Assisted living

What it means

Assisted living sits between independent living and a nursing facility: private accommodation, meals, help with bathing, dressing and medication, and somebody there overnight.

It is licensed and regulated by the state rather than federally, so what the term guarantees varies considerably.

Medicare does not pay for it. It is usually paid privately, sometimes by long-term care insurance, and in some states by a Medicaid waiver program.

Why it matters

Families often choose between settings on the basis of atmosphere and later discover the care limits — a facility may be unable to keep somebody whose needs grow.

Asking what triggers a required move, and what it costs when care needs increase, is worth more than any tour.

When you are likely to meet it

• When a parent can no longer live alone safely.
• When comparing costs between care settings.
• When a facility says a resident's needs have exceeded what it can provide.

How this varies by state

How assisted living is licensed, what care it may provide, and whether a state's Medicaid program helps pay for it are all set by state law.

Related terms

• Activities of daily livingThe everyday self-care tasks — bathing, dressing, eating, using the toilet, moving from a bed to a chair, continence — that care assessments and insurance policies measure.
• Adult day servicesA daytime program providing supervision, activity and often health care outside the home.
• Age-restricted communityA neighborhood that may lawfully require residents to be over a certain age, usually 55 or 62.
• Benefit triggerThe condition a long-term care insurance policy requires before it starts paying — usually needing help with a stated number of daily activities, or having cognitive impairment.
• Continuing care retirement communityA campus offering independent living through to nursing care, usually entered by paying a large fee up front.
• Custodial careHelp with everyday living rather than medical treatment — bathing, dressing, eating, moving about. It is what most long-term care actually is.
• Elimination periodA waiting period after a long-term care claim is approved, during which the family pays and the policy does not.
• Geriatric care managerA professional, usually a nurse or social worker, hired to assess an older person's needs and coordinate their care.
• Home careNon-medical help at home — bathing, dressing, meals, housekeeping, company. Medicare does not pay for it.
• Independent livingAge-restricted housing with services and no personal care — the step before assisted living.
• Long-term care insuranceA policy that pays toward help with daily living — at home, in assisted living, or in a nursing facility — which health insurance and Medicare do not cover.
• Long-term care ombudsmanAn independent advocate for residents of nursing homes and other care facilities, who investigates complaints and works to resolve them.
• MedicaidA joint federal and state program that pays for health care, including long-term care, for people with limited income and assets.
• Memory careResidential care designed for dementia — secured, higher-staffed, and more expensive than ordinary assisted living.
• Skilled nursing facilityA facility providing nursing and rehabilitation care that has to be delivered by licensed clinical staff — not the same thing as a nursing home in the everyday sense.

Sahvelo guidance that uses this

• Housing transitions
• Home safety