Senior Living vs. Assisted Living Facilities: Which Option is Best?
Long before the emergence of nursing homes and assisted living facilities, families have been taking care of loved ones regardless of cost, convenience, or care needs. In the so-called simpler times, seniors moved in with adult children and grandchildren gave up time, attention, and personal space to dote on their elders during the final years of life. As time marched on, families began to move to various locations to raise their families and make a living, separating seniors from their adult children and grandchildren. This changed the delivery of senior care with impacts still evolving today.
History of Senior Living
Before assisted living facilities came to be, senior living options were limited to homes with adult children, nursing homes, or congregate care facilities. Almost four decades ago, assisted living facilities began offering a homelike alternative to the nursing home environment. The nursing home environment had grown out of the sanitariums and asylums of days gone by, improving the care practices and physical environment while remaining a congregate-care facility for the chronically and critically ill. Developers of the assisted living movement recognized that many of the residents of nursing homes could benefit from a less restrictive, homelike, and person-centered environment. They also recognized that by creating these assisted care facilities, they could reduce the average cost of care dramatically per person.
What is Assisted Living?
The state regulatory agency, the Agency for Health Care Administration (AHCA), defines assisted living in Florida as:
“An assisted living facility (ALF) is designed to provide personal care services in the least restrictive and most home-like environment. These facilities can range in size from one resident to several hundred and may offer a wide variety of personal and nursing services designed specifically to meet an individual’s personal needs.”
Benefits of Assisted Living Facilities
- Less restrictive
- Homelike
- Person-centered environment
As assisted living facilities evolved, so did the needs of the seniors in need of care. With families spread across the country and less involved – or less of an influence – in their loved ones’ lives, seniors waited longer and longer to seek residency at these facilities. The seniors for whom these facilities were built proved to be their toughest sale, often waiting for a crisis to make a move.
Assisted living facilities vary greatly in the services they provide, requirements of staffing, as well as admission and retention requirements. Because of these variations, it is often challenging for seniors and their families to determine what will meet their needs. And, as many want this to be their last move, which facility will meet their needs for the longest period.
Florida Assisted Living Facilities
In Florida, assisted living has been a high volume, highly evolutionary business. As of April 2022, there are 3,096 assisted living facilities (112,583 private beds) across the state. There is year-over-year growth in the number of facilities in line with the increasing number of seniors moving to the state – in 2018, Florida’s 65-and-over population was 21% of the total population, while the national average was 16%. (2019 Profile of Older Americans, Administration on Aging, U.S. Dept of HHS). The growth trajectory in the 65 and older category for Florida continues at a stunning rate through 2050.
Assisted Living Facilities continue to be a wonderful option for some seniors. Care needs, average cost, and a strong aversion to getting rid of their “stuff” remain obstacles for families who are looking for the best option to take care of their aging loved ones. Understanding Assisted Living – and what it can and cannot do – is a logical place to begin a deeper exploration of senior living options in Florida.
- Every facility has a standard license
- Facilities can add a “specialty” license
- Small or large, all licensed assisted living facilities have the same rules and laws
Facilities are licensed to provide routine personal care services under a “Standard” license, or more specific services under the authority of “Specialty” licenses. ALFs meeting the requirements for a Standard license may also qualify for specialty licenses. The purpose of “Specialty Licenses” is to allow individuals to “age in place” in familiar surroundings that can adequately and safely meet their continuing healthcare needs.
All facilities in Florida are regulated by the same rules and laws, regardless of size. A small, residential home can serve as an assisted living facility and is beholden to the same rules and laws as the largest, resort-style facility. Each facility is licensed as a Standard facility and can add a specialty license to offer additional services.
Specialty Licenses in Florida
The State of Florida allows for three specialty license types, each of these licenses permitting certain and specific services to their residents:
- Limited Nursing Services
- Extended Congregate Care
- Limited Mental Health
A Standard License is the most basic license type that allows for assistance with personal services which can include activities of daily living, supervision of self-administration of medication, and other similar services as defined by the rule. All facilities are licensed as a Standard facility and can choose to add the specialty licenses.
A Limited Nursing Services license allows acts that may be performed by a licensed nurse. Limited nursing services shall be for persons who meet the admission criteria established for assisted living facilities and shall not be complex enough to require 24-hour nursing supervision and may include such services as the application and care of routine dressings, and care of casts, braces, and splints.
An Extended Congregate Care license allows acts beyond personal services that may be performed by persons licensed while carrying out their professional duties and other supportive services which may be specified by rule. The purpose of such services is to enable residents to age in place in a residential environment despite mental or physical limitations that might otherwise disqualify them from residency in a facility.
A Limited Mental Health license allows for the care and concern of those determined by the State to be mental health residents. Care includes assistance with personal services as well as additional services specific to those requiring mental health programs.
Each license allows the assisted living provider to provide services within the scope of its license offering some exceptions to those residents who consent to and are admitted to the services of a licensed hospice. These services include providing total care to bedbound residents who previously were required to leave their assisted living homes as their hospice status exceeded the scope of the facility license.
Each assisted living facility is required to have policies and procedures to address the care services provided in their facility. Starting with the Residency Agreement, an assisted living facility puts forth in writing the services it intends to provide – which are not necessarily all of those permitted by its license. Assisted Living providers have the option of providing services allowed within the scope of their license and it is important that seniors and their families know what will be provided as the senior continues to age in place.
Paying for Senior Living
Assisted living is primarily private pay, out-of-pocket expense. In some cases, seniors qualify for other resources such as Veterans Aid and Attendance. In Florida, we have Medicaid/Managed Care which pays a relatively small amount towards assisted living fees and the application for such should be handled carefully and in a timely manner.
Additionally, seniors may have signed up for long-term care insurance at some point in the past. It cannot be stressed enough – conversations regarding care and financial plans should be taking place well in advance of the actual need.
Consult with Elder Law for Financial Plan
Consulting with an elder law attorney (certified in Veterans’ assistance, if possible, and if applicable) to establish a full financial plan is best. While some are put off by the initial cost of planning, the money you will save and, if eligible for benefits, receive, will be well worth the time and investment you make.
What Help is Available to Navigate Facility Choices?
While it is important for seniors and their families to be familiar with some of the specifics and details, they need not be too concerned. In each community, there is typically a local agency that helps seniors and their families evaluate each facility and make recommendations about which may be the best choice. (There are national companies as well however they are not as familiar with the local assisted living market and only offer a written list of facilities to overwhelmed families who are still left to determine how to work through the list provided.)
Local agencies are a wealth of knowledge and often provide services at no cost to the family. Facilities will contract with these local agencies, also called “placement agencies” or “referral and information agencies,” and pay them a fee for a referral that results in an admission to their facility.
One of the best attributes of a local agency is that they are very familiar with the specifics of each local facility, including licensing, and the reputation of the facility. While there are State Inspection reports available for each facility (such as www.floridahealthfinder.gov), those often need interpreting as well.
These local agencies are also familiar with the licensing of each facility as well as how the facility chooses to use that license. Meaning – just because they have the license, doesn’t mean they utilize all aspects of what it allows them to do. And, to be fair, they don’t have to.
Asking for Help Could Save Money
Another helpful attribute of a local agency is that they do regular business with each of these facilities. They have a relationship and a rapport with the sales staff and often the administrator and feel comfortable asking for specials or reduced pricing that you may not know to ask for, or feel comfortable asking. Perhaps it is a special that just ended at the end of the previous month or an ask to reduce the community fee (a standard fee, like a security deposit, but non-refundable). Because the agency brings them regular business, a facility is often open to a reduction in fees based on the knowledge that additional business is coming their way. Why shouldn’t the individual consumer get the benefit of volume business?
And finally, many in the senior healthcare world speak a different language. Words and phrases that may be very common to them may leave you completely lost in a conversation. Your interpretation of what was said may be different than what was meant. A local agency can serve as your interpreter and guide through this world that most only venture into once or twice in a lifetime.
Moving to assisted living is a significant transition. Advance planning and accepting guidance from knowledgeable resources are critical to avoiding costly mistakes.
When is the Time Right for Assisted Living?
A move to senior living requires accepting that a smaller space is okay. As Dr. Dennis McCullough encourages in his phenomenal book, “My Mother, Your Mother,” take a look around the space your loved one lives in now. What rooms are they actually using? Rooms used for storing “stuff” do not count!) You most likely will find that they are already limiting their space to just a room or two.
Many seniors have lived in their current homes for decades. Some are still in the homes where they raised their children, enjoyed visits from grandchildren, and shared a lot of experiences, both bitter and sweet. These homes are filled with furniture, art, souvenirs from trips taken, and a lifetime of precious memories, the value of which can only be regarded as priceless. When it comes time to move into an assisted living facility, these possessions often become a seemingly insurmountable challenge to accomplish the move. Assisted living apartments are designed with efficiency in mind – efficiency of steps from the bed to the bathroom, for example.
Downsizing for Senior Living Communities
Adult children are finding less value in family “heirlooms” and have fully furnished homes of their own. Grandchildren are increasingly embracing minimalism and find family antiques to be less of a help and more of a hindrance to their lifestyle. The final disposition of their possessions can be a great stressor for the senior who is facing a life-changing move.
A plan for “stuff” can be just as important as a financial plan. The available family must participate in a conversation regarding the dividing of property if the property is to be divided. All the options must be discussed with the senior and the most pragmatic of solutions must be presented and agreed upon for there to be closure with these memories.
Even those who spend time planning for the day they will move from their home still find that Moving Day seems to sneak up very quickly. Moving to an assisted living facility is a huge transition for a senior who already may not feel well. It is a massive change in mindset as well as space. Taking the time to plan and allow big decisions like this to be processed can make all the difference in the transition to a new home and quality of life.
What about Fido or Fluffy?
A beloved pet can also prove to be an obstacle when it comes time to move.
Many assisted living facilities are pet friendly if the senior can still care for their pet. As facilities become more consumer savvy, some offer pet care services for a monthly fee, understanding that this is an invaluable service for those who will not leave Fido or Fluffy behind. It is important to include the senior’s pet in the planning process. Knowing that their faithful companion can join them in the move can help a transition go much more smoothly.
Expectations and Resources
This momentous step in the life of a senior, planned or unplanned, must be handled with a delicate firmness – an understanding like few other events in life where role reversal of adult child to decision-maker requires humility and a great deal of empathy.
Remove Roadblocks by Planning with an Elder Law Attorney
Sometimes, possessions or a pet can be purposeful roadblocks to a senior moving to assisted living, even when they acknowledge it is a must-needed move. A desire to stay in their own home can override their recognition that they are no longer eating well, or able to manage their care. If there is family involved, it is important to stay patient and work through their concerns.
If the senior parent has early-stage Alzheimer’s or other forms of dementia, this can be a difficult time for the family. This is where the plan a family has put in place comes in – whoever has been chosen to make decisions must step up and make those decisions based on the senior’s wishes contained within the plan.
Expanding the Circle of Care
When a loved one moves into an assisted living facility, their village grows – the circle of concern expands – additional caregivers are introduced into the daily routine. This can be a confusing collaboration for some – the spouse may feel they have lost their primary role as caretaker, and the adult child may no longer feel as though they contribute to the day of the senior. This reorganization of responsibility can be challenging; however, it is important that each family member still see themselves with an important role in their senior loved one’s life.
The essential role each family member has now is to encourage the senior to participate in community activities, work together with facility staff and administration, and, as positively as possible, embrace the new lifestyle they have entered.
Secrets to Success
– Stay positive and encourage participation
– Communicate concerns and compliments to facility staff
– Stay involved, visit often, embrace the new lifestyle
While all assisted living facilities offer the same basic services – nutritional meals, housekeeping, assistance with activities of daily living – they do so in wildly varying environments. From residential homes with 5 residents to large, resort-style buildings with hundreds of apartments, there are plenty of options out there to explore. This is not a One-Size-Fits-All situation so plan ahead and take time to explore. There may be no place like home, but with the amenities offered at local assisted living facilities – you might find that your new lifestyle makes that loss more tolerable.
It cannot be stressed enough – reach out for guidance and utilize resources. Brevard County, Florida offers a wealth of services specific to seniors and boasts a healthcare community arguably second to none. While your situation is new and unique to you, many professionals have been down that path – or a similar one – before and can offer suggestions regarding services that are available.
We walk down the road of taking care of an aging loved one only a precious few times in life – don’t choose to go it alone.
About the Author:
Kara Anderson, BSW, is a seasoned professional in the assisted living industry. A social worker by degree, Kara has spent over twenty-five years helping seniors and their families in a variety of senior services roles – including management, administration, and development of numerous assisted living facilities both in Florida and Georgia. An educator and advocate at heart, Kara currently owns an assisted living information and referral company and serves as a Florida State certified trainer for assisted living administrators.