Clients who shudder at the thought of entering a nursing home may be much more open to the idea of moving into an assisted living facility that offers one-bedroom apartments, a garden, an atrium and a piano lounge.
But the same regulatory flexibility that makes the facilities attractive and popular can lead to confusion, or worse, for residents and their families.
"These problems occur at every economic level, from $50,000-a-month or more paid to luxury assisted living to the 20% of seniors who access assisted living through public funds," Richard Mollot, executive director of the Long Term Care Community Coalition, testified in Washington last month at a Senate Special Committee on Aging hearing on assisted living facilities.
Sen. Bob Casey, D-Pa., the chair of the committee, noted that the hearing was the first the committee had held on assisted living in about 20 years.
"It's long past time for Congress to reexamine this model and ensure it's meeting our nation's needs," Casey said.
Here are 10 things any advisor who helps clients with retirement planning or income planning needs to know about the realities of how U.S. assisted living facilities work, drawn from the written testimony submitted for the hearing and from oral testimony given at the hearing.
1. U.S. assisted living facilities have a higher population than North Dakota.
North Dakota has about 800,000 residents.
The United States has about 30,600 assisted living facilities, and those facilities have about 478,500 workers, 1.2 million licensed beds and 818,800 residents, according to Jennifer Craft Morgan, director of the Georgia State University Gerontology Institute in Waleska, Georgia.
That means about one in every 400 U.S. residents lives in an assisted living facility.
Aside from true ultra-high-net-worth clients who can easily bring skilled nursing facility-level care to their homes, most clients who are doing anything about long-term care planning are probably thinking about the possibility that they could end up spending time in an assisted living facility, or in a continuing care retirement community that includes an assisted living facility component.
2. The facilities are supposed to serve people who need a little assistance with living.
A typical facility offers round-the-clock supervision; help with cooking, housekeeping and maintenance; medication management; and some help with personal care, such as showering.
"This differs from nursing home care in that there is no promise of 24/7 access to medical services or constant supervision" in assisted living, Craft Morgan said.
3. Many facility residents need extensive support.
Partly because older people and their families often prefer hotel-like assisted living facilities to hospital-like nursing homes, and partly because assisted living facilities need to fill beds, the facilities are serving many residents who need something close to nursing home-level care.
They may give a client a quick dementia and functionality test but go easy on the grading for a pleasant individual who can afford the monthly payments.
This means that families end up finding ways to add services that assisted living facilities rarely provide, such as home health care, physical therapy, occupational therapy and hospice, Craft Morgan said.
"About 42% of assisted living residents have a dementia diagnosis," she added.
One problem is that well-meaning clients who have lobbied to get Mom into the lovely ordinary assisted living facility apartments, rather than the smaller, darker, more closely watched memory care units, may learn than Mom has "eloped," or wandered out of the facility without supervision.
Elopement can lead to embarrassment for Mom's children and a quick shift to memory care at best, and, at worst, anxiety, injury or even death for Mom.
4. "Typically less expensive than nursing home care" does not necessarily mean cheap.
Casey reported in his opening remarks that assisted living facility care costs about $54,000 per year, or $4,500 per month.
Patricia Vessenmeyer, a family caregiver from Gainesville, Virginia, said that the starting figure for care for her husband was $7,900 per month but that care actually ended up costing $13,000 per month.
