As people age and need more help with daily activities, such as bathing or taking medication, moving to a facility that provides some assistance, without sacrificing independence, may be an option. This type of environment, known as assisted living, has emerged in the past two decades as an increasingly available option for housing and long-term care. In 1999, one third of the facilities that offered assisted living services had been in existence for less than five years, and 60 percent had existed for less than a decade, according to research published in January in the journal Health Affairs. The growth of assisted living facilities has leveled off in recent years, however, as the economic downturn hampered new construction and occupancy rates.
In 2007, there were approximately 38,000 assisted living facilities nationwide, serving about 975,000 residents. The overwhelming majority of assisted living residents in the United States are female, according to the National Center for Assisted Living. One of the most common types of facilities that provide assisted living are called community care retirement communities, which offer a stepwise approach to care, says Kerry Peck, an elder law attorney based in Chicago. "The concept is you age in place," meaning you never have to leave the grounds for housing, he says, "You buy an apartment or cottage, and then as your health declines, the facility agrees to provide continuing care. Some of the most successful [centers] have independent living, then assisted living, then a nursing home for acute care."
But much like deciding whether a nursing home is necessary, the decision to move into an assisted living facility is not an easy one. So what factors should you consider when looking for a place to move to? First, think about what activities you or your loved one need help with. People residing in assisted living facilities may need assistance with any number of daily activities, such as bathing, dressing, using the bathroom, cooking, or eating. About 87 percent of residents need help preparing meals, for example, and 81 percent need help with managing or taking their medications, reports the NCAL. Most residents come from living in private homes or apartments; fewer come from living with adult children or other family members, from nursing home facilities, retirement or independent living communities, or another assisted living or group home.
For some people, however, assisted living may not be an option, mostly for financial reasons. Assisted living facilities cost an average of $34,000 annually in 2009, compared to about $74,000 per year for a nursing home, according to research published in January in Health Affairs. How this expense is paid varies. Residents can buy into a facility by paying a large, upfront sum of money, followed by smaller monthly assessment fees. Or if the resident opts for a facility where he can rent instead, he would pay monthly for the cost of housing and care. The facilities are also mostly located in areas where home values are higher and people nearby have higher incomes. Because of this, people with low incomes, minority groups, and those living in rural areas do not have much access to assisted living facilities, the study reports. Also, some states are home to more assisted living facilities than others. Minnesota, Oregon, and Virginia each had more than 40 facilities per 1,000 elderly residents, according to the research, while Connecticut, Hawaii, and West Virginia each had fewer than 10 facilities per 1,000 elderly.
If you are contemplating an assisted living facility for yourself or a loved one, here are 9 considerations to help guide you:
Reflect on what is most valuable in you or your loved one's life. What gives your life purpose and meaning? "Keep that in mind when choosing your living environment," says Linda Fodrini-Johnson, president of National Association of Professional Geriatric Care Managers. Think about where your doctors, your church, your children, and grandchildren are located. Is the assisted living facility near the things and people you hold dear? Will you have transportation to get where you need to go? "Choose a place that can keep you connected to your medical team, church, clubs you belong to, [and] your family," Fodrini-Johnson says. "You want to keep as much [of a] social network as you can."