Assisted Living Options For People With Disabilities

Assisted living communities are residential options for older adults who need help with at least two of the six essential activities of daily living (ADLs) below:

• Moving from place to place independently
• Feeding oneself
• Dressing
• Managing personal hygiene tasks, such as bathing and grooming
• Controlling one’s bladder and bowel activity
• Accessing the toilet and using it appropriately

Assisted living residents often enjoy private apartments with staff assistance as needed. Communities typically provide access to 24-hour non-medical or nursing staff, along with three daily meals, housekeeping, transportation services and social outings and events. Assisted living residents typically pay different monthly rent rates based on their required levels of care, and facilities are often regulated at the state level.

An older adult with a disability may qualify as a person with a disability under the Americans with Disabilities Act (ADA), a federal civil rights law that protects access to work, education and community for people with disabilities.

The ADA defines disability as:

• A physical or mental impairment that substantially limits a major life activity
• A record of having such a disability
• Being regarded as having such an impairment

For example, an older person who has mobility challenges or cognitive issues may qualify as a person with a disability under the ADA. Someone with vision or hearing loss or another physical or intellectual impairment may also have a disability under the ADA.

Most assisted living communities accommodate people with mobility, vision and other age-related challenges. However, communities can further improve accommodations with assistive technologies, says Sharon McLennon-Wier, Ph.D., executive director of the Center for Independence of the Disabled in the New York City area.

“[For example], installing hearing induction loops in common spaces, such as meeting rooms, recreational spaces and lecture rooms, can assist a person with hearing loss to participate in the activities,” says Dr. McLennon-Wier.

Assisted living communities can also provide devices with voiceover capabilities that assist residents with vision loss with everyday activities, including reading digital media and books or using the television, says McLennon-Wier.

Assisted living communities are often built with disability and ADA compliance in mind, says Matt Salmon, CEO of SALMON Health and Retirement, which operates four assisted living communities in Massachusetts. However, assisted living communities can make additional accommodations based on the needs of the resident, he says.

For example, a community might set up an apartment differently, moving the bed to accommodate a person with immobility on one side of their body. Or if someone can’t walk the length of the hallway safely, a resident may be assigned an available apartment closer to common areas.

“We accommodate based on individual resident needs,” says Salmon. “Somebody may be more independent or less independent with the same diagnosis or the same disability.”

Meanwhile, finding an assisted living community for someone with an intellectual and developmental disability (I/DD) like Down syndrome is challenging. People with Down syndrome experience accelerated aging, which means they may need assisted living as early as their 40s or 50s. A person with Down syndrome also has an estimated 50% chance of developing dementia due to Alzheimer’s disease as they age, according to the National Institute on Aging^[2]Alzheimer’s disease in people with Down syndrome. National Institute on Aging. Accessed 8/3/2023. .

“When you start to get into [disabilities] like Down syndrome and developmental disabilities, facilities may not have that expertise,” says Salmon. “That’s not to say they can’t work with families to provide appropriate accommodations, but it does become very resident and facility specific as you’re making those decisions.”

Many assisted living communities are reluctant to accept residents with an I/DD because they don’t know how to handle them when they develop dementia or other cognitive issues, says Molly Nocon, CEO of Noah Homes in Spring Valley, California. Noah Homes operates lifelong residential housing options and two memory care homes for people with I/DD.

“[People with an I/DD] have more emotional outbreaks and behaviors that assisted living staff just aren’t trained for,” says Nocon. “I’ve yet to find a state [with a program] that allows I/DD folks to enter an interim facility before going straight to a nursing home. It’s very rare, and it’s starting to become more noticeable because there’s a crisis.”

The two primary types of residences that support older adults with disabilities include assisted living communities and adult foster care or group homes.

Assisted Living Communities

Assisted living community residents typically rent a private apartment and receive three meals daily, enjoy a range of amenities and receive help with ADLs. However, many assisted living communities are unprepared for more complex disabilities like I/DDs and don’t admit residents whose care needs exceed the facility’s care capacity.

Adult Foster Care or Group Homes

Licensed by the state in which they’re located, adult foster care and group homes often provide assistance with ADLs and a home-like environment that typically includes a small number of people (typically three to five, no more than 20) receiving care. Caregivers can also live in these residences.

The national median monthly cost of assisted living in 2023 is $4,774, according to the Genworth Cost of Care Survey^[3]Genworth Cost of Care Survey. Genworth. Accessed 8/3/2023. . However, prices vary significantly depending on geographic location, the community and its amenities, and the specific level of care required by the resident.

Meanwhile, adult foster care homes tend to cost between $2,000 and $5,000 per month, depending on the type of home and its location.

Medicare doesn’t pay for assisted living or other long-term care. However, all states provide Medicaid coverage for people with a disability who qualify based on income and family size, according to the U.S. Department of Health and Human Services.

Some states offer waivers based on income eligibility to help older adults with disabilities pay for certain assisted living costs. However, many require a nursing level of care for eligibility, which is around-the-clock care similar to what’s provided in a skilled nursing facility rather than an assisted living community. Contact your state’s Medicaid agency for eligibility requirements and limitations for assisted living coverage.

Long-term care insurance typically helps pay for assisted living depending on the particular policy. An individual may also qualify for assisted living coverage for assisted living services—but not rent—from the Veterans Administration (VA) if they’re enrolled in VA health care and meet income and other eligibility requirements.

People with a disability or parents or guardians of an adult with I/DD should first contact local social service agencies, says Nocon, that can provide information on assisted living and adult foster care for adults with disabilities. Also search city, state and county resources for older adults with disabilities.

Additional resources for finding assisted living for older adults with disabilities include:

• BenefitsCheckUp, which offers resources on housing programs for older adults.
• Benefit Finder, a government resource that can help identify benefits for which a person with a disability may be eligible.
• The Veterans Administration, which provides assistance to eligible veterans.