1. Much as you may want your loved one to be able to live at home for the rest of his or her life, this may not always be possible. As an adult caregiver, it’s important to be realistic about when your loved one needs too much help to stay in the home. Once you have decided that a move is necessary, evaluate your options. One option is an assisted living facility (ALF).


    Just thirty years ago, older adults whose needs could no longer be met at home had just one option: nursing home placement. This resulted in many adults who were still relatively independent being placed in restrictive and often depressing settings.

    The 1980s saw the introduction of assisted living facilities. ALFs were designed for people who needed some help with the activities of daily living but did not require the 24-hour care and supervision provided by a nursing home.

    Today the United States boasts over 36,000 state-licensed assisted living facilities. About one million residents live in ALFs. Of those one million, 31% to 47% are cognitively impaired by diseases such as Alzheimer’s or vascular dementia.


    There are several reasons why your loved one might prefer living in an ALF to living in a nursing home. Although each facility is different, most ALFs offer private apartments instead of the two-to-a-room minimum expected by most nursing homes.

    Most ALFs look more like apartment complexes or townhouses than they do nursing homes. Some are built to handle a large number of clients, but others are designed for just a handful of people, making it easier for your loved ones to get to know his or her new housemates.

    ALFs also tend to offer more activities such as shopping, going to the movies, going to a casino or simply dining out. Activities such as music programs and games are also provided inside the facility. ALFs do not force anyone to participate, however. If your loved one is more comfortable staying in his or her apartment and reading a book or watching television, that’s okay, too.


    As the name suggests, the staff at assisted living facilities helps residents with the activities of daily living. In a 2001 publication, the National Center for Assisted Living stated that 86% of ALF residents needed help managing their medications; 76% needed assistance with bathing; 57% required help to get dressed; 41% needed someone to help them get to the toilet, 36% needed help transferring from bed to wheelchair and 23% needed to be fed.

    Assisted living facilities typically also provide three meals per day in a common dining room or in the resident’s room, light housekeeping services and laundry.

    Many assisted living facilities also provide memory care services to people with dementia.


    If your loved one has a progressive neurological or physical condition, there will come a time when he or she needs more care than the ALF can provide. One study conducted in 2000 found that 78% of residents who left assisted living facilities did so because they required more care.

    Since moving can be traumatic, it’s a wise idea to have an honest talk with an ALF before placing your loved one there. If the facility can just barely meet your loved one’s needs now, it may make more sense to move your loved one into a nursing home from the beginning.   


    Unlike nursing facilities, which face stiff federal as well as state regulations, ALFs are regulated only by the state. This means that the rules, oversight, and quality of care can vary significantly from one location to another.

    It also means that different states have different rules about which residents are appropriate for assisted living placement. Some, for instance, merely state that the ALF resident cannot require 24-hour skilled nursing care. Other states ask much more of their ALF residents. "Pathway to Safety" states, for instance, require that an ALF resident be able to independently find his or her way out of the building in the event of a fire or other emergency.

    Who Pays?

    ALFs are typically less expensive than nursing homes, but they are not cheap by any stretch of the imagination. Depending on where your loved one lives, he or she can expect to pay anywhere between $2500 to $4000 per month for care in an ALF. The majority of assisted living residents, 86%, pay these charges out of their own income and assets.

    In 41 states, the Medicaid program covers the cost of assisted living for low-income residents who do not have many assets; approximately 11% of people in ALFs are on Medicaid.

    The rest have other payor sources such as long term care insurance.

    Checking Out ALFs

    If your loved one needs to move out of his or her home, and you think an ALF might be an appropriate placement, check with several assisted living facilities in your immediate area. Get a feel for prices, services, amenities, and any state-mandated limitations on care. If your loved one is cognitively able to participate in this decision, get his or her input as well. Honoring your loved one’s wishes as much as possible will make the move less traumatic.

    The Assisted Living Federation of America (ALFA) offers valuable information to consumers including a list of questions you may want to ask before selecting an assisted living facility.

    Just because your loved one is no longer safe at home does not mean a nursing facility is your only option. Check first to see if your loved one’s needs can be met by an assisted living facility.


    Do you have questions about this article, or is there an adult caregiver topic I haven’t tackled that you would like to see? If so, please send me an email.

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