Cost of Assisted Living

If you haven't planned for senior living care, you aren't alone. Few people do - either because they don't think they'll need it or because they want to save their assets for their children and believe that government subsidies will cover any care they need. This doesn't mean they can't afford suitable care; it just means the choices may be more limited. Fortunately, just like the variety in settings, styles, and amenities, senior living residences are available at a variety of price points.

Costs vary with the residence, apartment size, and types of services needed. The basic rate may cover all services or there may be additional charges for special services. Most assisted living residences charge on a month-to-month lease arrangement, but a few require long-term arrangements.

Base rates may fluctuate depending on unit size: for example, studio, one, or two-bedroom apartment. Note also that base rates typically only cover room and board and two to three meals. Additional charges may include entrance fees up to one month's rent, deposits, and fees for other services such as housekeeping and laundry, though many providers include those services as well.

The average cost for a private one-bedroom apartment in an assisted living residence is $3,022 per month, according to research compiled by several nonprofit senior living organizations, including the Assisted Living Federation of America (2009 Overview of Assisted Living). Assisted living is of often less expensive than home health or nursing home care in the same geographic area.

More than half of assisted living communities use a tiered pricing model with bundled services, according to research. For instance, a resident needing very little assistance would be at the lowest tier. Other pricing models include all-inclusive, a la carte, or fee-for-service basis. Providers regularly review service and care plans to ensure residents' needs are being met. Billing is typically done monthly.

Determining Your Budget for Senior Living Care

Senior living residents and their families generally pay the cost of service through private financial resources. Depending on the nature of your or your loved one's health insurance program or senior living care insurance policy, some costs may be reimbursable. Some residences also have their own financial assistance programs.

For most seniors, the home is the biggest asset. One option is to sell or rent the home and use the proceeds or rental payments to fund senior living. A less-known and less-understood alternative is the reverse annuity mortgage, which allows seniors to use the value of the home without giving it up. With this option, instead of the resident paying a mortgage, the financial institution pays the homeowner a lump sum or monthly payment, which the homeowner can then use for senior housing. Most experts suggest the reverse mortgage be considered only for the last five years or so of senior housing. AARP and HUD both have additional information on reverse mortgages.

When meeting with senior living providers, ask for written material, including copies of the community's resident agreement that outlines, at a minimum, services, prices, extra charges, move-in and move-out criteria, staffing, and house rules.

Click here for the checklist for evaluating communities, which includes important questions to ask providers about contracts and finances.

Financial Assistance for Assisted Living and Senior Living Care

Several government subsidies are available to fund senior housing. However, the reality is that these amounts are limited and will impose restrictions on what care you receive and where you receive it.

• Medicare: Neither Medicare Parts A nor B offer coverage for comprehensive ongoing long-term care. Medicare A (hospital insurance) may cover costs for a semiprivate room, meals, nursing and rehab services, medications, and medical supplies in a skilled nursing facility for the first 100 days after being released from hospitalization for an acute illness or injury. The first 20 days are covered at 80 percent, with the rest of that time period covered at decreasing rates. It never covers a private room nor services in an assisted living residence. Medicare B only offers reimbursement for covered services you receive from a doctor.
  
  Ask Medicare is designed to support and assist caregivers. Ask Medicare offers a wide range of helpful information for the nearly 66 million Americans who provide help to an aging, seriously ill, or disabled family member or friend. Ask Medicare offers tools that helps caregivers and those they care for make informed health decisions.
  
  
• Medicaid: Medicaid, which provides federal health-care assistance to low-income Americans, is the biggest payer for room, board, nursing care, and social activities in nursing homes. Many, but not all, states now cover some assisted living services under their Medicaid programs; however, these fluctuate widely in terms of eligibility requirements, and dollar amounts of coverage. The Senior Assisted Housing Waiver provides eligible low-income adults a choice of receiving senior living care services in a community-based setting rather than in a nursing facility. Bear in mind that faced with budget deficits for years to come, states are more likely to cut, rather than expand, these programs.
  
  
• Housing and Veterans Subsidies: Seniors with annual incomes under $12,000 may qualify for U.S. Department of Housing and Urban Development 202 and Section 8 senior housing, which provide rent subsidies that can help pay for the room-and-board portion of both independent living and assisted living environments. The Department of Veterans Affairs also provides some skilled and intermediate-level care to veterans in its own residences, depending on space availability.
   
• For more information on benefits, visit Federal Benefits for Veterans and Dependents or check out the VA's benefits fact sheets.
  
  
• Life Care Funding Group (LCFG) assists people in need of funds to cover the costs of senior housing and long term care. LCFG specializes in converting the death benefit of an in-force life insurance policy into a long term care benefit to cover the costs of skilled nursing home care, assisted living, home health care, and hospice.
  
  

• Center for Long-Term Care Financing
• AARP
• National Association of Insurance Commissioners
• America's Health Insurance Plans

Senior Living Care Insurance

Long-term care insurance is perhaps the best way to ensure you can afford to pay privately to receive the most choice in housing environment possible from your provider of choice, whether it's independent living, assisted living, or another housing option. Experts suggest consumers should be looking at long-term care insurance at 40 and own it by age 50. When choosing an insurance provider, consider the following tips:

• As with any insurance, read the fine print on the policy and ask questions.
• Compare at least three different insurers.
• Verify each company's financial strength through independent rating systems such as AM Best.
• Review the company's rate history for stability.
• Check to see if the policy is tax-qualified, in which case premiums may be deducted under medical expenses if you itemize your deductions.
• Select an inflation-protected policy to ensure sufficient coverage when you file your first claim years from now.
  
  

Of course, if you're reading this after you or your loved one has experienced an insurable health-care event if you're over 85 (the usual age limit for insurers), then it's too late to purchase long-term care insurance. Insurance is also more expensive as you get older, although adult children may find it cheaper to help a parent pay for a policy than pay for care later.