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Frequently Asked Questions

What is a senior assisted living facility?
An assisted living facility is a senior housing facility that provides housing, personal care, and limited healthcare services to seniors. Assisted living residents typically need support in daily activities, but are in moderate health overall.

Who owns assisted living communities?
According to the 2011 Overview of Assisted Living, 59% are private for profit, 12.6% are publicly held for profit, 25.7% are non-profit, and 1.3% are government sponsored.

Most assisted living facilities are free standing. Some share a campus with hospitals, nursing homes and other advanced care facilities; and some are on the campuses of independent living facilities and other senior housing communities.

Who regulates assisted living facilities?
Currently there is no Federal regulation on assisted care. Instead, the quality of care and facilities is regulated by state, county and local governments. This is a reason for the lack of a ubiquitous definition of what assisted living entails.

Do senior housing communities discriminate?
The Fair Housing Act of 1988 prevents discrimination based on race, disability, and familial status. However, it allows senior housing communities to discriminate by age to help ensure the availability of affordable housing for seniors.

To discriminate by age, a senior housing community must be designed for and occupied by seniors and licensed by a Federal, State or local government program. Programs may be occupied only 62-years or older.

Senior housing communities are not permitted to discriminate based on race, national origin, religion, sex, marital status, color, and ancestry.

How do I find assisted living for low or no income seniors?
Look for assisted living communities that are subsidized by the U.S. Department of Housing and Urban Development (HUD) for low income seniors. These facilities usually accept low income payment options such as Medicaid, SSI, Section 8 and other programs for senior with little or no income, savings or assets. However the availability of these facilities in your area may be limited, so get started as soon as possible because waiting lists can take years.

If you have no income, check and see if you qualify for Medicaid, Medicare, social security, or other public benefit programs. If you or your spouse is a veteran, Veteran's Benefits may also be available to you.

How do you apply for Social Security Income, Medicaid, Medicare or other benefit programs? is a very simple tool that makes finding benefits easy. Answer the questions to find out what programs are available to you.

How can I make my parent go into an assisted living?
Ask them and explain why the move may be necessary. Whether or not you can legally force a parent into assisted living, the process of gathering evidence and necessary legal documentation is long and painstaking. Forcing a parent into assisted living may also be detrimental to your relationship with them, and very emotionally hard on them.

If your options are limited and legal action is necessary, contact your local senior services agency for more information about the legal process in your area. This process may include medical and psychological evaluations, legal filings, and some financial legwork. All in all, persuading your parent to move willingly is usually the best option when assisted living is necessary.

What is the average cost of senior assisted care living?
Nationally, the average cost is $3,831/month (2011), but the average cost depends largely on the area where you live. Learn more about the cost of assisted living in your area, down payments, and other facts about paying for assisted living.

Do I have the right to get my parent out of a nursing home and into assisted living?
If you have power of attorney, you may have this right. If your parent is legally responsible for themselves, they also have this right. You may have to sign a document that your parent is moving against medical advice. However, make sure you are completely prepared for the move, and that the facility they are moving to has the supportive services they need.

Does an assisted living facility have the right to claim a resident's property and assets?
When a person's savings have been depleted and the individual's income is less than required on a monthly basis, a facility may have the right to liquefy assets owned and sometimes assets recently given to family members. There are many rules and exclusions to this process and these may differ from area to area so seek legal counsel in your area to learn more about your options.

What are factors of Assisted Living Pricing ?
Assisted living costs depend on many factors, including the cost of living in the area, services and amenities provided. In addition, square footage and the floor plan of the unit have major effects on the monthly costs. Floor plans may be private or shared, and may include or share kitchenettes and bathrooms.

In addition, there may be additional fees such as move-in fees, yearly community fees, or additional support outside of your care-level. Utilities, phone and cable may also be out-of-pocket costs in some communities. Consider these when looking at the cost of a particular facility.

Although the assisted living costs of may sound high, they are actually comparable to the costs of living at home, especially when you consider the costs of in-home care and home maintenance. Assisted living facilities often provide three meals a day, transportation, healthcare services, housekeeping, laundry and entertainment.

Each community is different so make sure to ask how the community you are considering divides the costs.

What is the difference between Assisted Living vs. In-Home Care ?
Assisted living or home care? This is the question you may someday be asking yourself, and when you do you will see that selecting a type senior care is not easy. The two major types of senior care, assisted living and home care, have very different offerings so it is important to look at the advantages and disadvantages of each.

Assisted living
Assisted living is a type of senior care that serves a specific group of seniors; particularly seniors who need assistance with some daily tasks but are not looking for daily medical assistance. Seniors live at an assisted living community in separate or shared rooms and generally participate as part of a community routine. Communities often provide transportation, housekeeping, laundry, and some healthcare services.

Assisted living facilities are designed for the mobility and safety of residents, and to be cost efficient in providing support and assistance. Residents in assisted living have less privacy and autonomy. Seniors may also experience emotional distress in the transition of leaving their homes and families.

Home care
Home care is a type of elder care for seniors who would like assistance in daily tasks in the comfort of their own homes. Home care costs vary depending on the level of assistance needed. Care is often paid for by the hour and by the type of care provided; home care services can include housekeeping, personal assistance, or medical assistance. Adult day care is a separate service for seniors who need supervision during work hours and is often provides recreational and social opportunities.

With this type of care, married seniors can receive care in place, preventing a move to a community when their spouses do not need care. In-home care allows seniors to more freely choose their schedules and is more private and comfortable, however this style of care may be intrusive or burdensome on other family members.

  In-Home Care Assisted Living
  • Allows a person to "age in place" with family
  • Privacy and comfort
  • Socialization and recreation in adult day care
  • Independence and control in scheduling and routine
  • Affordable
  • 24-hour support and supervision available
  • One monthly cost (minus any extra fees)
  • Facilities designed for safety and mobility
  • Nutritional and fitness support
  • Housekeeping, laundry, meal preparation, and transportation
  • Limited on-site healthcare
  • Socialization and recreation
  • High costs
  • Can be burdensome or intrusive to other family members
  • Support and supervision limited to hours designated
  • Separation from home and family can cause emotional distress
  • Low independence and control over schedule and routine

What are the differences in costs and coverage ?
When weighing assisted living against home care, assisted living is typically more affordable than in-home care. The all-inclusive fee of assisted living also often covers most bases, including housing and utilities, food, daily assistance, and recreation and social opportunities. Medicare benefits are limited for this type of care, but Medicaid benefits may include some health and support services. Room and board is generally not covered by either.

Home care is generally more costly than assisted living. However, because home care is paid on an hourly-basis, costs can vary widely based on the type and duration of care provided. Regardless, home care costs only cover services and do not include room and board, or many other amenities provided in assisted living. Medicare and Medicaid cover some home care services, and Medicaid covers some adult day services; however coverage with both is limited and varies by state.

  In-Home Care Assisted Living
Housing, water, utilities, trash, etc. Not Included $37,572 annually
Food Not Included Included
Assistance with ADLs $64,240 annually (8-hours per day of home health aide, 7 days per week) Included
Day-time supervision and recreation $17,420 annually (adult day services 5 days per week) Included
Medicare Generally not covered Limited to some medically necessary health-related services by certified providers. Adult day services are not covered.
Medicaid Some services may be covered by certified providers; services covered vary by state. Other housing/service costs are generally not covered. Some services may be covered by certified providers; services covered vary by state. Adult day services may be covered; varies by state and eligibility.
Medigap Insurance Not covered Not covered
Long Term Care Insurance May be accepted; coverage varies by policy May be accepted; coverage varies by policy
SSI May be accepted by certified providers for eligible seniors May be accepted by certified providers for eligible seniors
Veteran's Benefits May be accepted; varies by eligibility and state. May be accepted; varies by eligibility and state.
Private Funds, Life Settlements Generally accepted Generally accepted

Costs and amenities are yearly estimates based on 2009 national averages by the MetLife Market Survey of Long-Term Care Costs. Level of care, amenities, floor plan, location and other factors may determine a higher or lower cost.

When I should start considering the need for assisted living ?
  1. Weight gain or loss. This may be due to changes in diet (as a result of loss of ability to eat, cook or shop), reduced or increased appetite, or as a result of forgetting to eat or eating too often (memory loss).
  2. Body odor, bad breath, wearing dirty clothes, or other signs of neglecting hygiene. Loss of motor skills or mobility may make hygienic tasks difficult; memory loss may also be a culprit.
  3. Uncharacteristically dirty, messy or unmaintained home. Again, mobility and motor skills play a large part in home maintenance and both often deteriorate as we age.
  4. Falls and injuries related to mobility issues. The house may not be as accessible as it ought to be for your parent's needs, or they may need additional help.
  5. Decrease in interests and activities that are important to them, such as a hobby, social club, or physical activity. Lack of interest of social motivation may be a sign of depression, which is fairly common in senior populations, and may also be triggered by medication.
  6. Reports from friends and neighbors or noticeable behavioral changes (paranoia, aggressiveness), strange or unusual behavior, inappropriate behavior, or isolation. Many behaviors are symptoms of Alzheimer's, dementia and other diseases and disorders. And again, these behaviors may be a side effect of medication.
  7. Memory loss in a situation that has a moderate to severe impact or in a way that is highly unusual, such as forgetting doctor's appointments, taking medications daily, forgetting where they live, or forgetting important events such as a death, marriage, divorce, and other major occurrence.
  8. Neglect of bills and financial obligations, or other financially risky behavior, such as paying bills twice, receiving final notices or calls from creditors, investment or participation in scams, or excessive gambling.
  9. Risky driving behaviors, traffic tickets, or unexplained or frequent dents and scratches on their vehicle.
How can I tell if my Parent is Resistant to Assisted Living ?
With age, some people may isolate themselves, or worse, ward off loved ones with aggressive or anti-social behavior. They might have mood swings, throw temper tantrums, alienate friends, refuse to leave the house or see a doctor, lie and manipulate others, and display other types of behavior that may be hard to cope with. If your parent is in assisted living, it may be even harder to adjust.

You may be feeling guilty, trapped, or like you are constantly walking on eggshells. Dealing with the many emotions and behaviors of your aging parent may be very confusing and difficult to withstand. You may not have the support from other family members that you would like. Additionally, the emotional ties you have with your parent may put you in the forefront of physical and emotional abuse, even as your parent lives in an assisted living community.

What are Causes for Behavior Changes in Seniors ?
Whether your parent shows a single change in behavior or many, it is often the case there is a reason for the change. Some behaviors are related to the growing aches and pains of old age. Some are an ailment of their own. Some behaviors may even be side effects of medications.

For example, dementia may have symptoms including agitation, depression, psychosis delusions and hallucinations. Delusions concerning their caregiver or families are popular, and may include paranoia, distrust and accusations. These may be coupled with the inability to recognize familiar faces, another symptom of some forms of dementia, and the combination may be a hard thing to live with. Likewise, Alzheimer's symptoms may include apathy, hallucinations, dysphoria and anxiety; Diabetes may cause extreme fatigue and irritability; and arthritis pain may cause sleep loss and irritability.

Other medical reasons for a change of behavior include: Seek medical advice if you believe behavior may be health related.

What are other causes for change behaviors ?
Not all behaviors are health related. Some are just the effects of feeling a loss of control, independence and ability. Anger and resentment can be reactions to feeling separated from the family when moving to an assisted living community. Being unable to live independently might feel very humiliating for your loved one, and some behaviors might just be a way to cope. From the outside, some behaviors may seem irrational or unnecessary, but they might be a way to deal with all the changes occurring in your parent's life. Look to physiological and mental resources in your area if you feel like your parent may need some professional help.

What are different ways to cope ?
Whatever the reason for the unwanted behaviors, it is important to realize you are not alone. It can be hard to stay strong, but do so with the fact that thousands of others are also in a situation like yours, and hopeful for a better way of doing business. Here are some ways to cope when your parent isn't acting like themselves:

Don't hurt yourself trying to help. When airlines instruct you to place your own oxygen mask before doing so for dependents, they do so for a reason. If you become faint from a lack of oxygen, you can't help your loved ones put their masks on; and if you become emotionally worn down from taking care of a difficult parent, you can't help him or her deal with their own heavy emotions. Seek medical council. Your parent is not the first to experience these behaviors and a good geriatric doctor or mental health professional may be able to address some of those negative characteristics. What's more is that a doctor may have ways to help them cope with any anxiety, depression or anger not related to a health condition.

Change your own behavior. Don't sigh or complain when they need help. Don't rush to get them off the phone. Smile and listen to them. Act privileged to assist in their needs. It may sound ridiculous to pretend you are happy that they are allowing you to assist them, but it may be a great way to change behavior.

Change the setting. If a traditional visit always pans out negatively, plan visits in a way that distracts the conversation from negativity. If your dad loves to fix things, bring your broken toaster over and ask him if he can help you fix it. Bring photos of happy events over to have you mom help you make a scrapbook.

Communicate your feelings and encourage them to do the same. Sounds too simple, but it is surprising how hard it actually is to say what you are feeling without placing blame or alienation -- especially, in the middle of an emotionally charged situation. Listen to them and find out if there is an issue causing them to be negative. Use "I" statements, don't blame or assume their intentions, and stay calm.

Find a support network. Whether you join a support group who share support techniques and words of strength, visit an online forum where you can read other's experiences and seek advice on your own, or just sit down and with friends and family who understand your experience, knowing that someone else knows where you are and what you are feeling is a great way to get through this difficult experience.

Accept that their behavior may be a side effect or their way of coping. Your parent may be dealing with some very 'heavy stuff' emotionally and these behaviors may be their way of coping. On the other hand, the behavior might just be a symptom that needs to be addressed. You don't have to like it, but it also doesn't help to overreact either. Make them aware of behaviors that are hurtful or especially challenging, seek medical or psychological advice, and work to make the relationship better.

Know when to quit. If the situation if proving to be too difficult for you, find another family member to take over or seek a conservator-ship or contact your local adult protective services agency. It may sound cold, but it may be the thing you need to make sure you and your family are not the casualties of your parent's behavior. It is not selfish or ungrateful to protect yourself and your loved ones.

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