care Levels May Not Meet Individual Needs
Goyer reminds us that the key word in assisted living is “assisted.” While it’s true that facilities can provide some help at all hours of the day and night, they aren’t designed for people who need one-on-one, constant care.
“That’s the function of a nursing home,” Weston writes. “If someone requires medical care in addition to help with daily living, they would need a skilled nursing facility.”
While residents or their families sometimes expect help “on demand”, assisted living facilities aren’t staffed for that, according to Goyer. She adds, “They may wait half an hour for someone to help them go to the bathroom.”
Because of this staffing limitation, these facilities typically offer “tiers” of care, each tier being more expensive than the one below. Goyer explains that the first tier may include medication reminders and help getting in and out of the shower, while the next tiers offer increasing levels of hands-on care.
It’s important to ask what’s included in each tier, and what exactly bumps a resident up to the next level of need and cost. Granigan adds another important question to ask: whether private caregivers can be brought in, if the resident needs more care than the facility provides.
This is important, because not all facilities allow outside help, and this could signal that the resident must move to a nursing home if their needs increase.
Fact #4: Residents Can Be Required to Relocate
Few things can be harder on a frail senior than being forced to move, but it can definitely happen. Weston warns, “Scrutinize the admissions agreement — the legal contract that outlines the services, costs and other terms of admission — and ask questions about what can trigger an eviction.”
This is because assisted living facilities can kick people out for behavior problems, for requiring more care than the facility provides, or for inability to pay the bill, according to Jaclyn Flores, a consumer and policy advocate in California. She adds that facilities can also raise rates – with sufficient notice – and this is a very common practice.
“They’re increasing rates at an astronomical rate and people find themselves stranded because they can’t afford it anymore,” Flores says. Because of this, Flores recommends that prospective residents have a Plan B long before their savings are exhausted.
“Options might include moving to a less expensive facility or exploring public benefits such as the aid and attendance benefit available to veterans or Medicaid, the federal public health insurance program for people with low income and few assets,” Weston writes.
Fact #5: Finding Objective Advice Can Be Challenging
Weston tells us that AARP has a checklist for evaluating assisted living facilities, and advocacy groups such as California Advocates for Nursing Home Reform (CANHR) and Consumer Voice can provide additional information.
She adds, “If you’re looking for assisted living, you’ll likely come across online marketplaces, placement agencies and consultants who offer to help.” Goyer notes that you may get valuable information from these services, but the guidance “may not be objective or comprehensive”.
Facilities often pay these sources for referrals, so you may run afoul of someone simply out to earn a commission rather than truly interested in steering you in the right direction. Granigan advises seeking personalized advice from an aging-life-care professional, also known as a geriatric care manager.
These consultants are paid only by your fees. “For a cost that often ranges from $100 to $250 an hour, the pro — who is typically a nurse or social worker — can evaluate the aging person’s needs, recommend resources and help find appropriate facilities,” she says.
While finding the right facility for your needs can take time, a professional can make the process much easier, and can also recommend ways to keep your current home safer while you search. Weston concludes: “You can get referrals for an aging-life-care professional from the Aging Life Care Association.”
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