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Assisted Living Facilities: An Introduction

By Emily McDowell

What is assisted living? The Assisted Living Federation of America (ALFA) defines assisted living as "the housing and health care alternative combining independence with personal care in a warm, dignified, community setting." An assisted living facility is a viable option to consider if a loved one needs help with certain activities, from meal preparation to bathing, yet doesn't want or need to be completely dependent upon a caregiver.

All accredited assisted living facilities provide room and board, 3 meals a day, 24-hour security and emergency assistance, housekeeping, laundry services, and social activities. In addition, they are equipped to provide help with the basic ADLs (Activities of Daily Living). These include dressing, eating, mobility, hygiene, bathing, toileting and incontinence, using the phone, and shopping. At some facilities, all of these services are included in the basic fees, while others charge supplemental fees.

Assisted living facilities do not provide regular nursing or rehabilitation services, such as those offered by a nursing home. Residents of an assisted living facility typically live in one- or two-bedroom units, with private bathrooms, that are furnished with the resident's own furniture. Couples can stay together, and residents can choose to live alone or with a roommate. At a nursing home, by contrast, the atmosphere is far ranging, from institutional, with many beds in a single large area, to hotel-like accommodations.

Assisted living facilities are community-oriented and inclusive, with structured social and recreational activities. When you evaluate a facility's "fit" for a loved one, make sure you consider the type of community it offers, its quality of care, safety, and value. On your visits, try to view the facility through the eyes of a resident: can you "picture" living there? Also, try to make several visits at varying times of day and stay overnight if possible. This way, you can get the best impression of a resident's experience.

Choosing an assisted living facility is somewhat akin to choosing a college for your child. There are thousands of these facilities nationwide, and they vary immensely in terms of fees, services, size and layout, and type of community offered. The average bill for basic assisted living service can range from $5,400 to $100,000 or more per year, and the vast majority of residents pay the bills out of their own pockets. According to the Public Policy Institute's Fact Sheet on Assisted Living (March 1999), the average annual income of assisted living residents is $31,000. Moreover, the majority of these residents are not receiving additional public or private financial assistance.

Choosing a facility--or even discussing this option with loved ones--is an extremely difficult process. Experts recommend beginning your search early if you can: six months to a year before the anticipated move will give you ample time to weigh your choices and thoroughly evaluate your options. Also, keep in mind that the best facilities often have waiting lists of two or more years, so it's definitely to your advantage to shop around and add your name to a list long before you're confronted with an immediate need.

The ALFA site features a nationwide directory of assisted living facilities, searchable by location, type of services offered, price, and more. You can also find listings of facilities at Many assisted living facilities have extensive Web pages, making it easier to narrow down your choices from home. You can also use the Eldercare locator service to help you find assisted living resources by calling (800) 677-1116.

Other recommended resources include, which includes nationwide listings of various types of retirement communities and senior housing, as well as tax resources for the elderly and a "virtual marketplace" where you can buy books, products, and services tailored to the needs of seniors. Also check out for more listings--nationwide and in Canada, Mexico, and the U.K. The Website of the Massachusetts Extended Care Federation ( lists facilities within Massachusetts only but contains valuable educational information about long-term care options and related topics.



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