Assisted Living Facilities: Weighing the Pros and Cons of One of the Biggest Trends in Long-Term Care

Assisted living facilities are growing in popularity and for some, they offer a viable alternative to living alone or moving to a nursing home.

However, many older adults and their families have unanswered questions about when to consider this option such as – what are the pros and cons? And, what happens if/when the money to pay for an assisted living facility runs out?

Below is an excerpt of a reader’s question about assisted living facilities and my response on how to determine if such a place is right for your aging parent.


Dear Maria: My mother is 85 years old and lives alone in the two-level home I grew up in. She’s in relatively good health for her age, but she has lost weight fairly steadily since my father died two years ago.  Recently she expressed an interest in selling her house although we haven’t really talked about the reasons. I think she should consider one of those assisted living facilities as opposed to buying a smaller, one-level home, but maybe I’m not thinking about this the right way.  My main question is: What makes assisted living facilities better than just staying in your own home and hiring help through an agency? And what happens if she outlives her money? Since you don’t have any skin in the game, I’d appreciate any insights you can offer.

Bill, Tinton Falls, New Jersey

Dear Bill: Assisted living facilities have much to offer, but that doesn’t necessarily mean that this is the best move for your mom.  In your mother’s case I think there are four key questions to ask:

1) What’s not working about your mother’s current living environment from her perspective?

You said that your mother has expressed interest in selling her home and it’s important that you explore the reasons why.  A bi-level home can present unique physical challenges to an older adult.  What’s more, all homes (and particularly older homes) require a good deal of up-keep. Perhaps these are some things that are too much for your mother to manage at this stage of her life. If so, it may be worthwhile to look at some assisted living facilities with her.

2) What kind of assistance (if any) does your mother need on a daily or weekly basis and what might she need in the foreseeable future?

 

The best way to get at the answers here is to talk with your mother about her daily routine and/or hire a Geriatric Care Manager to perform an assessment of your mother and her home. I can tell you with a good deal of certainty that if she does not require a minimum of four hours of help, three or more days per week, then many home care agencies would not want to work with her. There is a fairly standard minimum in the world of home care and there’s not much wiggle room unless you hire someone whom you find on your own.

In addition to the help she may need now, it’s also important to consider her physical condition and what level of help she’s likely to need in the coming year(s). I say this because assisted living facilities charge extra for the one-to-one help of an aide; often they require a higher minimum number of hours too.  To get a sense of what the future may hold with regard to your mother’s physical condition, it wouldn’t hurt to speak with her physician particularly if she has one or more chronic conditions as these can affect her decline.

3) What kind of person is your mother – specifically, does she enjoy interacting with her peers?

 

Practically speaking, this may be the most important question of all because most assisted living facilities try to foster interaction among residents through a variety of outings and  activities. This sense of community is further reinforced by congregate meals.  If your mother likes to keep to herself, then chances are she will not like this element of assisted living facilities.  However, if she misses your father’s companionship – perhaps even lost weight because she has been eating alone – then exploring assisted living facilities may make the most sense. If an older adult lives alone, replicating this sense of community becomes more challenging.

4) What do her finances look like?

Contrary to what many people believe, assisted living facilities are not covered by Medicare and are not (in all but a few instances) covered under Medicaid.  Assisted living facilities are sometimes covered partially under a long term care policy though, so it’s important to check.

The Cost of Assisted Living

Most are paid for out-of-pocket by the resident or resident’s family and make no mistake – the cost of assisted living facilities vary greatly based upon location.  I would say that you can expect to pay a minimum of $3000 per month for an assisted living facility near a city and much more if it is actually in the city.  Again, this is just the base cost and all additional services would be extra.

Lastly, I want to address the important question you raise about what happens when an assisted living facility resident runs out of money.

For those who can’t afford Assisted Living Facilities

If the older adult cannot be cared for at home by family and the cost of private home care is also prohibitive, the often hard-to-swallow answer is that the older adult would need to obtain Medicaid and move to a nursing home.

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Do you have questions about the information shared here? If so, get in touch with me and let me answer them.  There is no fee and no spam! ;)  Also, since you’re looking for info about assisted living facilities, chances are good that you’re in the midst of planning care.  I’ve written quite a bit on this topic and hope you’ll check it out.

{ 2 comments… read them below or add one }

Maria December 30, 2013 at 6:40 AM

Hi Peg, This is a question best answered by an elder law attorney. I’ll see if I can get one to weigh in here.

Peg September 24, 2012 at 7:43 PM

Does a irrevocable trust that has been written up 5 years ago have to be included when applying for Medicaid. It states that the money may under no circumstances be used for her care.

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