Are you wondering if Assisted Living is the right choice for you or your parent? You're not alone. You're part of an Eldercare market growing at a rate of 6.4% and approaching 300 billion dollars annually. Marketing directors at Assisted Living facilities paint a pretty picture of community services and amenities. In response, provided the cost is affordable, the decision to buy or rent in an Assisted Living Community is often made emotionally. Is it time for me or my parent to move? Do my parent and/or I feel comfortable in that community? Will I or my parent adapt to the space? These are important questions to answer but don't stop there. Probe deeper to evaluate the potential long term costs, staff's ability to support increasing needs, and the facility's organizational stability.

It's important to know that Assisted Living is not governed Federally like Nursing Homes. Even the definition of an Assisted Living facility will vary state to state. There is no set standard. Each State enacts it's own oversights and protective laws. What quality, cost, and stability can you expect? It differs in most facilities. As you evaluate options your questions and observations are critical. What services, rights, and prices can you expect? It's up to you to find out.

Assisted Living is staffed by people who care deeply but their checks are paid by owners competing in a fast growing real estate investment environment turning high profits. Subsequently, resident's lives are impacted by both internal and external events. Here are some assessment questions to help you explore prospective Assisted Living facilities:

  • What is the ratio between staff and residents?
  • Do residents have a voice in governance?
  • What would cause this facility to ask a resident to leave?
  • Is there a limit to rent increases?
  • Is management or ownership consistent? Who owns it?
  • Has this facility changed its name in the past three years?
  • How does the facility rate in the most recent state inspection?
  • What rights can residents expect with regard to privacy and lifestyle?
  • How quickly do staff respond to calls for help?
  • Are there emergency plans in place?
  • What programs and amenities are offered?
  • Are there extra fees for any services? Room service?

Answers and reactions to these questions reveal facility philosophy, quality of care, degree of resident empowerment, and organizational continuity.

Most Assisted Living facilities provide: meal preparation, housekeeping, medications, hygiene, dressing. Some support escort to and from events or meals. Some provide transfer assistance and abbreviated nursing care. Limits to care may impact the ability to continue to live in that facility. Many marketers will state that the facility provides support for residents  and promotes aging in place but press further and you may find constraints. Maybe the facility can't support two person transfers, 24 hour observation, diabetic needs, nighttime emergencies, colostomy maintenance or progressed dementia care. Private caregivers could fill the gap but not all living facilities allow private healthcare workers. Some have burdensome requirements like proof of malpractice insurance that bar their entry.

  • How much training is required for facility staff?
  • Is a nurse on duty? How often?
  • Has staff undergone memory care training?
  • What policy governs outside healthcare workers such as private caregivers or visiting nurses?
  • How will medication be handled? Can residents choose their pharmacy?

These questions will clarify the potential healthcare fit for you or your parent's long term needs.

Questions help to evaluate levels of care and continuity in Assisted Living but pricing is harder to anticipate. The cost of buy-in or monthly rental is published. However, most facilities attach an additional deposit or move-in cost in the thousands which is often non-refundable. In 2012, according to Met Life, the average cost of an assisted living apartment was $3500 excluding move-in deposits or living assistance. It's reasonable to expect a cost somewhere between $2500 and $7500 in monthly apartment rent depending on space and location. Mandatory, recurring add-on living assistance costs are determined initially during a move-in evaluation and usually reassessed periodically. There may be three or four levels of assistance available which will drive total cost 25 to 100% above the basic rent. In addition, care limitations or facility determinations may require outside or inside health care workers for temporary or permanent supervision or 24 hour care. The add on price of living assistance is the hidden cost in Assisted Living.

Equally important to your decision is the social fit. In the blog, "8 Assisted Living Search Mistakes to Avoid," author Jeff Anderson cautions buyers if the apartment is not for you...choose surroundings suited to your loved one and not yourself. He relays the cautionary story of A Place For Mom spokesperson, Joan Lunden, who moved her mother into a beautiful facility only to realize later that, though it appealed to her, it was too big and intimidating for her mother's condition. Every community is different and every individual carries unique needs. Your role is to help locate the best fit.

Blogger Paula Spencer Scott profiles the personalities that generally adapt well to assisted living and those who are challenged by the setting. In my caregiving observation, people who are socially adept, involved in the search, in favor of the move, and still mobile generally make the most successful transitions. Occasionally the emotional challenge of a move causes a decline in well-being. It can be temporary but in cases of dementia the loss in familiar grounding and the stress of transition can cause a permanent advance in the condition. Know that you've made the best choice you could and realize that there are always unexpected variables that impact outcomes.

Assisted Living is a good fit for many people but its not the right fit for everyone. Total cost, care limitations, social fit, individual personality, and managerial/organizational continuity are key factors informing your decision. If you're evaluating assisted living for yourself or your loved one you're already facing difficult choices and ongoing changes. Take breaks, practice self care, and utilize resources. By comparing several assisted living facilities, asking questions, and evaluating answers, you're doing the best you can to ensure that a good choice is made. Take a minute to celebrate that success then draw a deep, steadying breath before you plunge into the changes to come.

Update August 2015- Considering Assisted Living? This important article describes the difficulty in accessing Assisted Living when you wait until there's a crisis. It's not like renting an apartment there is a much larger process involved and waiting until a crisis hits may complicate the ability to access Assisted Living.