Senior Living: Obstacles of Obtaining Assisted Living

This is part 1 of a 3 part series on senior living accommodations and is relevant for those with elder care issues as well as those interested in the subject for themselves. This article focuses on the soaring prices, waiting lists and other impediments to securing adequate assisted living accommodations for seniors. Part 2 will cover a novel program in Vermont that helps family members who are providing care to relatives and part 3 will cover other novel approaches to assisted living). The primary source of information for this part is a Wall St. Journal article entitle "Assisted Living: New Obstacles" (link, may require fee).

For the growing number of elderly, assisted living facilities have become popular alternatives to nursing homes. Assisted living residents get their own private apartment, with a full bathroom and kitchen but with things like housekeeping, help with pill popping and perhaps even meal preparation provide. Assisted living apartments can be quite luxurious. Most important there is the security of ready access to support staff and often nursing care if needed.

Seniors generally turn to assisted living facilities if they need just a little care and/or just want to be freed of the hassles of maintaining their own residence but aren't interested in living in a full-blown nursing home.

Demand is soaring for assisted living facilities and looking at demographic trends this is not likely going to change for a very long time. By the year 2020, it is estimated that 12 million older Americans will need long-term care and persons age 65 face at least a 40 percent lifetime risk of entering a nursing home. The high demand combined with the relative scarcity of openings (including waiting lists of 6 months or longer at many of the nation's 32,886 centers) has lead to record levels of occupancy (95%) and with it soaring prices. Complicating matters is that the multitude of add-on charges being charged by some facilities (for example $8 to deliver a single meal) that can make price shopping difficult.

The WSJ had the following tips for those shopping for assisted living for themselves or a loved one:

Comparisons: Look at everything from costs for room rent and health care to staff interaction with residents and the center's physical grounds. If a parent needs dementia care, are the facilities secured and monitored? [Note: Dementia and Alzheimer's raise additional issues and residents who live in assisted care facilities may be required to move out and into a full-blown nursing home. (See this link).

Costs: If money is an issue, build a safety net into your calculations. Monitor assets along the way and scale down early to a less expensive unit as necessary. To cut costs, family members can provide some services themselves, such as showing up every evening to help a senior prepare for bed.

Assessments: Don't try to hide needs as a way to reduce the costs. They always show up in daily activities. If you question an assessment at one center, have a second assessment done and compare.

Staff: A high turnover rate can be disruptive to the care of residents. Also, what sort of specialized training does the staff have, particularly those dealing with memory-care patients? Does the center perform criminal background checks on employees?

Health Care: Is a nurse on site or on call? What access to the resident does a personal doctor have? At what point will a center no longer be able to meet a resident's care needs? Is the center affiliated with a nursing home that will proved the resident priority admission?

Monitoring: Regularly monitor a senior's activities and the services he or she requires over the first few months to ensure you or they are paying for the right level of care.

Complaints: Most states conduct survey of assisted living facilities, which are public reports that the center can provide or which you can find in the state's licensing agency. Stat agencies are found at www.ncal.org. Each state also has a long-term care ombudsman to help manage complaints.

[Here is an even more detailed check list provide by the Assisted Living Federation of America.]

A few things to note about monetary requirements of assisted living. First, it is largely a private-pay industry meaning you will need to first figure out what you can afford and specifically how much time the assets you have will buy at the various facilities you are looking at. WSJ noted that the average stay in an assisted living facility is just two years. Traditional insurance policies typically do not pay for assisted living. If you have a long-term care policy then they might pick up some of the costs but you will need to read the policies conditions very carefully.

It is always a good idea to talk to the facilities residents and do not hesitate to ask administrators direct questions. One final note is to differentiate assisted living centers which are licensed and "group homes" which are not.

Additional resources:

• Assisted Living Federation of America

• Consumer Consortium on Assisted Living

• National Center for Assisted Living

• American Association for Homes and Services for the Aging

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