The phrase “assisted living” too often conjures dark images of nursing homes populated by infirm seniors who are neglected by uncaring staff members. Horror stories of nursing home abuse create legitimate fear in the minds of children who worry that their parents will be ignored or mistreated if they are left in the hands of care providers.
An assisted living facility is not a nursing home. These facilities serve a community of seniors who share common interests and activities while enjoying independent living. The facilities help seniors maintain as much independence, choice, and dignity as possible while assuring their personal safety, comfort, and happiness. Residents in an assisted living community do not have the kind of disabling health problems or impairments that require around-the-clock nursing care.
What do assisted living facilities provide to their residents?
What kinds of assisted living facilities are available?
Are staff members certified?
Which seniors are appropriate candidates for assisted living?
What are the advantages and disadvantages of assisted living?
Alert: There is no singular definition of assisted living facility. It is a generic term to categorize certain types of residences or communities that provide room and board and supportive services in a home-like environment. Depending on the state, location, level of services and size, assisted living facilities have a variety of names and license designations. They may be known as personal care homes, board and care homes, adult foster care, group homes, residential care communities, supporting living arrangements, adult congregate housing, or some other name. There is wide variation among states, and sometimes within states, in the types and levels of care provided and the population served.
Tip: If your parent needs hands-on medical help or specialized care, an assisted facility might not be the appropriate place for care.
In addition to room and board, the assistance or services provided vary widely, but nearly all facilities offer:
- Medication management.
- Meal preparation.
- Housekeeping and personal laundry services.
- Assistance as needed with activities of daily living (ADLs), including bathing, dressing, eating, and using the toilet.
- Helping residents use walkers, scooters, or other devices that promote mobility.
- Incontinence care.
Staff members are available to assist residents at any time of the day or night. While staff can be reached by telephone as needed, assisted living facilities typically have an emergency alert system that allows a resident to summon immediate help in a crisis.
Most assisted living communities also provide recreational opportunities to residents that are consistent with their interests and desires. Those may include nature walks as well as outings to malls, theaters, and festivals. They might also furnish or provide transportation to cooking or art classes, wine tastings, ballroom dancing, sporting events, and comedy clubs. Activity directors strive to find social engagements for seniors that will stimulate their minds and provide age-appropriate exercise.
Tip: The services an assisted living facility may or may not provide are defined by state regulations. For more information about what to consider when choosing the right facility for a loved one, see 10 Factors to Consider When Looking for an Assisted Living Community for Your Parent.
Read here for a short list of the less tangible qualities every assisted living facility should have to ensure the health and happiness of its senior residents.
Assisted living facilities offer more care than retirement villages or homecare providers, but less intensive care than nursing homes. Assisted living facilities help residents with personal care but do not provide medical services, although some may have a nurse on staff for emergencies or to provide services such as care assessments, taking vitals, CPR, blood draws, and wound dressings. About 20% of assisted living communities share grounds with or are connected to a nursing home, but the nursing home always operates as a separate licensed facility.
Assisted living facilities take various forms, ranging from single buildings to communities that resemble apartment complexes or college campuses. They may be a collection of single story buildings or multiple story buildings with elevators. Many communities feature nicely landscaped grounds that include safe, level walking paths.
Some facilities house only a few residents (as low as 25, as reported by the NIH, while other communities serve several hundred seniors. Some facilities provide apartment-style living with scaled down kitchens or kitchenettes while others offer a single room, similar to a small studio apartment. Some offer the option of shared rooms for residents who are on a tight budget and for residents who enjoy the companionship of a friend.
Residents of some assisted living facilities enjoy access to common areas where they can dine or socialize with visitors and other residents. Three meals a day are typically served in dining rooms, though some will provide the meal in the resident’s room. While amenities vary, assisted living communities may have gardening areas, indoor swimming pools, spa services, exercise rooms, libraries, TV rooms, sewing rooms, and rooms where residents can gather to play cards or bingo or access the Internet. Some facilities are pet-friendly.
Assisted living communities tend to offer the same basic services, such as meal preparation, housekeeping, 24-hour supervision and assistance with personal care. While many facilities offer additional services, not all facilities can meet the special needs of all seniors. For instance, not all assisted living communities accept patients suffering from dementia. Facilities that offer care for residents who suffer from Alzheimer’s or similar cognitive impairments have locked or alarmed units to assure that those residents do not walk or wander away from the facility.
Assisted living facilities are primarily regulated by state law. As such, those laws, and even the legal definition of “assisted living facility,” can vary greatly from state to state. As a general rule, however, the facilities, and often a facility’s administrator, must be licensed or certified by the state. Some states make licensing contingent upon the nature of the services that the facility provides. Regulations continue to evolve as seniors increasingly rely upon assisted living arrangements.
Training and certification of staff members may or may not be required, depending on state law and on the staff member’s job duties. The staff members who help residents with their activities of daily living (such as bathing, dressing, and taking medication) are usually known as direct care aides or personal care aides. Some states require direct care aides to be trained and certified while others do not. Nurses must always be licensed, but as a general rule, only “enhanced” or “special needs” assisted living facilities employ a full nursing staff.
State laws may mandate or restrict the activities of staff members. For example, state law determines whether a direct care aide can measure a dosage of medication and hand it to a resident. In some states, direct care aides are only permitted to remind residents to take their medication.
Assisted living is not right for everyone. Some seniors prefer to live in their own homes with help from a drop-in caregiver. Some are able to live in retirement villages and other independent living communities that offer social and recreational opportunities but provide minimal personal assistance to residents. Others need the more extensive services that would be provided in a nursing home or memory care facility.
Assisted living may be the best option for seniors who:
- need more care on a daily basis than relatives can provide;
- feel burdened or stressed by the activities of daily living;
- can no longer manage the upkeep of a home or grocery shopping;
- feel depressed, lonely or isolated;
- fear for their safety due to limited mobility, poor balance, or difficulty managing medications;
- do not need skilled medical attention but would benefit from support services in a managed community.
The primary benefit of assisted living is the opportunity it gives seniors to remain active while living, for the most part, independently. The facilities emphasize the wellness of community residents. They recognize that exercise is a potent form of medicine that improves the health, mobility, strength, and attitude of seniors. Facilities provide opportunities to exercise that vary in accordance with each resident’s level of fitness. Strolling, biking, dancing, swimming, stretching, and yoga are among the activities in which seniors are typically urged to participate.
Assisted living facilities also provide opportunities for residents to socialize and to pursue their interests. Hobbies and social interaction promote mental alertness while acting as a check against depression. Being surrounded by people of similar age helps seniors develop friendships and to maintain a sense of connection with people who share a common history.
The feeling of dependence after a lifetime of self-reliance can be an emotionally crushing experience. Assisted living facilities maximize their residents’ sense of independence by freeing seniors from the burdens of difficult chores (including cleaning and laundry) while providing only the degree of help that residents need.
The primary disadvantage of an assisted living facility is cost. (See What is the Cost of Assisted Living Care?) It is less expensive for a senior who needs assistance to live with children or other family members. That is not always a practical option, but it is an affordable alternative when funds to pay for assisted living are not available.
Other disadvantages depend upon the senior. Some do not adjust well to living in a group environment. Some resent the implication that they need assistance even when the need is obvious. Some seniors are embarrassed to accept another person’s help. Seniors with serious physical health problems, behavioral disorders, or dementia might not be adequately served by an assisted living facility (although some assisted living communities reside within larger continuing care facilities, allowing seniors to move up to higher levels of care as needed, including nursing home and even hospice care, all within the same facility).
All of these factors must be carefully weighed when deciding whether an assisted living facility is appropriate for a senior who is finding it difficult to live in his or her own residence.