Assisted Living
Medically Reviewed by: Christopher Norman, Board Certified Nurse Practitioner (NP)
When aging in place is not preferred or possible, assisted living can provide peace of mind and welcome support for older adults and their loved ones. These communities prioritize you or your loved one’s independence while also offering individualized, as-needed care.
Unfortunately, many people begin searching for assisted living when they’re already in need of care. In the AgingInPlace.org (AIP) Reviews Team’s March 2023 Senior Living Survey, we found that most respondents began their search for senior living options because they or a loved one needed help with activities of daily living (ADLs). About 40% started their search after a fall or diagnosis.
A recent fall, diagnosis, or lack of ability to perform ADLs such as bathing or dressing can make the search for assisted living feel overwhelming. The more information you have when you begin your search, the less time-consuming and stressful the process will be.
Why You Can Trust Us
Our team works hard to provide clear, transparent information to older adults seeking senior living and home care. To provide you with the best possible information, we have spent more than 250 hours:
- Consulting with our advisory board, which consists of a certified life care manager, a board-certified geropyschologist, and a geriatric nurse practitioner
- Analyzing and synthesizing nationwide data from the Centers for Medicare & Medicaid Services, the National Investment Center for Seniors Housing & Care, and the National Center for Assisted Living
- Analyzing and synthesizing state-specific data from government health regulatory agencies
- Surveying thousands of older adults and their caregivers about their search for senior living facilities
- Conducting focus groups with caregivers who are helping older adults find assisted living
- Mystery shopping dozens of brands and facilities associated with long-term care for older adults
What Is the Definition of Assisted Living?
According to the American Association of Retired Persons Public Policy Institute, there is no standard definition for assisted living in the United States. This is because regulations vary from state to state, making it hard to determine an exact set of services and standards found in every facility. So, what is assisted living?
Christopher J. Norman, a geriatric nurse practitioner with more than 20 years of clinical experience, defined assisted living as “a level of care that assumes a person cannot or should not be living independently for a variety of reasons, either physical, social, or psychological.” While features and services will vary from state to state and facility to facility, the majority of facilities deemed to be assisted living will fall under this general definition.
Today, a senior assisted living facility might also be referred to as a long-term care facility, residential home, retirement home, or, less commonly, a board and care home. Some people might also refer to assisted living as a nursing home, although these are not the same thing. Nursing homes provide a higher level of care than what is typically available in assisted living.
What Care Is Provided in Assisted Living?
Assisted living facilities can provide around-the-clock assistance with personal care, medication administration, and social engagement. Most notably, assisted living facilities help residents with ADLs that they can no longer manage independently.
ADLs can be divided into two categories: instrumental activities of daily living (IADLs) and basic activities of daily living (BADLs). BADLs include self-care activities like bathing, dressing, and toileting; IADLs include home and life management activities like meal preparation and housekeeping. Senior assisted living facilities help with all IADLs and some BADLs.
Assistance With IADLs
IADLs are activities that allow someone to live independently. This table provides an overview of primary IADLs and how the related tasks are managed for residents in assisted living facilities:
| IADL | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Cooking | Related Services in Assisted Living | Three communal meals per day and snacks are provided as needed. |
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| Cleaning | Related Services in Assisted Living | Regular housekeeping is provided in resident rooms and apartments, including laundry. |
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| Transportation | Related Services in Assisted Living | Shuttles take residents to and from doctor’s appointments.
On-site features like beauty parlors, chapels, libraries, and planned activities reduce the need for transportation outside of the facility. |
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| Managing Finances | Related Services in Assisted Living | One monthly bill includes room, board, and personal care services. |
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| Managing Health and Medication | Related Services in Assisted Living | Medication management is provided (sometimes for an additional fee).
Physical and occupational therapy are often available on-site. |
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Needing help with IADLs does not necessarily mean that you or a loved one is ready for assisted living, as these tasks can often be managed in the home with the addition of outside help. Still, an assisted living facility can provide welcome relief from daily tasks that some people find overwhelming.
Assistance With BADLs
BADLs, sometimes referred to simply as ADLs, are essential self-care tasks: bathing, dressing, toileting, transferring (in and out of bed or chair), eating, and continence. According to our Senior Living Survey, needing help with BADLs is a primary reason that people begin to search for assisted living options. Most respondents needed help with bathing and dressing.
This graph shows the number of respondents who needed help with each BADL.
The degree of help residents can receive with BADLs is very facility-dependent. “The standard is that residents will be mostly independent or partially independent with some supervision,” said Norman. If a resident starts needing constant supervision and assistance, they may become a candidate for a skilled nursing facility. The level of care that’s needed before entering assisted living is an important consideration when determining if assisted living is the right option.
Other Services Provided in Assisted Living
In addition to helping with IADLs and ADLs, assisted living facilities provide a host of other services for residents. Our research shows that most assisted living facilities offer therapy, social activities, and fitness classes.
Physical, Occupational, and Speech Therapy
According to the American Health Care Association and the National Center for Assisted Living, 71.4% of assisted living communities provide physical, occupational, and speech therapy. When prescribed by a doctor, these therapies are usually covered by Medicare or Medicaid.
Social Activities
Social engagement for older adults has been linked to positive health outcomes and a greater quality of life. A full activities calendar is central to the positive experience of residents in many assisted living facilities.
One facility we researched in La Porte, Indiana offered a weekly meditation group, a daily walking club, and seasonal community events, like an Easter egg hunt and brunch for residents and their families.
Another facility in Oceanside, California offered regular happy hours, Netflix movie nights, weekly religious services, and meet-ups for games like Rummikub and Bingo.
An assisted living facility in Royal Oak, Michigan offered classes in floral arrangement and weekly pet therapy visits, which guide residents through interactions with trained animals.
Fitness Classes
According to the Surgeon General, physical activity has many benefits for older adults, including a reduction in high blood pressure, depression, and the risk of falls.
The facilities we researched offered a variety of fitness activities, including chair yoga, morning stretch classes, resistance band and weight training sessions, and Tai Chi. Most of the facilities we researched offered regular walking groups.
What Kind of Care Is Not Provided in Assisted Living?
Assisted living facilities are not required to have registered nurses (RNs) on staff. Care is usually managed by licensed professional nurses (LPNs), certified nursing assistants (CNAs), and other non-licensed personnel. Therefore, assisted living facilities are not equipped to provide skilled nursing care and, according to Norman, cannot support the care of individuals who have:
- Medical needs that require skilled nursing care, such as a feeding tube or tracheostomy
- Late-stage neurocognitive diseases like Alzheimer’s or Parkinson’s that result in uncontrolled incontinence or an inability to feed oneself
- Behaviors that cannot be managed otherwise, such as wandering or being combative with caregivers
Assisted Living Daily Schedule
In general, the assisted living lifestyle is structured, but with lots of room for residents to make their own choices about how they spend their time. Based on the facilities we researched, a day in the life of an assisted living resident may look something like this:
7 a.m. Wake up in your own room or apartment. Receive help from staff with ADLs and medications.
8 a.m. Enjoy breakfast with friends in the communal dining room.
10 a.m. Participate in planned fitness activities, like a walking group or yoga class, or join a group for a game of Rummikub or Bunco.
12 p.m. Enjoy lunch with friends in the communal dining room.
1:30 p.m. Choose from a variety of activities, including;
- Reading, watching TV, or spending time with friends
- A structured activity such as a floral arrangement class, writing group, or pet therapy session
- Visiting the onsite salon for a haircut or spending time with visiting family
5 p.m. Enjoy dinner with friends in the communal dining room.
7 p.m. Watch a movie in the theater or community room or attend another on-site activity or concert.
9 p.m. Return to your apartment to bathe, take medications, and get ready for bed with the assistance of staff.
Because of the individualized care provided in senior assisted living communities, it’s important to note that each assisted living resident will spend their day differently. For example, more social residents may spend most of the daytime hours outside of their room. Others may prefer to take some meals in their room or apartment rather than in the communal dining room. Be aware, though, that there may be rules governing some resident preferences. For example, if a resident has a history of choking or a swallowing disorder, they may need to sign a waiver if they wish to eat alone, or they may be discouraged from doing so.
Is Assisted Living Right for Me?
The National Institute on Aging shared the following signs as indicators that a loved one needs more help than they are getting:
- Changes in behavior, such as depressed mood or withdrawal from friends and family
- New problems with self-care, such as poor hygiene or forgetting to take important medications
- No longer maintaining a clean house or keeping up with household chores
- Safety issues, like leaving a hot stove unattended
- Confusion
These issues could indicate that your loved one needs the next level of care, whether that’s assisted living or in-home care.
In his work with older adults and their families, Norman said he often hears people worry that their mom or dad shouldn’t be living on their own anymore. His advice? “If you’re visiting a loved one and leave with the gut feeling that this person really isn’t okay on their own anymore, the need for more care services is past due.” The best first step is consulting with a skilled healthcare provider who has experience in older adult care. “Having an appropriate diagnosis and care team can be a game changer in getting people the help they need at the right time and at the right level of care.”
Who Should Consider Assisted Living?
Assisted living is ideal for older adults who are not thriving in independent living. Here are two hypothetical scenarios, provided by Norman, of people who might consider a move to assisted living:
James, 82, lives alone in a two-story home. He’s having trouble managing the stairs and getting in and out of the shower on his own. Though he’s able to keep track of his medications, household chores like grocery shopping and cleaning have become increasingly difficult. He enjoys reading and solitude but is feeling isolated and lonely since his wife died two years ago.
Claire, 77, lives alone on the fifth floor of an apartment building. She is still driving, though her loved ones have expressed concern that it may no longer be safe for her to do so. They have noticed a decline in her personal self-care, including forgetting to take necessary medications, and they often find spoiled food in her refrigerator. Claire often expresses frustration that there’s nothing to do in her apartment building or local area.
If these scenarios sound familiar and you choose to pursue a move to assisted living, Norman encouraged older adults to think of it as “a stop along the way.” Most people will need a higher level of care as they age, he shared. The average length of stay in an assisted living facility is about 22 months. After that, about 60% of assisted living residents will transition to a skilled nursing facility.
Who Is Not a Good Fit for Assisted Living?
Assisted living provides more care than independent living but less than a nursing home. Here are two hypothetical scenarios, again provided by Norman, of people who might not be a good fit for assisted living:
Carol, 85, can bathe, dress, and eat on her own. However, she is not able to manage medications or keep track of hearing aids and other important items without help or reminders from caregivers. She lives in an independent living facility with daily help from health aides, but she recently wandered outside of the facility at night. Though she was safely returned after the police were alerted, she was confused and disoriented.
Bob, 85, is a stroke survivor who is able to walk short distances with the assistance of a rollator, but most of the time, he needs a wheelchair. He needs assistance transferring in and out of bed and to and from chairs. He cannot bathe or dress on his own, and he often has trouble communicating his needs. His wife is no longer able to care for him in their home.
If the last two scenarios ring true for yourself or a loved one, know that there are other long-term care options beyond assisted living. “Many folks think that it’s assisted living or a nursing home,” Norman said, “but these are not the only options.”
Alternatives to assisted living include independent living paired with visiting nurse services or aging in place with the support of in-home care.
Qualifying for Assisted Living
Qualifying for senior assisted living is less a matter of meeting certain standards and more an issue of overcoming barriers to this level of care.
When it comes to personal and medical care, you qualify for assisted living by showing that your or your loved one’s needs do not exceed what the facility can realistically provide. If you require skilled nursing or constant supervision, you’ll need to seek an alternative to assisted living.
Aside from personal care and medical needs, the most significant barrier to assisted living is cost. Because Medicare and Medicaid do not cover assisted living, this level of care is not a viable option for many middle and low-income Americans.
How Much Does Assisted Living Cost?
In the United States, assisted living costs about 4,000 per month or about $48,000 per year. The cost of assisted living varies by state, averaging $3,500 in Alabama, $4,500 in Nebraska, and $5,250 in California.
Usually, the room and board fee covers a shared or private apartment, regular housekeeping and laundry services, in-room Wi-Fi and cable, and three meals per day. It’s important to note that most facilities charge extra for personal care services, like help with bathing or dressing. The amount of additional fees corresponds with the level of care you or your loved one requires.
Assessing Level of Care
Before or shortly after you or a loved one is admitted to an assisted living facility, the staff will perform a level of care assessment, also referred to as a needs assessment.
- For example, level of care assessment forms in Rhode Island and Missouri rate the level of assistance the resident needs with each ADL. They also evaluate behavioral trends and record a thorough medical history. Though assessment forms vary by state, most evaluate the resident’s medical history and level of independence with ADLs. This form determines the resident’s level of care within the assisted living facility.
Level of Care Costs
Most assisted living facilities charge additional fees based on the resident’s level of care. Our research shows that most facilities have three to five levels of care, each with a corresponding additional fee per month. We researched the level of care fees at facilities in North Carolina and Michigan.
Assisted Living Facility in Chapel Hill, North Carolina
This facility, with a total of 91 assisted living units, charged a monthly room and board fee of $6,210 for a private studio and $4,475 for a shared suite.
This facility had four levels of care, starting at $400 per month for Level One and $1,250 for Level Four. In this facility, Level One care was for residents who were mostly independent with ADLs and needed minimal assistance throughout the day. A Level Four resident required assistance with ADLs multiple times throughout the day, possibly including bed transfer and escorts to and from the dining room.
The monthly fee for a Level Four resident with a private studio in this facility would be $7,460.
Assisted Living Facility in Grand Rapids, Michigan
This facility, with a total of 100 assisted living units, offered all-inclusive tiered pricing. Tier One residents paid $5,100 monthly for room, board, and personal care services, and Tier Three residents paid $6,700. Tier One residents required minimal assistance with ADLs, while Tier Three residents required help several times throughout the day, possibly including bed transfers or walking escorts.
In all of the facilities we researched, residents were regularly assessed and moved to a higher or lower level of care as their needs changed.
How to Pay for Assisted Living
Medicare will not cover any form of long-term care. While Medicaid will usually cover the cost of long-term care in a skilled nursing facility, it will not cover the cost of an assisted living facility. Most older adults and their loved ones will need to use the following personal savings and assets to afford the cost of senior assisted living:
- Personal savings: To pay for assisted living, many older adults will pull from Social Security benefits, pension payments, stocks, and 401(k) or IRA accounts.
- Long-term care insurance: If you plan to use long-term care insurance to pay for assisted living, be sure you know the details of your policy. Some have a 90-day out-of-pocket period that could leave you with thousands of dollars of non-reimbursable assisted living expenses.
- Home equity: You can put proceeds from the sale of your home or property toward assisted living expenses. Some people also pay for assisted living with a reverse mortgage, which allows homeowners aged 62 and older to borrow money using their home as security for the loan. Some people take out reverse mortgages if an older adult is living in the home but their spouse is moving to assisted living. Be sure to check with a trusted financial advisor, though, before committing to this kind of financial agreement.
How Do I Find Assisted Living Near Me?
To find assisted living in your area, consider using this step-by-step guide:
- First, work with a trusted health care provider to make sure you or your loved one is a good fit for assisted living.
- Reach out to people you trust for recommendations on assisted living facilities. This may include health care professionals, neighbors, local senior living experts, or friends and family who have searched for assisted living in the past.
- Determine the geographic location where you or a loved one wants to live and make a list of assisted living facilities within those parameters.
- If possible, visit every assisted living community you’re considering. You can call ahead to schedule a visit, but unplanned visits, if allowable, offer a clearer picture of the facility and the well-being of its residents.
- Take notes during your visits so that you can later make a list of the pros and cons for each facility. The key thing to think about, Norman shared, is “goodness of fit.” Does the facility provide the kind of care you need? Do you feel comfortable there?
- Once you have chosen a facility, keep in mind that a move to assisted living can take time. The facility may require a physician referral, and the facility will want to perform its own needs assessment. You’ll also have to set up payment arrangements and make a plan to move. Enlist help from friends and loved ones to help you make it through this transition.
Assisted Living Compared to Other Forms of Senior Living
As you’re making decisions about senior living, it’s helpful to understand which services are offered in each type of facility or home setting. The following table offers an at-a-glance comparison of what services are generally available in each type of senior living arrangement.
| Housekeeping | Home Care | ✓ | Independent Living | ✓ | Assisted Living | ✓ | Memory Care | ✓ | Skilled Nursing | ✓ |
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| Some Assistance with BADLs | Home Care | ✓ | Independent Living | Assisted Living | ✓ | Memory Care | ✓ | Skilled Nursing | ✓ |
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| 24/7 Assistance with all BADLs | Home Care | ✓ | Independent Living | Assisted Living | Memory Care | ✓ | Skilled Nursing | ✓ |
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| Physical and Occupational Therapy | Home Care | ✓ | Independent Living | ✓ | Assisted Living | ✓ | Memory Care | ✓ | Skilled Nursing | ✓ |
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| Skilled Nursing Care | Home Care | ✓ | Independent Living | Assisted Living | Memory Care | ✓ | Skilled Nursing | ✓ |
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| Facility or Halls Locked to Prevent Wandering | Home Care | Independent Living | Assisted Living | Memory Care | ✓ | Skilled Nursing | ✓ |
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| Accepts Medicaid | Home Care | ✓ | Independent Living | Assisted Living | Memory Care | ✓ | Skilled Nursing | ✓ |
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It’s important to note that services will vary from state to state and from facility to facility. For example, there are different types of home care services, some of which offer medical care and others that provide only light housekeeping and limited help with ADLs.
Alternatives to Assisted Living
In their search for senior living facilities, older adults and their loved ones often find that the gap between independent living and skilled nursing care can be hard to fill. For some, assisted living isn’t a viable financial option. Others would rather receive care at home than move to an assisted living facility. In these cases, there are alternatives to assisted living.
- Companion care: The U.S. Department of Labor defines companionship services as “the provision of fellowship and protection for an elderly person or a person with an illness, injury, or disability who requires assistance in caring for himself or herself.” A companion makes sure that the older adult is safe in their home while also providing social, physical, and mental engagement, including conversation and activities. They can also provide minimal help with ADLs.
- Program for All-Inclusive Care for the Elderly (PACE): For older adults who qualify for skilled nursing care, it’s possible to use a waiver to pay for in-home services that would otherwise go toward a facility. These waivers are made possible through PACE, which is operated through the National PACE Association, whose mission is to promote the highest possible level of independence for individuals with significant health care needs.
- Medical alert systems: These systems connect people with help in an emergency. For about $20–$30 per month, a medical alert system can provide peace of mind for older adults who are aging at home.
- Adult day centers: For older adults who are being cared for in the homes of their loved ones, supervised adult day programs can provide social engagement for older adults while offering the caregiver time away from caregiving responsibilities.
Frequently Asked Questions About Assisted Living
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About 55% of assisted living residents are 85 years or older; 26% are 75–84 years old; and 12% are 65–74. Only 7% of assisted living residents are under the age of 65.
Sources:
Assisted Living and Residential Care in the States in 2010 | AARP Public Policy Institute
What Are the Signs That an Aging Parent Needs Help? | National Institute on Aging
Cost of Care Survey | Genworth
Assisted Living Resident Assessment | Rhode Island Department of Health
What is a reverse mortgage? | Consumer Financial Protection Bureau
Eldercare Locator | U.S. Administration on Aging
Fact Sheet # 79A: Companionship Services Under the Fair Labor Standards Act (FLSA) | United States Department of Labor Wage and Hour Division