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What are activities of daily living?
Activities such as dressing, bathing, eating, and administering medications that a person completes daily for personal health and hygiene. Senior living providers often provide personal care services to assist residents with these activities of daily living.
What is an individual care plan?
Often abbreviated as an ICP, this is a plan developed by the community that describes the personal care and medication management services to be provided. This is similar to an individual education plan in schools, in that it is designed to set goals and provide a process for achieving those goals. In this case, the goals are for the resident's care and quality of life.
What are personal care services?
Services that assist residents with activities of daily living (dressing, bathing, eating, administering medications, etc.). As a person ages, he or she may no longer be able to complete the activities of daily living. Communities provide personal care services to meet those needs, improving quality of life for the resident.
What is Simply Senior Living?
A service to connect prospective residents and their families to senior living communities.
What is medication management?
Reviewing, ordering, organizing, and administering medications to a prospective resident. Seniors often take ten or more medications. This can be difficult to manage, resulting in non-compliance and reduced health outcomes. Assisted living and memory care facilities will manage this process for residents utilizing tools and systems to increase accuracy, reduce errors, increase compliance, and improve quality of life for the residents.
What are levels of care?
Levels created by providers to quantify the cost of personal care services. For example, a level one resident may pay $500 per month for minor help with dressing. A level two resident with more intense needs (perhaps bathing and dressing) would pay more. Communities perform an assessment (questionnaire) before move-in to place a resident in a level and to determine how much the resident will pay per month. Reassessments are typically done annually or as the resident's needs change. Nearly all residents have increased care needs over time, so prepare for additional levels of care costs when you complete your financial planning. Most communities have between three and five levels of care, but this can vary.
What is home care?
Medical and health services such as personal care services, hospice, or palliative care provided in the home. Home care is an alternative to senior living, although residents in independent living may receive personal care services from a home care provider.
What is hospice care?
This is end-of-life care focused on treating symptoms and alleviating pain while meeting phyiscal and spiritual needs. Treatment for the underlying health conditions is discontinued during hospice care.
What is a nursing home?
Nursing homes are long-term care facilities that provide 24/7 nursing care to patients. When these facilities also offer physical therapy or rehabilitation then they are called skilled nursing facilities.
Nursing homes serve two primary patient populations: long-term care residents and rehabilitation or therapy residents. Long-term care residents often need direct nursing care available 24 hours a day.
Therapy residents are typically recovering from a medical operation and will work with a physical therapist in a therapy gym to develop skills in order to regain independence. Not all nursing homes provide rehabilitation or physical therapy, but it is becoming more and more common since the reimbursement to providers is higher for residents that need therapy.
What is Included in Nursing Home Care?
Like other types of senior housing, nursing homes provide housing (typically a studio apartment), dining (three meals per day), personal care services (medication management, dressing, grooming, etc.), and social activities.
The primary difference between nursing homes and other types of care is that nursing homes offer 24/7 nursing care, which is a step closer to medical care. For instance, residents in specially licensed nursing homes may be on a ventilator or other residents may be receiving some form of wound care.
How Much Does Nursing Home Care Cost?
The median cost for nursing home care in the United States is $8,517 per month for a private room in 2019 according to Genworth. That compares to a median of $7,513 per month in 2019 for a semi-private room according to Genworth. These figures are for long-term care and do not include therapy or rehabilitation. Rehabilitation care is more expensive, but is often covered by Medicare.
The cost for nursing home care varies greatly from state-to-state and even between communities. Communities with more private pay rooms and in more expensive urban areas tend to be the most expensive. Nursing homes in low-cost, rural areas may be much more affordable.
How Can I Pay for Nursing Home Care?
Of the types of senior living, nursing homes' services are the most likely to be paid for by a government program. In fact, the single largest program to pay for long-term care is Medicaid, which covers all nursing home long-term care costs for qualified seniors. Therapy residents are often covered by Medicare, but for a very limited time frame.
Paying for Long-term Care in a Nursing Home
Medicaid (long-term care)
Social security, pension, investment, or other income
Long-term care insurance
Long-term care residents are often covered by Medicaid, but many seniors do not qualify for Medicaid and must pay out-of-pocket for long-term care. Medicaid Waiver programs have two tests to determine if you qualify for Medicaid. These tests are an asset test and an income test.
The asset test requires that those seeking care must have countable assets of less than $2,000. Many people are confused by this, since there is a lot of disinformation available on the subject. Many wrongly believe that the resident must have less than $2,000 of any assets.
Non-countable Assets for Medicaid in a Nursing Home
Primary home (with equity limits)
Certain prepaid funerals
Assets exclusively in the name of a spouse
Properly structured assets in a trust
*The prospective nursing home resident must express the plan to return to the home.
The income test only requires that the resident's income is less than the cost of the nursing home care. Since nursing home care is very expensive, this is often the case.
Even if you pass Medicaid's asset and income tests and are qualified for long-term care paid for by Medicaid, your estate could be subject to a claw-back process known as estate recovery. This is a process, upon the resident's death, where a department of health in your state of residence and the Center for Medicaid and Medicare Services (federal department) will attempt to get reimbursed for care provided to the senior in the nursing home and paid for through the state's Medicaid waiver program.
Some assets can be protected from the estate recovery process depending on how the resident, or his/her family, owns assets. For instance, assets may be transferred to children in a trust that prevents CMS from recovering the funds. If you're interested in minimizing the impact of estate recovery, then we suggest speaking with a trustworthy elder law attorney.
Paying for Rehabilitation in a Nursing Home
Medicare will pay for up to 100 days of rehabilitation or therapy in a nursing home for qualifying stays. The primary requirements for Medicare to pay for the physical therapy is that the resident must have had a three night qualifying stay (not in observation or triage) in a hospital, must have doctor's orders for therapy, must be covered by Medicare, and cannot have had a recent Medicare paid stay.
If the senior does qualify for Medicare to pay for the nursing home stay, then the full cost of living in the skilled nursing facility and receiving services will be covered by Medicare for the first twenty days. After the first twenty days, a typical copay will be required from the Medicare beneficiary.
How Long Will Medicare Pay for a Nursing Home Stay
Medicare will continue paying for a portion of the nursing home stay up to 100 days.
Most stays in skilled nursing facilities for therapy or rehabilitation are much shorter than 100 days. In fact, most stays are in the 15 to 25-day range. While providers would like to receive the continued revenue from having residents stay longer, Medicare tries to control costs by moving residents into a different care setting as soon as the resident has recovered enough.
Nursing Homes in CCRCs
Nursing homes on continuing care retirement campuses (CCRCs) often have limited access on admissions. As a result of their certificate of need, license, or policies, the CCRC may only offer nursing home care to those residents that already have a contract with the CCRC. This is a common marketing point for CCRCs. However, some CCRCs have the proper license and a policy to accept non-contract seniors that weren't already living in the CCRC.
Do All Nursing Homes Accept Medicaid or Medicare?
Nursing homes are not usually required to accept Medicaid or Medicare, but most accept one or the other. Nursing homes that offer physical therapy or rehabilitation and accept Medicare as a source of payment are known as skilled nursing facilities.
Nursing Homes Versus Assisted Living
Nursing homes and assisted living facilities are similar in many ways, which results in confusion about what separates nursing homes and assisted living communities. For instance, both nursing homes and assisted living communities typically provide personal care services, dining (three meals per day), housing, maintenance, housekeeping, laundry services, and social activities.
The primary difference is that nursing homes provide 24/7 nursing care and typically have residents that need higher levels of care than those in assisted living. For instance, residents with extreme mobility limitations that may require two or three staff to lift for dressing or grooming, would likely be in a nursing home versus in an assisted living community. Also, residents in nursing homes may have more intensive wound care issues or may need a ventilator, which are available in specialized nursing homes.
Also different are who pays for care, how much care costs, and what the environment is like. In most nursing homes, many residents are being paid for through Medicaid and some are receiving physical therapy for which Medicare is footing the bill. In assisted living, most residents pay through private funds such as social security income, long-term care income, pension income, and investment income among others.
Finally, the environment or facility is a common major difference between nursing homes and assisted living. Many assisted living communities are newer with a more home-like environment, nicer finishes, and more amenities.
Nursing Home Design
If you have been in one or two nursing homes, then you've probably got a good sense of how several thousand nursing homes across the United States are designed.
Many nursing homes were built in the mid to late twentieth century under building codes and regulations that required the nursing homes to have an institutional feel. For instance, most nursing homes are one or two stories with long corridors of studio rooms, with a nurse's station at the intersection of the corridors, with vinyl tile flooring, and handrails along the walls. Nursing homes also typically have one or more courtyards, a kitchen and dining room, an activity room or two, and some office space for the staff. If the nursing home offers physical therapy, then a therapy gym is often included as well.
Many newer nursing homes have popped up in areas near major hospitals in the past couple of years. These nursing homes are often focused around rehabilitation or therapy and have features that resemble more of a luxury resort or spa than a traditional nursing home. For instance, many of these communities have private rooms with nice finishes and flat screen TVs. The communities often have a spa or rehabilitation pool and offer better dining than some traditional nursing homes. The problem with many of these communities is that they don't typically take long-term care residents, so paying with Medicaid is usually not an option.
What is a care-inclusive or all-inclusive community?
Care-inclusive communities include levels of care and medication management fees in the base monthly rent. Non care-inclusive communities charge those fees on top of the base monthly rent. For example, a resident in a care-inclusive community may make one monthly payment of $4,500 for all of the services. Whereas a resident in a non care-inclusive community may be required to pay a $1,000 levels of care charge and a $500 medication management fee in addition to paying the base rent of $3,000, for a total of $4,500. Some residents like the care-inclusive model, because it makes calculating costs simpler and provides a certainty that the costs to live in the community won't go up as a residents' needs increase. Other residents prefer a non care-inclusive model so that they only pay for the care that they use.
What is an entrance fee?
An entrance fee is a large ($30k - $1 million or more), sometimes refundable, cost at the time of move-in. These are typically charged by continuing care retirement communities and ensure access to care as residents' needs increase.
Entrance fees are typically refundable (often 100%, 90%, or 50% of the original amount) and are sometimes used by a community to offset lower monthly rent payments. For instance, with a $100k entrance fee the community may charge $4,700 per month in rent, but with a $200k entrance fee the community may charge $4,000 per month in rent.
The refundability of an entrance fee is dependent on several factors including the amount of care the resident consumes, when he or she leaves the community, the monthly amount paid in rent, or the community's ability to rent/sell the space after the resident has moved out. It is important that you and your estate explore all of the scenarios in which you will receive a refund.
What is senior living?
Senior living, or seniors housing, is a group of housing options that cater to the lifestyle and care needs of senior citizens. These options, ordered from more lifestyle focused to more care focused, include independent living, assisted living, memory care, and skilled nursing facilities (nursing homes).
Types of Senior Living
As seniors age, their care needs will drive a change from the more lifestyle focused (begins with independent living) to the more care focused (ends with skilled nursing). It's common for seniors to live in independent living for a couple of years then move to assisted living, memory care, or skilled nursing. This progression based on increasing care needs is what the senior living industry calls the continuum of care.
Since senior living is essentially a class, or group of housing options for seniors, these options are available in different combinations. For instance, independent living, assisted living, memory care, and skilled nursing may be offered together as part of a larger senior living campus. Some of these campuses are called continuing care retirement communities or CCRCs. These campuses may be in one or several buildings and may offer hundreds to thousands of apartments or cottages. Many seniors prefer senior living campuses, because they allow seniors to age-in-place as their care needs grow over time.
Other senior living offerings are standalone where only one or two types of care are offered. Standalone memory care communities with 40-60 apartments are very common, due to the specialized needs of those suffering from Alzheimer's or dementia. Standalone assisted living or skilled nursing facilities are common as well.
Who Needs Senior Living?
The easiest way to think about who needs senior living is to think about how much care a person needs.
How Much Care is Needed?
Usually no care = independent living
1-2+ ADLs = assisted living
1-2+ ADLs due to memory impairment = memory care
24/7 nursing care or rehabilitation = skilled nursing
Independent living residents need little or no care and are making a lifestyle choice to live in independent living. Assisted living residents need assistance with 1-2 or more activities of daily living (medication management, dressing, bathing, grooming, walking, etc.). Memory care residents need 24/7 supervision due to memory impairment from Alzheimer's or dementia. Nursing home residents typically have the highest care needs with either 24/7 nursing care or daily rehabilitation/therapy to recover from an injury.
Senior Living Costs
Independent Living - $2,500 - 7,000+ per month
Assisted Living - $3,000 - 8,000+ per month
Memory Care - $3,500 - 10,000+ per month
Nursing Homes - $6,000 - 10,000+ per month
Senior living costs range from $2,500 - $10,000+ per month. Senior living costs vary greatly by the type of care that is needed, by the quantity and quality of amenities and services offered/consumed, and by the competition relative to demand in the local market.
Independent living is typically the least expensive type of care while skilled nursing is usually the most expensive.
However, the costs can also vary greatly from community-to-community even for the same care type. For instance, a three-bedroom penthouse in independent living on a luxury CCRC campus may cost $7,000 per month or more, while a studio in an affordable independent living community may only cost $2,800 per month.
Why Senior Living Costs Vary
Care services needed
Who Pays for Senior Living
Who pays for senior living varies by type of care and the assets/income of the senior. Independent living is typically paid for through private means (social security, pension, investment income). Assisted living and memory care are also paid for through private means (including long-term care insurance). Some lower income individuals, however, can obtain assisted living or memory care through a state's Medicaid Waiver program. Nursing home care is often paid for by Medicaid for those that qualify, by private pay, or by Medicare for qualifying stays where the individual is receiving therapy or rehabilitation.
Veterans and their surviving spouses are often eligible for a Veteran's Aid & Attendance benefit that will pay for a portion of independent living, assisted living, memory care, or nursing home care.
Memory care is a type of senior housing that provides personal care and hospitality services to seniors that suffer from dementia or Alzheimer's. These services can either be provided in an assisted living or a nursing home setting, but memory care is more often provided in assisted living.
What's Included in Memory Care
Memory care is focused around the holistic wellbeing of the residents that suffer from Alzheimer's or dementia. Residents are typically cared for around the clock by staff that provide meals, activities, socialization, manage and dispense medicines, and assist with the activities of daily living.
Memory care typically has two requirements: age and need for care.
Most age restrictions typically only require that the resident be 55 or 62 years or older. Most memory care residents, however, are much older, with many in their 70's, 80's, or beyond. Sadly, a few younger individuals do develop dementia or Alzheimer's. However, if you find a memory care community with several younger residents then they're likely serving a mentally ill or challenged population, which will not appeal to many seniors.
The most pertinent admission requirement is that the prospective resident must have a medical professional's recommendation that the senior needs personal care services for memory impairment. Communities often complete a parallel test to determine if they also agree with the needs assessment and to determine the appropriate level of care. Most seniors qualify for memory care once they have progressed beyond the earliest stages of dementia or Alzheimer's.
Memory Care in Nursing Homes
Most memory care is considered "assisted living" memory care. That is, memory care is really a sub-type of assisted living since they both provide similar personal care services to meet the senior's needs, but memory care's services are focused around the needs of seniors with memory impairment. Some nursing home communities, however, also offer memory care services. This is where it gets confusing.
Memory care offered in nursing homes provides the same core services that assisted living memory care provides but has some unique quirks as well. Both provide three meals per day, housing, medication management, and the personal care services (bathing, dressing, grooming, etc.) tailored to those seniors that suffer from Alzheimer's or dementia.
The primary differences between memory care in nursing homes and "assisted living" memory care are the costs, who pays for the care, the setting, and the intensity of care.
In general, the cost for memory care in a nursing home is significantly more expensive than the equivalent assisted living memory care. This is the result of a few staffing and other requirements that raise the average cost to provide care in nursing home. For instance, most nursing homes are required to employ one or more registered nurses, which are not required in other memory care communities.
Even though memory care in a nursing home is often more expensive, it's less likely that the senior resident or his/her family is picking up the bill. Many seniors in nursing homes qualify for Medicaid. This means that the state and CMS will be covering the resident's stay.
Assisted living memory care is often paid for by the resident or family. So even though memory care in a nursing home is more expensive, for residents that qualify for Medicaid it is cheaper to receive memory care services in a nursing home.
Like most nursing home care, the setting for memory care in a nursing home tends to be more institutional than that of a newer assisted living memory care community. Nursing homes have many building and other code requirements that result in a more institutional feel: these laws included certificate of need law, building code requirements (vinyl tile flooring, handrails, line-of-sight to nurses' stations), and previous or current Medicaid or Medicare reimbursement requirements that encourage low cost facilities. Assisted living memory care communities often offer a more home-like environment with nicer finishes.
Finally, like all nursing care, memory care in a nursing home can take residents that need 24/7 nursing care, not just assistance with personal care services. This means that the most acute (in need of care) residents may only be able to have their needs met in a nursing home.
Memory Care Costs
Memory care frequently costs from $3,500 - 10,000+ per month, with an average of approximately $5,400 per month. This makes memory care the second most expensive type of senior housing after skilled nursing.
Memory care costs are typically broken up into a couple of items: monthly rent, levels of care costs, medication management, and extra costs. Monthly rent is typically the largest cost and may be the only ongoing cost for all-inclusive or care-inclusive communities. Levels of care and medication management often vary from resident-to-resident depending on the actual care need of the senior. These costs are sometimes charged in addition to monthly rent.
One-time or up-front costs may also be required. For instance, one-time community fees of $1,000 - 10,000+ are commonly charged. If the community is part of a CCRC, then a larger fee called an entrance fee may be charged.
Memory care in assisted living is typically paid through a combination of funds: social security income, long-term care insurance, pension income, investment income, veteran's benefits, sale of assets, and other sources of income. Some states will pay for memory care in assisted living for qualifying residents through Medicaid. However, it's more common for states to reimburse nursing homes for memory care through the Medicaid Waiver program.
Paying for Memory Care
Social security, pension, investment, or other income
Long-term care insurance
Selling a home or other asset
Receiving assistance from friends or family
Most memory care apartments include a living area, a sleeping area, and a bathroom. Due to obvious safety reasons, memory care apartments do not include kitchens. Also excluded are large walk-in closets. Sometimes memory care residents will get disoriented in a closet and may become trapped. This is a common enough phenomenon, that most memory care communities exclude closets and place the residents' clothes in a wardrobe or dresser.
Most memory care apartments are studios, although some one-bedroom and two-bedroom apartments exist. In a studio, the resident's sleeping area and living area are combined into a single room. One-bedroom apartments are common in more expensive communities. Two-bedroom apartments are rare, except when a community is offering a more-private companion suite option.
Companion suites or shared apartments are frequently offered in memory care to provide an affordable option. These apartments feature two residents in the same room (studio) or more privately with separate bedrooms and bathrooms with a shared living area (two-bedroom). Semi-private apartments may not be for everyone, but the rent savings per resident can often be $1,000+ per month. So, if you or your loved one is on a tight budget, then it may be a helpful option.
Memory care communities come in many different forms and types. Some are standalone communities where other types of senior living are not available. Other memory care communities are part of a larger senior housing campus that includes independent living, assisted living, memory care, and skilled nursing.
Many standalone memory care communities have been built over the last couple of years. These communities are typically single-story, house 48-64 apartments, are split into two or more main neighborhoods, and offer exclusively memory care services. Most of the providers for standalone communities focus either exclusively on memory care or have many other memory care communities. Some seniors and their families like this exclusive knowledge of the community.
Another common format is a combined assisted living and memory care community. Many providers like this community type, because assisted living and memory care residents have similar needs and the staffing and expertise needed to meet those needs is similar. Increasing the size of the community, may also result in cost savings for the provider, some of which may get passed down to the resident or the family.
Also common, are large senior housing campuses, some of which are called CCRCs, that offer independent living, assisted living, memory care, and skilled nursing. Some couples prefer these campuses, because one spouse can be in assisted living and walk over to visit the other in memory care. That way, both of their needs are being met, but they aren't far from each other.
Another benefit of these types of communities is that residents can "age-in-place". For instance, a senior may move into independent living when she is relatively healthy, move into assisted living as her need for care increases, then moving into memory care when dementia or Alzheimer's have begun to run their course. Many seniors and families like that this model prevents the need to move multiple times.
This is a type of senior living that combines hospitality services (dining, housekeeping, laundry, maintenance, security) with social events and community amenities. Independent living communities often offer significant community amenities, larger apartments (500 sf -1,500 sf), and a maintenance-free lifestyle.
What is a community fee?
A community fee is a non-refundable, one-time fee paid by seniors to senior living communities at move-in. Community fees typically range from $1,000 to $5,000 or more. Many senior living communities use these fees to cover the costs of preparing an apartment to rent.
Community fees are charged by most care types including independent living, assisted living, and memory care. Nursing homes or skilled nursing facilities, however, rarely require an upfront community fee.
What is the Typical Cost of a Community Fee?
Community fees typically range from $1,000 - $5,000 or more. Very affordable communities will have a fee on the lower end of that range while luxury communities will likely charge more.
Community fees are often discounted in order to encourage seniors to move-in. These discounts may be as little as $1,000 off or as much as waiving the community fee altogether. This is often done when a community is struggling to fill-up or has an internal goal to reach a certain occupancy in a limited time.
Community Fees vs. Entrance Fees
Community fees are often confused with entrance fees at a continuing care retirement community (CCRC).
Smaller ($1k - 5k+)
No Care Included
Larger ($30k - 1M+)
May Prepay Care
Entrance fees are often much larger ($30k - $1MM+) and partially refundable. This is because, they are often used by communities to pay for some portion of the resident's care in the future. For instance, the resident may need one year in a skilled nursing facility, which is partially paid for by reducing the refundable portion of the entrance fee in half.
Some seniors like entrance fees due to certain tax advantages of prepaying for care. Other seniors like the lower upfront cost and reduced risk of community fees.
Assisted living is a type of senior living, or senior housing, that offers personal care and hospitality services (dining, housekeeping, etc.) to senior citizens. Some of the personal care services provided in assisted living include assistance with bathing, grooming, and medication management among others.
Assisted living comes in many different forms and costs. Some assisted living communities are standalone communities that don't offer other types of care. Other assisted living communities are part of larger senior housing campuses that may include independent living, memory care, and skilled nursing.
Some assisted living communities are affordable and have smaller or semi-private apartments. Others are luxurious with large apartments, rich amenities, and convenient services.
Whether large or small, affordable or luxurious, standalone or part of a larger campus, almost all assisted living communities offer the same basic services.
Key Assisted Living Services
Personal care services
Housing - apartment
Dining - 1-3 meals daily
Who Needs Assisted Living?
Most assisted living residents are in their 70's or 80's and need assistance with 1-2 activities of daily living or more. The age requirement is not particularly strict, with most communities only requiring that residents be 55 or 62 or older. The care needs for the resident, however, is more exacting in who qualifies for assisted living.
Assisted living communities, or appropriate state laws, typically require that assisted living residents need assistance with 1-2+ activities of daily living. The activities include bathing, dressing, grooming, toileting, eating, and medication management among others. If an appropriate doctor or other qualified medical professional has determined that the senior needs assistance with 1-2 or more of these activities of daily living, then the senior typically qualifies for assisted living.
So, Who Needs Independent Living?
If the senior doesn't need much care, then independent living is usually a better fit. Independent living is designed around a maintenance-free lifestyle with many conveniences, such as restaurant-style dining, maintenance, housekeeping, and social activities. Independent living communities are not designed to provide care services by default, by definition, but many independent living communities incorporate those services through a third-party or by licensing their independent living apartments for assisted living.
If a senior's needs are more intense, then he or she may need to find an assisted living community that provides care to high-acuity (high-need) residents. If that type of community isn't available or the resident needs 24/7 nursing care, then a nursing home may be the most appropriate type of care.
Assisted Living vs Nursing Homes
Many people think of assisted living communities as less care-intensive nursing homes. This is true in a sense that the residents in assisted living usually require less care than those in nursing homes. However, assisted living communities may differ in several other ways from nursing homes.
For example, assisted living communities typically offer larger apartments, more amenities, and better dining/social options. This makes the communities more attractive to prospective residents. Paying for these enhanced amenities and services, however, typically comes out of pocket.
How to Pay for Assisted Living
While nursing home care is typically more expensive than assisted living, most nursing home care is paid for by Medicaid, while nearly all assisted living is paid for primarily with private means. That means that residents need to come up with the funds from a couple of common sources.
Financing Assisted Living
Social security, pension, investment, or other income
Long-term care insurance
Sell a home or other asset
Receive assistance from friends or family
How Much Does Assisted Living Cost?
The median cost of assisted living in 2019 is $4,051 according to Genworth. These costs vary greatly from state-to-state and community-to-community. For instance, according to Genworth the most expensive state for assisted living in 2019 is New Hampshire with a median monthly cost of $7,021. The least expensive state for assisted living in 2019 is Missouri with a median monthly cost of $2,881.
Between communities and even within a community the costs of assisted living can vary dramatically. Luxury communities with more amenities (pool, coffee shop, theater, etc.) will charge more on average than more affordable communities that only offer the essentials. Inside a community, residents renting larger apartments, such as two-bedrooms, will often pay significantly more than those residents just renting a studio.
In addition to rent, many assisted living communities have additional care charges called "levels of care". Levels of care are often broken into 3-5 levels, with the higher levels requiring more care and costing more. For instance, a resident with limited care needs may only need a level 1 of care that costs $300 per month (paid on top of rent), while a resident with many care needs may be a level 3 with a monthly cost of $1,000 per month.
Personal care services are the primary form of care in assisted living. These services help senior residents get through their day by assisting them with daily activities that many of us take for granted; activities such as bathing, dressing, grooming, brushing our teeth, etc. The senior living industry calls these activities, the activities of daily living.
Getting assistance with the activities of daily living can be a big boost in the welfare and wellbeing of seniors in assisted living. For instance, receiving assistance with bathing and grooming can help residents avoid infections and other diseases.
Activities of Daily Living
One of the most important personal care services offered by assisted living communities is medication management. Medication Management is the ordering, organizing, and administering of medications to seniors. Since consistent compliance with a medicine regimen can be key to better health for many seniors, this assistance can be invaluable. Many seniors, for instance, take 10+ medication pills or supplements daily. Keeping up with this can be very difficult, especially for someone that may be suffering with some memory loss.
What are Assisted Living Apartments Like?
Assisted living apartments are typically studios, one-bedrooms, or two-bedrooms with most apartments falling in the 250-800 sf range in size. Certain
Assisted living apartments typically include a living area, one or more sleeping areas, a bathroom, and a kitchenette or kitchen. That being said, there can be a larger variation in assisted living apartments and sleeping arrangements.
For instance, in more affordable assisted living apartments semi-private or companion suites are common. This means that two residents live in the same room or apartment. This is particularly true for memory care communities.
Studios are also common in most assisted living communities. Studio apartments feature a combined living and sleeping room as opposed to having a separate bedroom for sleeping.
More luxurious assisted living communities may offer two or even three-bedroom apartments. These apartments offer additional space and may give couples the extra bathroom that they need.
Temporary stays in a senior living community; these are also known as respite care. Short-term stays are commonly used to test drive life in the community, while a caregiver is on vacation, or to receive therapy or rehabilitation services while recovering from a surgery or a medical procedure.
How are nursing homes different from assisted living communities?
Nursing homes focus on direct medical care, with an emphasis on therapy, in addition to providing the same personal care services as assisted living communities. Assisted living communities are typically more hospitality focused than nursing homes, which are institutional in nature.
How is memory care different from assisted living?
Memory care is a subset of assisted living where the services are designed specifically for residents suffering from dementia or Alzheimer's. Memory care is often provided in a secure neighborhood (to prevent wandering) with unique design features and requirements for staff training. Since memory care residents require more assistance than assisted living residents, memory care is often more expensive. In addition, memory care apartments tend to be smaller (250 sf - 600 sf) versus assisted living apartments (250 sf - 1,200. sf). Occasionally, memory care is provided in a nursing home, but this is usually the most expensive solution.
How is assisted living different from independent living?
Personal care services are provided in assisted living, but are not provided in independent living (with a few exceptions). There are other common differences between independent living and assisted living, but these can vary greatly from community-to-community. Independent living apartments tend to be larger (500 - 1,500 sf or more) versus assisted living apartments (250 - 1,200 sf). Independent living facilities may focus on hospitality and amenities while assisted living communities focus on care, but this can vary significantly. Independent living residents tend to be younger (average in the low 80's), but this average has been increasing over the past couple of years such that it is almost the same as the average for assisted living. Both independent and assisted living can be great options, but the better choice really depends on your situation and care needs.
Is senior living more expensive than home care?
The cost of senior living is often comparable to living at home with the same services, but the bundled nature of senior living (hospitality services and care are often included in rent) can make it difficult to compare. If you go to any senior living community and ask for a cost comparison with staying at home, they will provide a comparison chart that lists all of the items included in senior living (food, real estate taxes, housekeeping, maintenance, utilities, entertainment, etc.) on one side, and on the other side gives you space to write-in how much the same items cost at home. The point of the exercise is that senior living includes way more than housing, and when you add up all of the benefits, it is often nearly the same price or cheaper than staying at home.
How are entrance fees different from community fees?
Entrance fees are typically larger ($30k - $1 million or more) and partially or fully refundable fees charged by continuing care retirement communities. Community fees are typically smaller ($500 - $10k or more), but are non-refundable and are charged by what the senior living industry calls "rental" communities. Both are paid at or near move-in and are only charged once. A community will either charge an entrance fee or a community fee, but never both.
Why is senior living expensive?
Senior living includes way more than housing, which can make it seem more expensive at first blush. For example, it often includes housing, utilities, real estate taxes, dining/food, social events, transportation, maintenance, housekeeping services, laundry services, and care. These goods and services are bundled into a single monthly payment (most communities break-out care and some additional costs). The bundled payment is similar to staying at an all-inclusive resort in the Caribbean where the meals, drinks, and resort amenities come with the nightly room rental. Since many services are included in the monthly rent, it is very important that you make a well-informed decision on where you choose to live.
Unfortunately, several economic factors are increasing the cost of senior living. Construction of new facilities has not kept up with the tremendous population growth for seniors. In addition, labor costs, which can exceed 50% of the costs to operate a community, can be high in certain areas. These factors are driving costs higher.
I can’t imagine living in a senior living community; tell me why I’m wrong.
We are in a golden age for senior living. New providers and communities are popping up everyday with exciting features, amenities, technology, and exceptional services. These communities offer movie theaters, general stores, community gardens, swimming pools, on-site therapy, fine dining, trips to local sporting events or live theater, convenient transportation to shopping or church or medical appointments...the list goes on and on. Many people think of industrial, run-down nursing homes when they hear about senior living. Times have changed. Your opportunities to find great food, friendship, convenience, care, and hospitality in a senior living community have never been better.
Why do some communities charge a community fee?
Senior living communities charge a community fee to help cover expenses incurred in renting apartments. The community may use the fee to cover the cost of replacing carpet, painting walls, replacing furniture, marketing the apartment, or simply to serve as revenue for the community.
Many seniors do not understand community fees or are annoyed by them, but essentially, these fees are another form of income for the assisted living provider. This source of income can be added to the monthly rent, levels of care, or other fees paid by senior living residents. Together they permit the community to cover the labor and upkeep costs of running a senior living community.
Many people mistake community fees with entrance fees. Entrance fees, however, are larger fees paid to continuing care retirement communities that may or may not be refundable. Community fees are rarely refundable, but are also much smaller.
If you're looking at a particular senior living community, but the community fee seems like a major barrier, then you may consider asking for a reduced or eliminated community fee. Community fees are often one of the most negotiable costs paid to assisted living communities.
Why do levels of care costs vary so much between communities?
Senior living communities use different pricing strategies to market to residents. Some will offer a low monthly rent, but have higher levels of care fees to make up the difference. Others will offer a care-inclusive model with one price no matter how much care the resident uses. Still others will include level one of care in the monthly rent, but charge additional levels.
The pricing models don't matter per se, what matters most is your all-in monthly cost, what you get for that cost, and how much it will change over time. For instance, a community where care is separate may be cheaper initially, but as a resident's level of care increases then care separate model can become more expensive than a care-inclusive model, which offers a single inclusive price. To make sure that you're comparing apples-to-apples, always look at the levels of care and medication management fees in addition to the monthly rent.
I can’t find a community on Simply Senior Living; why isn’t it included?
We try hard to provide the most comprehensive group of senior living communities possible, but occasionally a community may choose not to be a part of our service. If a community that you're interested in is not listed on our website, please reach out to the community and let them know that you'd love to learn more about them on Simply Senior Living.
Why are entrance fees so high?
Continuing Care Retirement Communities use these fees to offset lower rent payments (sometimes, but not always lower), provide superior amenities and apartments, and to ensure access to care as the residents age.
I need assisted living, but my husband only needs independent living; can a couple with different care needs stay in the same apartment?
Sometimes, it depends on the state's regulations, the licensing for the particular apartment, and the community's policies. Typically, an independent living resident can stay with another resident in assisted living. However, an assisted living resident cannot stay with another resident in independent living, unless the particular apartment is licensed by the state as an assisted living apartment. Email communities on their community profile page to see if they can accommodate your arrangement.
The community that I want to live in does not offer medication management; how can I manage my medicines?
You can always use an organizational system or hire a home health agency. There are many helpful tools that have been developed to assist in medication management. These may be as simple as a Sunday-through-Saturday pill box or as complex (but simple to use) as a digital medicine dispenser/reminder system. Often, an adult child will setup and manage these tools to assist the resident in what can be a complex medicine regimen. Pharmacies can also assist by packaging all of your medicines in blister packages. Here is a list of links to some of these systems and services:
Simply Senior Living is providing these links for informational purposes only, as Simply Senior Living neither endorses or recommends these tools and has no financial interest in the companies selling/providing these services; our lawyers made us write that...
How are levels of care determined?
A resident will complete an assessment to determine which level of care is needed. The Healthcare Coordinator, or another staff member, guides the resident through the assessment by asking questions about the resident's routine, abilities, and needs. Based on the responses, the assessor will use a chart or tool to determine the level of care.
How can I pay for care?
You can pay with a long-term care insurance plan, Veterans Aid & Attendance, Medicaid (if eligible), by selling an asset such as a house, by paying out of pocket from investment or pension returns, by receiving assistance from friends and family members, or by some combination thereof. It is not uncommon for adult children to help their parents by paying 15-20% of the monthly costs of senior living. Senior living can be expensive, but there are several options to pay for care.
Veterans Aid & Attendance is a program that pays for part of your senior living costs if you or your spouse were in the military. More information can be found here. Most communities are familiar with this program and can help you receive your benefit if you decide to move into the community.
Are entrance fees refundable?
Yes, but it depends. Most entrance fees are setup with some refundability, but it is important to understand the conditions and amount of the refund. The refund may be a percentage of the original entrance fee (100%, 90%, 50%, etc.) or some other number. Some communities deduct the amount of care that you use from the entrance fee, or reduce it based on your length of stay. It is important to understand how much and under what scenarios you or your estate will receive a refund. For instance, some communities must rent or sell your unit prior to providing a refund. Entrance fees can be large amounts and may provide access to key care, but their potential cost and refundability need to be thoroughly understood before moving into a community.
What are shared or companion suites?
A shared, companion, or semi-private suite is an apartment that is shared by two residents. Shared or companion suites are more common in memory care or assisted living than independent living, and are often provided to offer a more affordable option.
Luxury companion suite in assisted living
The residents in companion suites are typically not related (i.e. not a couple, although siblings are not unheard of), since senior living communities often use a different pricing structure for couples.
Companion suites or semi-private apartments vary in privacy and space. The least private setup is a studio (two residents in the same room) with one bathroom. In this setup, the beds are typically placed shoulder-to-shoulder along the same wall with a tv on the other side of the room. This is a common setup in nursing homes and more affordable assisted living or memory care communities.
The most private companion suite type is a two-bedroom apartment where the residents have separate bedrooms and bathrooms, but share a common living area.
Monthly rent for companion suites is typically much more affordable, per resident, than rent for private assisted living apartments. Companion suites are often $1,000 - $2,000 per month per resident less than the same apartment rented privately. For example, a 350 sf studio in assisted living may rent for $4,500 per month if rented privately by one person. The same apartment may cost $3,300 per month per person if rented as a companion suite.
Residents in companion suites typically pay the same amount for additional charges as residents in private apartments pay. So, levels of care, medication management, and other charges are not cheaper for companion suite residents. This is because the additional costs to the community for those services are essentially the same whether a resident is in a companion or other suite.
Finding a Roommate
The senior living community is usually responsible for finding a roommate for a companion suite resident. Finding compatible roommates in senior living can be tough, so some seniors are lucky enough to have a semi-private room alone for a couple of months, but this fortunate situation does not usually last.
While some seniors appreciate the savings that companion suites in assisted living offer, others view these as a relic of an era when Medicaid-focused nursing homes were the primary senior housing option. As a result, many newer communities are eschewing shared apartments in favor of more private apartments.
Can an additional care taker accompany me in the community?
Yes, some families prefer to have a caretaker with the resident often or at all times. This is an expensive solution, but may provide additional peace of mind.
Will communities drive and escort me to medical appointments?
Yes, most communities include group or scheduled transportation that will take you to medical appointments. An escort on medical appointments is often an extra expense. If possible, having an adult child escort you to medical appointments can ensure a continuity of care.
How can communities help residents with diabetes?
Communities can serve balanced, regular meals that are diabetic friendly, monitor glucose levels, and administer insulin and other medications in consistent intervals and doses. The consistency in diet and blood sugar regulation can lead to improved health outcomes.
Can I receive home care in an independent living apartment?
Yes, almost all states permit you to receive home care in your independent living apartment since it is your home. Most home care providers are separate companies that will require separate billing, although some communities may coordinate with the home-care provider for a more seamless experience. Occasionally, independent living providers will discourage residents from receiving home care if assisted living is offered on-site.
How much does it cost to use Simply Senior Living?
Free to you! Simply Senior Living is a free service available to senior living residents, prospective residents, and their friends and family. Simply Senior Living is compensated only by senior living providers.
Do independent living communities provide medication management?
No, typically independent living communities cannot provide medication management due to state regulations. To work around this limitation, some communities will dual-license independent living apartments as assisted living apartments in order to provide these services. Otherwise, residents can hire a home health agency or utilize tools in managing medications.
How does Simply Senior Living earn money?
Simply Senior Living is a free service to senior living residents, prospective residents, and friends and family. If a prospective resident connects to a community through Simply Senior Living (emails, calls, etc.) and then moves into the community, then the member community (not the resident) is required to pay a portion of the first month's rent to Simply Senior Living. We have children to feed, after all, and a hungry dog or two as well.