Assisted Living: A Guide to Decision Making

Arete Rehab is redefining successful aging.

Arete Rehab is redefining successful aging.

What is Assisted Living?

Assisted living, also called residential care, is a type of living arrangement in which personal care services such as housekeeping, meals, transportation and assistance with activities of daily living are available. An important aspect of assisted living is to provide security, comfort, meaningful activities and dignity for residents.

Assisted living communities are designed to provide residents with assistance for basic Activities of Daily Living (ADLs) such as dressing, grooming/hygiene, bathing and toileting. In some states, assisted living is allowed to offer medication assistance and/or reminders. The communities are staffed with nurses and nursing assistants. Assisted living, however, is not set up to provide complex medical care.

The definition of assisted living and the name in licensing regulations vary from state to state. Regulations to govern these facilities are not uniform and allowable services also vary from each state. Assisted living services allowed in one state may only be available in a nursing home in another state. The differences in licensing are based on the size of the facility or the services it can offer.

Different states use different titles for assisted living facilities. The following are examples of the title that states use for assisted living:

  • Residential care

  • Personal care

  • Adult congregate living

  • Board and care

  • Adult living facilities/Supported care

  • Enhanced care

  • Adult homes

  • Sheltered housing

  • Retirement residences

  • Adult foster care

  • Community based retirement facilities

For example, residential or board and care is usually a converted home or a small facility with three to ten beds where the caregiver is the homeowner or single proprietor with little or no support staff.

These facilities are typically not allowed to offer much care beyond dressing, bathing, providing meals or assisting residents with mobility. Some of these homes may contract with home health agencies, visiting doctors or nurses to provide care. The cost for board and care homes is typically much less than those with large, new apartment-style assisted living facilities.

Filling the Gap

Assisted living fills a gap between home care and nursing homes. Before the creation of assisted living facilities, a person needing professional care went to a nursing home even though the individual did not require the intensive care provided.

The alternative of assisted living provides a more homelike environment for those individuals needing or anticipating assistance with activities of daily living or instrumental activities of daily living (housekeeping, laundry, meal preparation, medication management) but for which 24-hour nursing care is not a necessity. Assisted living costs approximately 60% of the cost of a nursing home.

Physical and Environmental Designs

Assisted living communities range from a stand-alone residence to being one level of care in a continuing care retirement community (CCRC). The physical environment can be similar to a more home-like environment or with apartment styles that include studio, semi-private (shared), and one-two bedroom models.

Kitchenettes usually include a sink, refrigerator and microwave for light meal preparation and snacks. The bathrooms in both studio and bedroom models are private and accessible for those with mobility limitations.

Assisted Living Amenities

Assisted living communities offer many of the following amenities:

  • Gyms/Exercise classes

  • Social/recreational activities and events

  • Transportation to medical appointments and shopping

  • Community outings

  • Beauty salons

  • Pools 

  • Light housekeeping and laundry

  • Libraries

  • Gardens/gardening

  • Current event discussions

  • Movies

  • Dining with 3 meals per day

  • Mail delivery

  • Guest apartment


Pets can be important companions for many seniors. On the other hand, some individuals have allergies or are not fond of pets. It is recommended to check the pet policy and associated fees when investigating assisted living communities.


The cost of assisted living will depend on four major factors:

  • Geographic location

  • Size of accommodation

  • Level of care required 

  • Additional amenity and service fees

The most expensive states are: District of Columbia, Delaware, New Jersey, Alaska and Connecticut. The least expensive states are: Missouri, Georgia, North Carolina, Utah and Louisiana. The estimated median monthly rate is $3,600. It is predicted by industry analyst that a 4.28% annual increase is expected for assisted living facilities.

A refundable deposit fee is required to secure an apartment within a 2-week period. A one -time community fee covers maintenance and repairs. Additional fees include pets, transportation, and guest meals.

The costs of assisted living are NOT covered by Medicare; however, in some states assisted living will accept Medicaid. Long term care insurance can cover assisted living depending on the type of policy. Veterans can apply for benefits that cover a portion of the costs. The remaining costs are covered by individual savings, proceeds from home sales, stocks and social security.


Many assisted living communities allow residents to age in place. Several communities have care available on site, and if they do not, they contract with local healthcare providers to allow a resident to remain at the community as his or her level of care increases. The care is paid for on top of the monthly rent and varies depending on the amount of care required.

Many assisted living facilities contract with rehabilitation services to provide occupational, physical and speech therapy on site. The assisted living staff can alert the therapy team regarding residents’ functional decline, recent falls and recent hospitalizations.

A common and growing trend is for care providers to integrate care systems in one complex or in close proximity to each other. For example, a nursing home may have an assisted living wing along with an adult day center and an in-house home health agency. These could be in the same building or in a building on a common campus.

Is this the Right Fit?

In making the decision as to whether assisted living is the right fit, the following are questions to consider:

  • Have you experienced a slight decline in health and need assistance with one or more activities of daily living?

  • Do you need assistance with medication management and home management tasks?

  • Would you enjoy living in a community of peers?

  • Can you abide by the facility’s regulations and policies?

  • Would you enjoy relinquishing the responsibilities and expenses of home ownership?

  • Can you afford the costs of this type of living?

  • If more care is needed, can you afford the cost of these services?

  • Would you prefer the additional security and assistance available by these communities?

  • Can you make the transition from living in your own home with familiar surroundings and routines with decades of memories to a smaller and unfamiliar space?

How to Choose an Assisted Living Residence

With the proliferation of assisted living communities, selecting the right one can feel daunting and overwhelming. Furthermore, wait lists can be months long; therefore, the pressure to find a community is intensified.

The following guide can help make this daunting process easier:

  • Atmosphere: Is the décor welcoming and homelike? Do the current residents appear to be compatible with your interests? Will the particular personality and culture of that setting support your (or your loved ones) physical, mental, emotional and spiritual needs?

  • Physical Features: Upscale might be aesthetically pleasing; however, ease of movement and comfort is vital. Are the doorways wide enough for wheelchair/walker access? Are the bathrooms large enough for maneuvering a walker/wheelchair? Are the hallways too long without railings or poorly lit for those with low vision? Are there walk-in showers with seats, grab bars and hand held showers?

  • Contracts, Costs, and Finances: Understanding future costs for increased level of care and services if cognitive and physical function decline, and a written care plan that addresses the resident’s needs and updated as needs change.

  • Education and Health Care: Understand specific policies regarding medication management and any medical emergency that will arise. Is a licensed or registered nurse available in a full time capacity? Will blood pressure be monitored and recorded on a frequent basis if hypertension exists. Does a staff person arrange for visits from physical, occupational or speech therapy?

  • Services: Be specific about the type and amount of assistance required and what is available for activities of daily living and ease and availability for transportation to shopping and medical appointments and associated costs.

  • Social/Recreational Activities: Is there a diverse program of planned activities within the residence and the community? Do residents have a voice in planning activities both within and outside the residence? Does the choice of activities reflect the interests and lifestyle of the residents in meaningful ways? Do the activities encompass physical, mental, social, emotional and spiritual development?

  • Food Service: What is the ambience in which the food is served? Are the acoustics conducive to conversation in a noisy environment if there is hearing loss? Is there a choice of an entrée and dessert? What is the quality of the food and the variety served? Are the meals prepared in accordance with special diets? Can meals be served in the residents’ rooms if they are ill? Can the residents provide feedback about the menu selection? Can alcohol be served if a resident requests it? Is there flexibility about the times meals are served for late sleepers, and early dinner eaters?

  • Location: Is the residence close to family and medical providers? Is the residence located in a familiar community/neighborhood close to shopping? What are the noise level from nearby traffic and the view from the facility?

Although there may be urgency in selecting assisted living, it is imperative that the prospective resident can feel physically and emotionally cared for and safe in their new environment. Many older adults who are living independently, but struggling each day with physical, sensory or cognitive disabilities are isolated and scared. Moving into the appropriate assisted living residence can alleviate the daily struggle to function, and joyfully engage in life again.

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