My parents don’t want to leave their home but they can’t live alone anymore. How can I get them to understand they need help?

It may be time to have a family meeting. Gently explain your concerns. We suggest that family members start a preliminary search to find suitable communities. Schedule a tour to go visit them and narrow down your search to just a couple you think they will like. When they are ready, bring them by for their own visit. Most communities will invite them to spend the day, enjoy a meal or on-site activity, and meet other residents. Many places even offer what is referred to as ‘respite care’ where potential residents can stay for a month or so without any further commitment to see if they like it before making a long-term decision. Giving up one’s independence is difficult. It won’t be easy, but by easing them into the idea, hopefully they won’t feel pressured.

What’s the difference between assisted living and a nursing home?

Assisted living facilities can provide a broad range of services including meals, transportation, housekeeping, personal care assistance such as bathing and dressing assistance, medication administration, feeding assistance, etc. Caregivers are not permitted to provide any skilled medical care. In most ALF’s residents must have some level of independence and cannot require 24-hour care.

Nursing homes provide round the clock, 24-hour skilled nursing care and are able to provide all levels of assistance all the way to end of life care. Patients needing constant supervision or who are non-ambulatory or bed-ridden would need skilled nursing care.

Is Assisted Living covered by Medicare?

Medicare does not cover assisted living. Medicare will cover any skilled services, such as therapy or skilled nursing but room and board is not a covered expense.

What is a personal care home?

Personal care homes are small, independently-owned care facilities that usually house just 6-12 residents. Often, the owner lives in the home and provides hands-on care to the residents. Residents usually have private or shared rooms and live in a family-style setting. The quality of care in these homes will vary greatly based on the caregiver staff. Many personal care homeowners provide the highest level of care possible, treating each resident like family. In many cases, personal care owners will charge one all-inclusive price and are able to provide care all the way to the end of life. Personal care homes are usually much more affordable than larger assisted living facilities. One other bonus with personal care homes: in some states, Medicaid will pay for care.

Can my parents live together if they have different care needs?

Both assisted living communities and continuing care retirement communities can accommodate couples with different care needs. In most cases, there will be additional fees for higher levels of care. An assessment will be required to determine the level of care required. The marketing or admissions staff will be happy to explain the different care levels available at their community.

What is a Continuing Care Retirement Community (CCRC)?

A CCRC is a community that offers all levels of care including independent, assisted, skilled nursing, and even hospice care, allowing residents to remain in place until the end of life. Most will require that residents are able to live at the independent level initially. (For couples care needs can be different, as long as one can live mostly independently.) An assessment is required to determine the resident’s care needs and as their needs increase, additional services are provided. Fees are adjusted as the needs increase. CCRC’s often have on-site health clinics and rehab services as well. Because many of the residents are independent, CCRC’s will often have other amenities such as on-site restaurants, pubs, and even theaters. Residents can often buy or rent and they will often offer a variety of housing types such as apartments, free-standing cottages, or town-homes. Fees vary widely between communities.

What is a buy-in fee and why do I have to pay it?

Some CCRC’s charge what is called a ‘buy-in fee’. This fee can be quite high and essentially holds a spot for the resident for the highest level of on-site nursing care. Because preference in the on-site long-term nursing facility goes to current residents, each facility must keep beds open for when their residents need them. Terms for the buy-in fee vary greatly between communities. Some are partially refundable at move-out if the resident leaves. Some facilities will charge a lower monthly fee if the resident pays a higher buy-in. Negotiating fees can be complex and it helps to have someone with you when signing any agreements to make sure all the details and costs are clear.

What is a community fee?

Most assisted living communities collect a one-time community fee at move-in or over the course of the first few months. Often this fee is negotiable or can be waived entirely. Ask if they are offering any specials when you visit. Due to the current economy, many communities offer incentives. It’s definitely worth asking. The community fee is pooled to help pay for activities, transportation, and other special services that benefit all of the residents.

Are residents allowed to have pets in an assisted living facility?

Each community establishes its own rules regarding pets but many allow small pets, such as cats, small dogs, and birds, sometimes requiring a pet deposit. Some communities can even provide care for the pet for a fee. Ask the admissions/marketing director about their community’s pet policy.

My parents can no longer drive. Will there someone to help them with their shopping and errands?

Most assisted living communities and CCRC’s provide regular, scheduled transportation for shopping, errands, doctors, entertainment, group outings and more. Most include transportation in their monthly rental fee. If they need a caregiver to accompany them, that is usually available as well. Services will vary by location.

My father is a veteran. Are there any benefits available to help pay for his care?

Assisted living guidelines vary by state but most include personal care assistance such as bathing, dressing, medication administration, incontinence care, and more. Some states allow ALF’s to provide even higher levels of care, particularly in smaller, personal care homes. Most assisted living facilities will include basic services such as meals, housekeeping, linen service, transportation, and activities in the base rent.

What kinds of services are available in an assisted living facility?

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Can my parents bring their own furniture to the facility?

Most facilities encourage residents to bring their own furniture so they feel at home in their new surroundings.

My grandmother is being discharged from the hospital soon and the staff is telling us we need to find a rehab facility. Where do we start?’s database includes facilities that offer long and short-term rehab care. Searching for skilled nursing facilities will display facilities that offer rehab as well. For best results we suggest you contact the admissions department. Specific questions about their rehab department services can usually be answered by the head nurse.

My aunt has Alzheimer’s and we are worried about her safety. What kind of facility should we look for to make sure she is safe and well-cared-for?

If there are any issues with wandering, a secure dementia unit is best. These units will usually have a keypad to enter and leave to ensure that residents cannot wander off unattended. Facilities that provide specialized dementia care are usually more focused on memory skills and memory retention activities. Their staff should also be more experienced with dementia patients. You may want to consider contacting the Alzheimer’s Association to see if there is any helpful feedback on communities you are considering.

My mother is terrified of being ‘sent away to a home’. She needs more care than I can provide. How can I help her understand things have changed?

Most assisted living facilities and nursing homes today are designed like modern-day resorts. Start by checking out the communities and facilities on your own. Once you have narrowed down the choices to your favorites, you can broach the subject with your mother. Depending on her current needs, she may be able to go into an assisted living facility. Refer back to the first question on how to broach this delicate subject. Reassure her that you will not be abandoning her and be sure to keep your promise.

My grandfather is in a wheelchair. Can he live in an assisted living facility?

Rules vary by state but most assisted living facilities can accept residents in wheelchairs as long as they are able to self-propel and evacuate in the event of an emergency within a designated amount of time, usually just a few minutes. This is obviously to ensure that the resident will be safe in the event of a fire or similar emergency.

My parents don’t need help yet but want to sell their house and move to an assisted living facility before they need help. Can they do that?

Each community has their own guidelines for admission. The best options for this scenario are assisted living communities or CCRC’s. Some assisted living facilities require that residents have some care needs but others may not. Give them a call and speak with the admissions or marketing director for more information on their facility. They will be happy to answer any questions you may have. CCRC’s offer all levels of care from independent through end of life care.