How Much Does Assisted Living Cost?

Assisted living facilities (AFL) are specialized community living residences designed to provide a safe environment for individuals who need help with activities of daily living (ADLs), which include bathing or showering, dressing, getting in and out of bed or a chair, walking, using the toilet and eating. The people who reside in such facilities are usually called residents. Assisted living residents may have medical needs, but they usually do not need extended, around-the-clock nursing care supervision, according to the National Council on Assisted Living (NCAL). The NCAL suggests thinking of assisted living as a bridge between living at home and living in a skilled nursing facility or nursing home.

Based on specific signs, placing a person in an assisted living facility might be the appropriate choice, according to Don Minter, a certified senior advisor and certified dementia practitioner in the Kansas City area. Below are indicators and signs that can help you make a decision regarding whether an assisted living facility is the right choice:

• Increased number of falls or significant risk of falls
• Wandering away from home and not being able to navigate back
• Wearing the same clothes on multiple consecutive days
• An unsafe, cluttered or unclean home
• Frequently forgetting to take medications
• Difficulty with at least one ADL, such as bathing, preparing meals or using the bathroom independently
• A need for nighttime supervision that cannot be met by an in-home caregiver
• Repeating questions and making multiple phone calls with the same question
• Not eating nutritious meals or drinking enough fluids
• Unsafe behavior, such as leaving the stove on or exterior doors open

In addition, a thorough cognitive assessment of each client helps ensure that assisted living is the best fit for them, says Minter. “Many residents in assisted living have some form of dementia,” he says. “The biggest differentiating factor is if they are a ‘wander risk.’” For a person who might leave the community and not find their way back, a specialized memory care community might be the best option. Memory care is also necessary in advanced stages of dementia, when individuals may need full assistance with medications, eating, bathing, dressing and transferring from the bed to a chair, adds Minter.

To address an individual’s various needs, assisted living facilities offer a range of services. Some are included in the price of a resident’s monthly rent while others are provided at an additional cost, depending on the community’s policies. According to the NCAL, services most often available to the residents are:

• Around-the-clock assistance when needed, with some communities even providing medical alert systems for this purpose
• Up to three meals a day in a shared dining room
• Assistance with medications
• Assistance with bathing, dressing and navigating the bathroom
• Assistance with Alzheimer’s disease, dementia and other cognitive challenges
• Recreational and spiritual activities
• Laundry and linen services
• Housekeeping and maintenance services
• Transportation to medical appointments and grocery stores

In addition, facilities may coordinate care with outside medical, dental and other health providers chosen by the resident.

Assisted living residents often maintain plenty of independence and autonomy. “Many [assisted living residents] are able to drive,” says Minter. ”Many have pets that are allowed as long as they can take care of them. Overnight guests are allowed as well.” He adds that for safety, communities require residents to sign out when they leave the premises.

One major benefit of assisted living is that it allows the resident’s adult children and spouse to be family again rather than caregivers, says Minter. “The family will be able to concentrate on just having good times with their loved one instead of having to manage their day-to-day care needs,” he says.

Assisted living costs vary widely based on the location. In the Midwest, for example, the base cost of assisted living ranges from $3,500 to $8,000 per month, according to Minter. The number of occupants and size of the living space affect the price. An individual living in a studio-size apartment would pay less than a couple living in a larger apartment unit, for instance.

The geographic location dramatically affects the average cost of assisted living. Genworth, a financial advising company serving retirees, compiled the 2021 Cost of Care Survey, which lists the average cost of assisted living facilities in various U.S. locations. By entering your ZIP code, city and state, you can find the average price in your area. For example, the average assisted living monthly base price in San Francisco is $6,319. In Sioux Falls, South Dakota, it’s $2,910.

Additional charges that might be added to the base price depend on the level of care the resident needs, says Minter. An in-person assessment with a member of the facility’s medical staff determines the amount of help the person will need to complete their ADLs. Some assisted living facilities assign a point value to each ADL to determine the level of care (and price) required for a resident. Others use a tier system to determine levels of care and associated costs.

Medicare doesn’t cover any of the room and board or personal (caregiver or custodial) costs of assisted living, but it does cover most medical costs incurred while a person lives in an assisted living facility.

Private medical insurance doesn’t cover assisted living expenses, either, but long-term care insurance can help defray the cost. Be sure to read the fine print on your policy, though. Most long-term care insurers require that the policyholder needs assistance with at least two ADLs to receive benefits.

Some life insurance policies have a cash-out value that may be used toward long-term care expenses. An “advanced death benefit” (ADB) in a policy grants the policyholder a tax-free advance on their death benefit while they’re still alive.

A “life settlement” is an option by which a life insurance policyholder sells their policy to a third-party company for a lump sum. This amount will be smaller than the full policy death benefit, but it can be used to cover the costs of assisted living.

Fortunately, options beyond insurance can provide financial help when it comes to paying for assisted living. However, these programs require applicants to meet specific criteria in order to qualify.

Veteran Benefits

Aid & Attendance (A&A) is a need-based benefit offered to eligible veterans by the U.S. Department of Veterans Affairs (VA). Received in addition to a VA pension, this monthly stipend may be used to cover the cost of a long-term care or assisted living facility.

In order to be eligible for this benefit, a veteran must meet at least one of the following criteria:

• They are confined to a bed.
• They are a resident of a long-term care facility.
• They need assistance with ADLs.
• They have severe vision impairment.

Medicaid

Medicaid covers some costs of assisted living for residents who qualify. Recipients must:

• Live in the state where they’re applying for Medicaid.
• Reside in an assisted living facility that’s licensed for Medicaid.
• Meet certain financial need requirements.
• Demonstrate a functional need for assisted living.

Benefits and requirements vary from state to state.

Reverse Mortgages

With a reverse mortgage, a person borrows against the equity in their home. The most common type of reverse mortgage is a Home Equity Conversion Mortgage (HECM). These mortgages are available only to homeowners who are at least 62 years old.

The home’s title remains in the homeowner’s name, and no mortgage payments are made over the life of the loan. Unlike a conventional mortgage, interest and fees make the amount owed on the loan increase over time, decreasing the homeowner’s equity.

The home must remain the principal residence of the borrower, so a reverse mortgage can only be used to pay for assisted living if there is a second borrower still living in the home.

The loan is repaid (either by the homeowner or heirs) when the homeowner no longer lives in the home.