This article explains the Assisted Living segment of the Senior Living industry. While we will tangentially mention both Memory Care and Residential Care Homes in this discussion, they are not the focus here, and we have other articles on each of those market segments.
Essentially, Assisted Living is an apartment building surrounding a central dining room, with a meal plan, as well as with caregivers who provide help with Activities of Daily Living (sometimes called “ADLs”). The seven ADLs are dressing, bathing, eating, transferring, toileting, incontinence and medication management.
As these activities of daily living are all non-skilled services, Assisted Living is considered “Custodial Care.” In this sense it is different from Skilled Nursing, which is for “Medical Necessity,” and is different from Independent Living communities, which are not health care providers at all.
Who Goes to Assisted Living
Assisted Living residents generally need a significant amount of care. They are often fall risks, and may have a lot of mobility issues. Probably 50 to 75 percent of residents have some degree of cognitive decline. They may have special needs, which not every Assisted Living can accommodate, such as special diets, catheters, diabetes care, wound issues, and others. The most common service in Assisted Living is medication management, and the average resident takes 11 pills a day, and it is not uncommon for residents to take over 20 pills a day.
From a regulation standpoint there are Type A communities, where each resident is required to be able to self-evacuate within 13 minutes in the event of emergency, and Type B communities, where the community has to have ample staff to evacuate all residents who can’t self-evacuate.
In Texas, a large Assisted Living community is defined by regulation as having 17 or more residents, but usually with 60 residents and larger. These communities are required to have a nurse on site for 40 hours a week, and to have a dedicated activities director.
End of Life
Most often, Assisted Living residents can stay through end of life, and Hospice services are welcome in the building. It is always a good idea to make certain you know when a community might ask your loved one to move elsewhere. Some buildings can’t accommodate two-person transfers, and most won’t accommodate transfer devices, such as Hoyer Lifts. Sometimes exceptions are granted for end-of-life situations. But you should always ask the question, because its not a time of life when surprises are welcome.
Small Assisted Living
Small Assisted Living communities are defined as having between 4 and 16 residents, and are not required to have an on-site nurse or activities director. I have a separate video on small Assisted Living communities, including Residential Care Homes. But let me note here that the primary differentiator between small and large communities is that large communities have more intellectual stimulation, while small communities may have better care and lower prices.
There is substantial overlap in the services Assisted Living provides compared to Independent Living, Memory Care and Skilled Nursing. Let me give you some differences between Senior Living Segments, just for an overview. You should watch my other videos for a more in-depth discussion of these Senior Living segments.
Independent Living communities are not licensed health care providers, but outside caregiving agencies may have an office in the building with five or six caregivers helping residents with ADLs. In a sense then, Independent Living can be thought of as “Assisted Living-lite.”
Skilled Nursing differs from Assisted Living primarily by who pays the bills. Assisted Living is all private-pay, while about 75 percent of Skilled Nursing residents are there because Medicaid or Medicare are paying the bills. Provision of ADLs are far and away the largest portion of services performed by any Skilled Nursing Facility. Skilled Nursing is run on a medical model, and emphasis is solely on caregiving, not on entertainment or mental stimulation. Also Nursing Homes can handle services which Assisted Living providers are prohibited by regulation from accepting, such as ventilators, intravenous drips, feeding tubes and bed bound residents.
Memory Care in Texas is an Assisted Living License with an additional certification for Dementia Care. A dementia diagnosis is required to be admitted. Memory Care has a lock on the front door for residents’ safety, and by regulation has more caregivers in order to care for this much more challenging population. Someone goes to Memory Care when they need more supervision or caregiving assistance than can be provided by an Assisted Living, or when a resident’s socialization is not appropriate for an Assisted Living’s environment.
Pricing in Assisted Living is a bit complicated, and starts with a base price, plus extra charges for caregiving services. Nationwide Assisted Living is said to average about $4,000 per month. In Austin in a Large Assisted Living community a small studio apartment might average about $3,300, a large studio about $4,250, and a 1 bedroom about $4,900. Average caregiving costs might add around $800 per month. Shared rooms exist and are cheaper, but they’re not exactly common in large Assisted Living communities.
Residential Care Homes
Smaller Residential Care Homes are less expensive, and commonly have all-inclusive pricing. A private room averages about $4,500 and a shared room $3,500. Rock bottom Assisted Living with services is about $3,000 per month, and if I try, I can spend upwards of $12,000 per month for the largest apartment in town in the most luxurious place with a balcony and a view.
There are 55 large Assisted Living communities in the Austin area and they have an average capacity of 84 residents. In small Assisted Living there are 45 communities that average 11 residents. About 40% of large communities allow pets. Places for smokers are difficult to find. Diabetes care, when shots need to be administered, is a significant complication. The caregiving ratio of residents to caregivers is around 12 or 14 residents per caregiver in large Assisted Living communities, and around 7 to 1 in Personal Care Homes.
I hope this introduction to the Assisted Living segment of Senior Living has been helpful. My name is Michael Gill of Texas Senior Living Locators, and if you need help finding an appropriate solution in Assisted Living, Memory Care or Independent Retirement Living in the Austin area, please give me a call at (512) 630-7133.
This information is also available in a video on our YouTube Channel.