Assisted living programs are sometimes known as "board and care" or "residential care." They provide a way for America's elderly population to remain independent while at the same time receive help with daily tasks, like dressing, when needed.

Assisted living is a good alternative to a skilled nursing home when your loved one is still able to care for him or herself to some degree and doesn't need intensive medical or nursing care.

The operations and services offered by these programs vary from facility to facility. Licensing and other requirements also vary greatly from state to state.

Where Are Assisted Living Services Provided?

Assisted living services aren't provided in your loved one's own home. Aside from that, the services may be delivered in any type of building, ranging from single-family homes to residential facilities. A resident may live in a single room, in a one-bedroom apartment, or in a multi-room apartment with another resident-patient.

Licensing of Facilities

In most states, assisted living programs must be licensed, and they can provide only those services that are specifically listed in that state's laws. The services vary from state to state, so be sure to check the laws in your area to see if your local assisted living facilities give the services that your loved one needs.

Also, the programs must comply with health and safety laws, and they are subject to strict requirements regarding how they operate their facilities. State regulations may govern everything from the ingredients meals must contain to requiring locks on laundry room doors.

State officials typically review each facility at least once a year to ensure they meet health and safety laws. If a facility violates state law, it is subject to sanctions, such as limits on the number of individuals it may serve and fines.

State licensing boards keep records of these reviews. They also keep information about complaints and any resulting investigation and action taken. These licensing boards usually provide this valuable information to prospective assisted living clients upon request.

Services Provided

Typically, assisted living programs provide services such as:

  • Meal preparation
  • Assistance with daily hygiene and dressing
  • Housekeeping
  • Laundry

The amount of help provided in daily dressing and grooming depends upon each resident-patient's needs. Needs assessments, or evaluations, are provided before a resident moves into the facility or shortly thereafter. Needs are reassessed periodically to ensure they are being met.

Typically, assisted living programs can't provide ongoing skilled nursing care, such as:

  • Ventilator services
  • Intravenous therapies or medications
  • Skilled health monitoring

If a resident's condition worsens and skilled nursing care is necessary, state law governs whether he or she must be moved to a different facility. Some states allow assisted living programs to provide these services on a limited basis. Other states, however, absolutely prohibit assisted living programs from providing these services. The patient must be moved to a skilled nursing facility or a hospice.

What Records Must Assisted Living Programs Keep?

Most states require that facilities keep not only a resident's identifying information and health records, but also a copy of the agreement signed when the client moved in, the service plan, a list of emergency contacts, and medical orders and care notes. Again, the laws in your state will specify what records must be kept.

Paying for Assisted Living Care

Almost always, the resident (or his or her family) must pay the cost of assisted living. Medicare doesn't cover assisted living, and Medicaid assistance is rare, although some states are starting to cover some of the services provided.

Be certain to find out exactly how much a facility charges for "basic" care, included services, and how much any additional services will cost, such as providing special dietary needs.

The Contract

In most, if not all cases, you'll have to sign a contract or some type of agreement with the facility. The agreement will specify things like price and the types of services that your loved one will receive.

Sometimes, a key aspect in the contract is a "negotiated risk" clause, that is, an agreement on the risk the resident is willing to take. For example, it might specify that a resident doesn't want help with dressing, despite risk of falling based on a past fall.

Often, it will also include a "waiver of liability," where the resident agrees not to hold the facility liable for problems resulting from the negotiated risk. Again, state law governs whether a facility can include a waiver of liability in its contracts.

It is critical that you read and understand the contract completely. Check with an attorney who is experienced in elder law to make sure it's fair and legal.

Questions for Your Attorney

  • If my mother signs a contract with an assisted living facility, can she end it at any time?
  • Can a facility require that I sign a waiver of all liability on behalf of my parent or loved one?
  • I asked for a copy of my mother's records, but the staff at the assisted living facility hasn't given them to me yet. What can I do?