How to Find the Best Assisted Living Community for You

If you or your parents live long enough, you will likely face a common problem: How do you find the right assisted living facility?

There are about 15,000 assisted and independent living facilities in the U.S., plus 1,500 continuing care communities, according to Andy Cohen of Caring.com, which features lists and reviews of facilities. And that figure doesn't take into account nursing homes, group homes and active adult communities.

There is no standard definition of assisted living. What's called assisted living in one state may be called something else in another. Many of the same communities also offer independent living for people who want communal living but need less help. One facility may charge by tier of care and another may charge for specific services, making it hard to comparison shop, which is important when you're trying to save money.

"You can find places that are like the Four Seasons, and you can find places that are like budget motels," Cohen says. "They're not one size fits all. They're very different."

Most assisted living communities charge a monthly fee for basic room and board, with additional fees for special services such as managing medication or bathing. Residents have their own apartments, and there is usually communal dining, transportation and activities.

These communities are a good choice for people who need some assistance but don't have complex medical problems, says Emily Saltz, CEO of LifeCare Advocates in Boston and a past president of the National Association of Professional Geriatric Care Managers.

Residents at assisted living communities are fairly independent, which is reflected in the rules the facilities maintain. If residents run out of money, they will need to find a new place to live unless the facility accepts Medicaid. They may also need to move out of the community if their health declines, but rules will vary by facility.

In that way, assisted living homes are different from a continuing care community, where you can stay the rest of your life, moving to higher levels of care as needed. These communities usually require a significant payment upfront as well as a monthly fee.

Choosing the right facility is not easy, especially in a situation where a crisis requires families to move quickly.

"The elder care journey is fraught with lots of pitfalls, lots of crises," says Saltz, whose agency works with families to find facilities and services. "A care manager will really know what the skinny is on these places versus the marketing fluff. ... The consumer cannot know it all. It's not just like finding a great condo and moving in."

Because each facility is different, it's important to ask lots of questions, says Robyn Grant, director of public policy and advocacy for the National Consumer Voice for Quality Long-Term Care. If the facility says meals are provided, ask how many, at what time and whether there is an extra charge for bringing a tray to the room. If transportation is part of the package, ask where you can go, how often, at what times and how far. What does "nursing care" mean to the facility?

"You don't want to make any assumptions as to what will and won't be provided," Grant says. "Consumers have to be constantly going for the details with assisted living."

The 2014 Cost of Care Survey by Genworth Financial estimated the average monthly cost of assisted living at $3,500 per person. Memory care units, for elders with cognitive issues such as Alzheimer's disease, are more expensive.

Some elders may discover that they're better off staying in their homes and hiring aides to help with daily tasks, cooking and cleaning. Others may prefer the social atmosphere of a communal facility.

In some areas, especially popular retirement destinations such as Florida and Arizona, another option for those in good health is buying a home in an active adult community, a neighborhood or condo complex restricted to residents 55 and older. Residents must maintain their own homes, but the homeowners association comes together to organize activities.

"There are more [assisted living] options than you know at first glance," Saltz says.

Here are 12 tips for finding and evaluating an assisted living facility.

Make sure assisted living is the right choice. People who are happy where they are may do better with in-home help and community services. People with complex health problems or who need help with basic tasks like going to the bathroom may need more help than assisted living provides.

Tour any facility you're considering. Stay for a meal so you can taste the food and talk to other residents. Look at the available apartments. After you've had the tour, come back again on the weekend for an unscheduled visit. Many facilities will allow you to "try before you buy" with a weekend or a week of what is called respite care.

Ask detailed questions about what services are and are not included. Is there a washer and dryer in the unit? Will the facility do your laundry and at what cost? Will you have to arrange for your own cable TV and Internet service? Saltz estimates that most facilities offer an hour a day of personal care, but you should ask about that anyway.

Drill down on costs. Ask about charges for specific services, and make sure you know about all the fees. Most administrators are well-informed about potential veterans benefits, ways to tap life insurance policies and community grants, as well as Medicaid options.

Ask what happens if you run out of money. A few facilities accept Medicaid patients, but most do not. If you exhaust your funds, you may have to move to a nursing home or another facility. Some long-term care insurance may cover assisted living. "You cannot run out of money in assisted living and expect to stay," Saltz says.

Ask what will happen if your health or cognitive ability declines. Some facilities will have higher levels of care on the premises, at a higher cost, and others will require you to find a new home. If you would like to stay put, find out if you can hire your own aides to provide additional services.

Ask about the staff. How many staff members are there for residents and what do they do? If nursing care is provided, what does that mean? Find out how long the staff members have been working at the home, which is a key indicator of stability. "A lot of people look at the packaging, not the staff," Cohen says. "What really makes a community great is the staff."

Look at the menus and activities calendar. Find out if meals are provided only at specific times or all days. Are there choices? Do the activities fit your interests?

Consider hiring a care manager, especially if you're seeking a facility in another town. Members of the NAPGCM charge $100 to $200 per hour, and they do not receive any compensation from facilities. They will be familiar with community services as well as know the inside story on communities.

Look at options before there is a crisis. If you or your parents are having trouble managing on your own, start looking sooner rather than later. You have more choices and can spend more time on research if you're not in a hurry.

Consider living near family. Saltz works a lot with families seeking care for parents who live far away. In some cases, it makes sense for the parents to move to a facility near their adult children, so they can see family and get help dealing with issues.

Get the contract and read it carefully before it's time to sign. The resident agreement will spell out the rules of the facilities, the charges and other issues, such as what happens if there is a disagreement. Don't wait until signing day to look it over. Get a copy in advance, and consider having adult children or a lawyer read it over. If there is anything you don't understand, ask questions before you sign. "Consumers really need to go through this with a fine-tooth comb," Grant says.