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The Basics: Assisted Living for Your Parent

When it's wise, how to choose a facility, what it costs

By Jacob Edward

When your parent needs help with the basic activities of daily living, it may be time to look into an assisted living facility for him or her.
Choosing whether assisted living would be the right option can be a complex decision requiring a dispassionate evaluation of the situation and careful consideration.
3 Types of Assisted Living Candidates
Typically, you’ll identify the potential need for assisted living in one of three ways:
Your mother or father may have had a fall or hospitalization, after which a member of the hospital discharge staff (such as a social worker or nurse) recommends assisted living.
You, family members or your parent’s friends may notice a general decline in the maintenance of your mom or dad’s home and an avoidance of certain tasks that are now difficult but were formerly done with ease — such as cleaning the house, buying groceries and maintaining personal hygiene.
In cases like this, it’s very common for people to cover up or make excuses. So raising your concerns with a parent facing such sensitive issues should be done with the utmost care and respect. You may want to consult with a medical professional to help decide whether assisted living would be appropriate.
If your parent has been diagnosed with Alzheimer's disease or dementia, that could also be a time to consider an assisted living facility; more specifically, a specialized version called a memory care community. Its staffers are trained to deal with symptoms and behaviors that come with these diseases, such as wandering and agitation.

(MORE: Bringing Someone With Dementia Back to Life)
Your mother or father may be extremely resistant to the possibility of moving into an assisted living facility. It would not be an exaggeration to say that someone who has fallen repeatedly, resulting in multiple hospitalizations, will say: “I’m not ready for assisted living; that's for really old people.”
It's important for your parent and you to understand that an assisted living facility is different from a skilled nursing facility or nursing home, where patients are very sick and under care 24/7 or dying. Assisted living is for people who need help on a daily basis but are generally much healthier than nursing home patients.
Choosing an Assisted Living Facility
Once you and your parent are open to the idea of assisted living, the next step is identifying prospective communities.
The first thing to decide is whether you’re more interested in large communities or smaller residential care homes. Each has advantages and drawbacks.

(MORE: Relocating Your Parents)
A large assisted living facility — the kind most people think of — generally has about 50 to 100 residents, a group dining hall and shared common areas.
By contrast, residential care homes are smaller, usually renovated single-family homes, and house between three and 10 residents.
Larger communities offer greater possibilities to make new friends and more diverse amenities. That’s why they’re conducive to residents who are more independent.
Residential care homes may be a better choice for those with mobility issues, who need help getting to the toilet often and fall frequently. They typically offer far superior response times to residents’ calls than larger communities.
These homes also offer a much smaller staff — two to four primary caregivers. That allows for more chances to bond and can be helpful for people who are apprehensive of strangers or uncomfortable in large groups.
Once you find potential communities that seem like a good fit for your parent, check with your state's Department of Health for information about state inspections of the facilities. Most states put inspection reports on their health department’s website. If you can’t find it there, call the agency to get the lowdown by phone.

(MORE: PBS' Powerful Assisted Living Expose)
Paying for Assisted Living
Assisted living can be quite expensive, often ranging from $1,500 to $5000 per month (or $18,000 to $60,000 a year).
Your parent may qualify for a government subsidy to help cover the cost, either through Medicaid’s long-term care benefits or the Veteran’s Administration VA Aid and Attendance benefits, which pay for long-term care.
Each state has its own rules about qualifying for Medicaid benefits; applicants usually must complete a financial disclosure statement and receive a care assessment from the state.
Some states require Medicaid beneficiaries to live in state-run communities. Others only offer Medicaid coverage to residents in certain communities contracted with the Medicaid program. You can learn the rules in your parent's state at the federal government's website,
The VA program is available to veterans and their spouses if the vet served during a recognized period of wartime (such as World War II). Applications can take up to nine months to process. But for those who qualify and already have been receiving care, the VA will provide back pay from the application start date.
Be sure you fully understand an assisted living facility’s pricing policy and get an estimate of the entire cost to live there now, as well as a forecast for the future.
There may be a “base price” and then additional fees for certain services, known as “cost of care.”
If a facility uses the “cost of care” model, be sure to get its schedule for charging and increasing fees. Some unscrupulous homes move people in at the base price and then almost double the monthly charge by adjusting the cost of care after 30 or 60 days. You don’t want that to happen to you — or your parent.
Jacob Edward is the founder and manager of Senior Planning in Phoenix, which has helped many Arizona seniors and their families navigate the process of long-term care planning.

Jacob Edward is the founder and manager of Senior Planning, in Phoenix, Ariz., which has helped many Arizona seniors and their families navigate the process of long-term care planning. Read More
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