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

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

The operations and services offered by these facilities of course vary from facility to facility, and licensing and other requirements also vary greatly from state to state.

Where Are Assisted Living Services Provided?

Assisted living services are not 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 usually govern everything from what ingredients meals must contain, to requiring locks on laundry room doors.

State licensure programs typically review each facility at least once a year to ensure compliance with health and safety laws and to ensure that programs do not exceed their licensed levels of care. If a program violates state law, it is subject to sanctions, such as limiting the number of individuals it may serve, as well as civil and criminal penalties.

State licensing boards keep information about these reviews. They also keep information about complaints they have received 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 always provided before a resident moves into the facility or shortly thereafter, and needs are reassessed at periodic intervals to ensure that they are being met.

Typically, assisted living programs cannot provide ongoing skilled nursing care, such as:

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

If a resident's condition worsens so that 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, and so a patient must be moved, usually 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 client's service plan, and the client's 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 does not 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, what services "basic" care includes, 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 that the resident is willing to take. For example, it might specify that a resident does not want assistance in dressing, despite the risk that he or she has a history of falling.

Often, it will also include a "waiver of liability," where the resident agrees that he or she will not 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 but she later changes her mind and wants to move, will she be able to?
• Can a facility require that I sign a waiver of all liability?
• I requested 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?

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