Senior Moments: Assisted living offers different levels of care By Jackie Byrd
A column for seniors and those who love them
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Old age is no place for sissies. - Bette Davis, American actress
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The number and diversity of housing facilities for the over-55 crowd continue to increase. Various names and descriptions of these facilities can be confusing, especially to persons who've never given senior housing a serious thought. People who have been forced by circumstances to think about this housing are also often confused. Today we'll concentrate on some facts regarding one type of housing called assisted living.
According to the Assisted Living Federation of America, more than a million people live in an estimated 40,000 assisted living residences in the United States. Broadly speaking, the term assisted living is used to refer to a type of care that combines housing and services in a homelike environment. It is generally group housing for older adults who can no longer manage on their own, but do not need 24/7 nursing care. They may need help with some day-to-day activities such as light housekeeping, bathing, grooming or dressing. Meals are generally provided and medical care may or may not be available. This type of housing attempts to bridge the gap between independent living and nursing homes. Assisted living is an intermediate level of long-term care that may be appropriate for certain seniors.
Assisted living is available in remodeled homes, generally called "small assisted living," and in everywhere from high-rise apartment complexes to renovated schoolhouses. Some facilities are huge, housing over a hundred residents, and some are tiny, housing three or four residents. Some now offer lock-down units for people with Alzheimer's disease and other dementias.
Levels of care are important in assisted living communities. Level one, for instance, is low-level care required, level two is moderate care needed, and so forth. As these levels increase, so do the needs of the resident and, presumably and hopefully, the required ability of the staff. The levels are determined by the facility's evaluation methods. Normally, costs increase as the care level increases.
As a general rule, assisted living charges are paid privately, from the personal funds of the resident or the resident's family. It is difficult to get financial assistance for this purpose, but it can be done. The state of Maryland has a Senior Assisted Living Group Home Subsidy Program that will pay a maximum of $550 per month directly to the assisted living residence. There are income and eligibility tests for this assistance, and you must be 62 or older to qualify for this help. You can find out about this by contacting the program manager at 410-767-1269 or visit dea@ooa.state.md.us.
Additionally, Maryland provides the Medicaid Waiver for Older Adults, which under certain very strict circumstances will allow Medicaid eligibility for assisted living residents. To be eligible, you must be age 50 or older, you must meet Medicaid's long-term care admission criteria and meet other financial and technical requirements. There is also a waiting list before you can even begin. To learn more, you can speak to the office of the waiver manager at 410-767-1065 or e-mail fws@ooa.state.md.us. To add your name or a loved one's name to the waiting list, call 866-417-3480.
Perhaps the most surprising thing about recent developments in the assisted living area is a nonrefundable facility or community fee. This fee differs from place to place. I have seen it as low as one month's rent and as high as three months' rent. Admissions managers are very serious about it being nonrefundable, so be prepared.
Carefully review the admission contract from any assisted living facility you are considering. There may be other documents included with the resident agreement, and they need to be carefully reviewed as well. You may have seen beautiful advertisements or brochures that describe the facility. However, these documents are not a legal part of the contract unless they are included as a part of the resident agreement.
Be careful to make it very clear who is responsible for paying the cost of the facility and with what funds. A facility should clearly state any charges that are additional to the room and board contract. Too often residents and their families are shocked to discover that something they assumed was covered by the monthly fee was not.
If, as time goes by, the resident needs a higher level of care, the facility most likely will charge more. It needs to be clearly defined and understood who determines the higher level of care and how. Also, it's important that residents understand whether they will be able to keep their room or their bed if they take a vacation or need to be an inpatient in a hospital. This is called "bed-hold" and the bed-hold policy must be included in the admissions agreement.
Many of us have seen assisted living facilities that we ourselves would consider moving to right now. They can be wonderful. However, as always, it is buyer beware. Do your homework before making a final decision regarding assisted living.
Thank you for reading. Stay well. See you next week.
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The writer, a longtime resident of Bowie, is secretary of the Maryland/D.C., chapter of the National Academy of Elder Law Attorneys and a member of the Elder Law Section of the Maryland State Bar Association. You can e-mail her at jbyrd@byrdandbyrd.com.
