Frequently Asked Questions
In Michigan, as well as throughout the nation, the concept of assisted living is experiencing phenomenal growth. This growth is actually a shift taking place in long term care services for the elderly. Pursuant to consumer demand, a wide variety of residential programs has been developd for the elderly who are looking for supports and services which are less costly and more homelike than traditional nursing homes. Consumers are keenly interested in the availability of personalized residential settings rather than more institutional environments.
This section contains answers to frequently asked questions from Association members and individuals concerned with assisted living. Select a question from the list below and you will be taken to the answer.
- What is assisted living?
- Who lives in assisted living residences?
- What types of residences are out there?
- How is assisted living regulated?
- What types of services are offered in assisted living residences?
- What about costs?
- Who pays the bill for an assisted living residence?
There are numerous definitions used throughout the country to define assisted living. Because of the great diversity in the physical plant characteristics as well as the level and intensity of services, it is most difficult to articulate one definition which is an accurate portrayal of all assisted living facilities.
In light of this difficulty, the Assisted Living Federation of America (ALFA) strategically addressed this issue by defining assisted living as a philosophy of care. Specifically, ALFA defines assisted living as:
"...a special combination of housing, supportive services, personalized assistance and health care designed to respond to the individual needs of those who need help with activities of daily living and instrumental activities of daily living. Supportive services are available 24 hours-a-day to meet scheduled and unscheduled needs in a way that promotes maximum dignity and independence for each resident and involves the resident’s family, neighbors and friends."
Currently, more than a million Americans are living in an estimated 30,000 to 40,000 assisted living communities. The vast majority of residents are frail elderly, with an average age of 83.
In Michigan, approximately 10,000 elderly adults reside in assisted living facilities licensed as Adult Foster Care homes. Approximately 11,000 elderly adults reside in licensed Homes for the Aged. Tens of thousands of other adults are estimated to be living in a variety of unlicensed community living or retirement residence settings which offer a wide range of supports and services. There is currently no generally accepted definition of assisted living in Michigan and no systematic means of counting these unlicensed facilities and their resident capacity.
There are dozens of variations on not only the physical plant characteristics BUT ALSO the array of supports and services available with an assisted living facility. An assisted living facility can range in appearance from a high-rise apartment complex to a converted Victorian home to a renovated school to a single family dwelling in a traditional residential neighborhood. Occupancy can range from one to two hundred or more individuals. There is no single blueprint because consumers’ preferences and needs vary widely.
The variety is great. An assisted living facility may be a free standing multi-occupancy apartment building with individual self-contained apartments. Residents may be very independent in their own apartment and have access to extensive common areas which are available for dining and activities. An assisted living facility may be a multi-occupancy building with private or semi-private bedrooms and bathrooms while common areas are used for all dining, socializing and activities. An assisted living facility may be a stand-alone facility or be one of several similar but independent facilities on a large parcel of property. Finally, an assisted living facility may be a single family dwelling with 2, 3 or 4 bedrooms with semi-private bathrooms and living, dining and recreational rooms.
While a number of federal agencies have some jurisdiction over consumer protection and quality of care in assisted living facilities, the individual states have the primary responsibility for developing standards and monitoring care provided in these programs.
In Michigan, the Bureau of Child and Adult Licensing (BCAL), part of the Department of Human Serives (DHS) (formerly the Family Independence Agency) is charged with the responsibility of licensing and monitoring assisted living facilities. There are currently two licensed categories which consist of Adult Foster Care homes and Homes for the Aged. In general, programs which provide 24-hour personal care, supervision and protection are required to be licensed. Specific exceptions occur where the consumer leases a private residence (i.e. apartment) and contracts with a home health care agency to provide personal care.
Due to the various levels of service and levels of intensity, it is difficult to compile a comprehensive list of the available services in assisted living facilities. However, the following services are typically available in an assisted living facility:
- Up to 24-hour staffing
- Meal preparation and accommodation for special diets
- Personal care and assistance with activities of daily living such as:
- Laundry and housekeeping
- Health promotion and maintenance programs
- Special needs programs for persons with dementia or Alzheimer’s disease
- Medication management
- Transportation to doctor’s offices and other appointments
- Organized social and recreational activities
- Community outings
While assisted living facilities are not rest homes or 24-hour skilled nursing homes, they do provide an extensive array of services through a variety of means. Many facilities directly provide the services while others utilize the services of a home health care agency or other professional health care-related service.
Costs vary with the residence, room size, and the types of services needed by the residents. Across the nation, daily basic fees range from approximately $20 to $200 -- generally less than the cost of home health services and nursing home care. A basic assisted living fee may cover all services or there may be additional charges for special services. Most assisted living residences charge month-to-month rates, but a few residences require long-term arrangements.
Residents or their families generally pay the cost of care from their own financial resources. Depending on the nature of an individual’s health insurance program or long-term care insurance policy, costs may be reimbursed. In addition, some residences have their own financial assistance programs. Government payments for assisted living residences have been limited. Some state and local governments offer subsidies for rent or services for low income elders. Others may provide subsidies in the form of an additional payment for those who receive Supplemental Security Income (SSI) or Medicaid. Some states also utilize Medicaid waiver programs to help pay for assisted living services.