Don't Wait to Check Out Assisted Living
Consider timing, type of facility and costs when choosing a long-term care option.
Late last summer, William Senior, of Reston, Va., put down $2,000 to get on a waitlist for a two-bedroom assisted-living apartment at a nearby continuing-care community for himself and his wife. His children had urged their parents to move into assisted living, a step between independent living and nursing-home care, ever since their mother, Lorraine, 85, began requiring consistent home care in January 2015 for back issues that limited her mobility. After waiting nearly a year and twice getting bumped from the top of the waitlist by current independent-living residents in need of assisted-living care, Lorraine fell on Thanksgiving weekend and broke two vertebrae and two ribs.
“I should have followed my son and daughter’s advice and moved more quickly,” said Senior, 89, the Retirement Report’s founding editor. After his wife spent 10 weeks in a rehabilitation facility, Senior moved her to a temporary one-bedroom flat at a less-than-ideal assisted-living facility while he continued to search for a residence they could share. Finally, after trying to get into three different communities, the Seniors plan to move this summer into a newly built one just a few miles from the home they shared for 50 years.
The Seniors’ experience is a lesson for those considering assisted living: Start your search early. Doing so can help avoid delays, frustration, wasted money and even buyer’s remorse. But, often, assisted living is far from top of mind until a crisis strikes. “It is usually a crisis-driven decision,” says Maribeth Bersani, chief operating officer of Argentum, the national association representing assisted-living facility operators.
There is a lot to consider when it comes to assisted living. First is figuring out when the time is right. Most of us want to stay in our homes as long as possible. But if assisted living may be in your future, do some preliminary shopping both locally and in an area to which you may move, to be near your children, for example. Assisted living is geared to those who are healthy enough to live on their own but may need some help to live independently, perhaps with bathing, dressing or managing medicines.
Of the one million seniors living in some 31,000 assisted-living centers across the U.S., more than half are age 85 or older, and nearly 40% require assistance with three or more activities of daily living, according to Bersani.
Seeking Assisted Living
When you start your search, consider only state-licensed facilities. Your Area Agency on Aging is a good place to get a list of options in your area, says Catherine Seal, a Colorado Springs, Colo., elder law attorney. “You really have to physically visit,” advises Seal. Have a meal at the facilities on your list, and talk with residents about their experiences. “Walk around, see if the residents look clean and attended to,” she says.
Another consideration: the type of facility. Assisted-living arrangements vary widely, from a handful of residents in a home-like setting to a high-rise building with hundreds of neighbors to a campus-like atmosphere, with high-end services. In some locales, assisted living is called an adult home, retirement residence or residential care facility. Residents typically lease apartments—which can range from studio-like digs to two-bedroom spreads—on a monthly basis and eat in a common dining area.
Care services and amenities also vary widely. For example, some facilities may provide a resident doctor, skilled-nursing care and physical therapy, whereas others provide little care. Some communities have concierge services, in-apartment dining, happy hours and top-notch fitness centers; others don’t offer much more than transport to doctors’ appointments. Argentum has developed a set of voluntary standards on a range of issues from resident rights, care, staff training and qualifications, medication delivery and memory care. (Find a checklist of the standards at alfa.org.)
According to Argentum, “typical” services include access to health care and medical services customized to specific needs, 24-hour emergency call systems for residents, three daily meals served in the dining area, housekeeping and laundry services, assistance with eating, bathing, dressing, toileting and walking as needed, as well as shuttle buses, and exercise and wellness programs. Some assisted-living communities have specialized assistance for residents with dementia.
It’s important to read the fine print of the contract, which outlines services, pricing, extra charges and staffing. Inquire about how much and what time help is available and the level of care. “There is a price for every package,” says Seal. Getting escorted to dining and back comes at a higher price than going on your own, for example, as does medication management. Make sure the facility conducts criminal background checks on employees. Inquire about employee turnover rates and the staff-to-resident ratio.
Like services and amenities, costs vary widely. The median monthly cost for a single, one-bedroom apartment in an assisted-care facility nationally runs $3,628 a month, according to the Genworth 2016 Cost of Care Survey. In the Washington, D.C., metro area where the Seniors live, the median runs $4,400 for one person. They will pay $10,000 a month for a spacious two-bedroom, two-bath apartment. “The facility will have a better-than-average caregiver-to-patient ratio,” says Senior, adding that his wife will get help getting out of bed, dressing and showering, and managing medicines.
The cost includes laundry and housekeeping services, an exercise facility, a small theater, transportation to medical appointments and events, plus a pub offering coffee and snacks throughout the day, in addition to three meals a day. If either of the Seniors need nursing-home care, it will be available next door.
“Dining will be restaurant-style. Eat when you like between certain hours, no assigned tables,” says Senior. “At some facilities, you have an assigned seat and everyone gets served at the same time. I figured, hell, you don’t even have assigned seating in the Army.” Before you sign a contract, consider having an elder law attorney review it. Seal also stresses the importance of being honest upfront about the care needed or behaviors of a loved one, such as combative behavior. Be certain such issues are addressed in the care plan, rather than left as a potential cause for eviction.
Finally, ask to review complaints made to state agencies, as well as inspection reports. You can do some initial facility comparisons at alfa.org. Find a state’s ombudsman through the National Long-Term Care Ombudsman Resource Center.