Assisted Living


Assisted living residences or assisted living facilities (ALFs) are residential facilities that provide assistance with daily living activities, the coordination of services by health care agencies and the monitoring of residents to promote their well being, and health.

The type of assistance is tailored to the individual but can include administering medication, assisting with daily hygiene, provision of food, and other types of personal care. People who make use of assisted living facilities generally are no longer able to live independently, but also no not require around the clock care or monitoring such as is found in a nursing home.

Assisted living facilities are regulated at the state level. Assisted living facilities have gain in popularity over the past several decades as an alternative for individuals who are recuperating from a hospital stay or major illness and who seek a level of recovery so they may once again live independently. For other individuals who are not fully prepared for a nursing home, assisted living can be a transitional living arrangement.

Assisted living communities can be run by for-profit or non-profit organizations.  Residents determine their own schedule for sleeping, eating, bathing, and exercising.

Assisted living usually offers residents a variety of social events, outings, and group activities, but residents are also encouraged to engage in their own independent activities at their own discretion. As such, assisted living facilities are less structured and insitutionalized than nursing homes.

Selecting an Assisted Living Facility

Recognize that assisted living facilities may be a wonderful option for someone who wants to have quality care available, desires certain aspects of their life to be independent, but also desires to have assistance available on an on-demand basis. Recognize that an assisted living option can provide peace of mind, safety, and the recognition that independent living is not a feasible option for the moment. If you are considering an assisted living facility, consider these factors.

  1. Will an assisted living facility provide a higher level of care and quality of life than a nursing home? What resources does a given assisted living facility provide that are not available in a nursing home or would be available if you had someone provide homecare?
  2. What is the cost of assisted living compared to a nursing home? Does the assisted living facility have residential options (such as apartments or townhomes) should there be less care or assistance in the future?
  3. Ask the following questions when you visit an assisted living facility:
  • How does the staff address a medical emergency?
  • What social events are available on a regular basis?
  • Are there facilities for family or friends to stay for a day or two as a guest?
  • What level of articulation is provided with health care providers, social workers, and other health care services?
  • How many staff is there for the resident population? What are the job functions of the staff? What is the average length of employment of the staff?
  • What options are available should it be necessary to have a higher level of care?
  • What is the average length of stay for the residents in the facility?
  • What contractual obligations are there for residents of the facility?
  • What steps are taken to ensure the safety of the residents? Does the facility have a report documenting any safety inspections?
  • What is the range of ages of the residents and what type of medical conditions do they have?
  • Is there an advisory board for the facility? How are concerns by family members and residents addressed?
  • On average, how much direct care does the typical resident receive each day?

For a more detailed checklist of issues to consider when evaluating an assisted living facility, The Assisted Living Federation of America has produced a booklet entitled ” Guide to Choosing an Assisted living Residence.” This document is concise and well written resource.


The Assisted Living Federation of America offers a comprehensive Web site devoted to assisted living. This federation was established to represent the interests of the companies operating assisted living facilities. Their Web site offers these resources:

  • The ability to search for an assisted living facility in your area
  • The costs of assisted living and coverage offered by Medicare and Medicaid
  • A downloadable checklist for evaluating an assisted living facility
  • A searchable listing of state regulations for assisted living facilities
  • links to senior living services and associations and general information on aging

Medicare and Assisted Living. Under certain limited conditions, Medicare will pay some nursing home costs for Medicare beneficiaries who require skilled nursing or rehabilitation services. To be covered, you must receive the services from a Medicare certified skilled nursing home after a qualifying hospital stay. A qualifying hospital stay is the amount of time spent in a hospital just prior to entering a nursing home. This is at least three days. To learn more about Medicare payment for skilled nursing home costs, contact your Medicare Fiscal Intermediary or the

State Health Insurance Assistance Program (SHIP) in your State.

Medicaid and Assisted Living

In assisted living, Medicaid will not pay for “room and board”: living quarters, meals, utility bills, etc. However, state Medicaid programs may pay for personal care services provided in the assisted living facility. Examples of “personal care services” are assistance provided to residents in bathing, dressing, eating, cooking, or cleaning. Personal care services in general are less medical than home health care. The services usually are provided by individuals with relatively little training, at least in comparison to the years of training required of nurses and therapists

Usually, in order to be covered by Medicaid, personal care services must be approved by a doctor and be part of a comprehensive plan of service individualized to meet the resident’s needs. Personal care services can be provided through an agency (similar to how home health services are provided by a home health agency), but increasingly personal care services are provided by individuals unaffiliated with an agency.

In most states, Medicaid-funded personal care services are available only to those residents who receive care through a Home and Community-Based Services (HCBS) waiver. The term “waiver” is used because, for home and community-based services, the federal government has waived the general requirement that all Medicaid services be available equally to any eligible individual within the state. Because this rule has been waived, the state Medicaid program can choose to offer home and community-based services only to a limited number of eligible persons. An HCBS waiver is meant to keep individuals out of nursing homes to the extent possible. Accordingly, HCBS waiver services are available only to those individuals whose medical or physical condition otherwise would have required nursing home care. In general, the services provided through the HCBS waiver must be no more expensive than what nursing home care would have cost for that same resident.

In a relatively small number of states, eligibility for HCBS waiver services is not required for receipt of personal care services. In these states, it is not necessary that an elder have a medical need for nursing home services, and the state must provide personal care services to all eligible Medicaid beneficiaries, without any waiting list. In many cases, however, the state Medicaid program will not authorize the number of hours of personal care services that the elder feels that he or she needs.

For information on whether assisted living is covered under your state’s Medicaid program, contact your state program. Click here for a list of contact information for each state.

The American Health Care Association’s National Center for Assisted Living provides an easy to read description of the purpose of assisted living, personnel and services provided by assisted living, ways to finance assisted living and a comprehensive worksheet for evaluating an assisted living facility and financing care. The on-line resource also provides a link to locate assisted living facilities in your area.  and Living Senior are commercial sites which provide a unique resource for locating nursing homes, assisted living facilities, memory care centers, hospice care,independent living centers, respite centers and care homes. Users can enter their city or zip code to locate each of the aforementioned facilities in their area. In addition to providing information on facilities in one’s area, this site provides a description of the different living or care options, financing for that care, and checklist for criteria one should consider in selecting that type of facility. These sites provide is a rich resource for individuals who are seeking to locate senior living options in a specific geographic area.

Photo by: Jenny Downing