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Assisted Living Facilities

Summary

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An assisted living facility is a residential facility.  In addition to a place to live, assisted living facilities generally provide housekeeping, meals, transportation to doctors and treatments, activities and personal assistance. While assisted living homes are primarily for the elderly, they accept any residents who need assistance with living - so long as the assistance is not the kind of nursing requirements which are provided in a Nursing Home. Some retirement communities offer a assisted living by providing a place to live, meals and nursing care as needed.

Currently there is no federal oversight over the industry. Each state sets its own definition and decides what oversight and inspections are required.

There are no objective standards developed to assess assisted living homes.  If licensing is required in your state, restrict your search to licensed homes if there are any in your area. In addition to the protection of licensing, you can and should read the governing agency’s inspection report. You can ask the facility for a copy of inspection reports. (To learn about requirements in your state, through the Eldercare Locator: www.Eldercare.gov offsite link, Tel: 800.677.1116

It is advisable to visit and inspect the premises at least once, and preferably at least one other time. It would be helpful if one of the visits was not expected by the personnel at the home so you have a chance of seeing what life is really like there.

Payment: 

  • Medicare: As a general matter, Medicare does not pay for care in assisted living facilities unless certified skilled care is delivered. Most skilled living facilities are not certified. 
  • Medicaid: Medicaid pays for care in an assisted living facility in some states depending on amount of income and assets,  
  • Private health insurance: Most private health insurance plans do not cover assisted living facilities. However,  you can try to negotiate with the insurer for coverage based on the argument that staying in an assisted living facility is less expensive than going into a hospital.

Contracts: It is advisable to read the contract carefully - or have an attorney do it for you. The contract should include all the matters you care about, including a move to a nursing home or hospital and your right to be involved in the process.

NOTE:  Ideally, an assisted living facility would be linked to a nursing home in case there is a need to move to a higher level of care. If both faclities were in the same building(s) you would be able to move smoothly into the nursing home and back to the assisted living facility when and as appropriate.

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