First some background.

Independent living communities serve the social needs of people who don’t need support. Assisted Living Communities (ALCs) support basic, custodial, activities of daily living so people can live as independently as practical. 

ALCs’ monthly fees include maintenance, housekeeping, security, nursing observation, three meals a day, programming, and 24/7 staffing. Personal care (assistance with bathing, dressing, grooming, toileting, and medication administration) may be billed separately.

ALCs are not covered by Medicare, but long-term care insurance and the subsidized “Programs of All Inclusive Care for the Elderly” (PACE) can help. 

ALCs are both nonprofit and for-profit. Both rely on Medicaid and private pay for revenue. Medicaid generates less revenue per resident and has lower margins. Private pay can command a higher price from residents for a high level of care. For-profit facilities account for 80% of facilities and are run by individuals, corporations, and national chains to generate profits for investors. Nonprofits typically have missions (often religious) they support in addition to residents. Small ALCs’ high staff-to-resident ratios create more personal relationships, while for-profits gravitate to large-scale facilities with lower ratios to increase profits.

Unlike nursing and other medical facilities, they aren’t in the Medicare Compare tools. A private sector alternative to screen and create an initial list of candidates is the Caring.com assisted living directory.

The basic screening, vetting, visiting, and revisiting process outlined for picking a nursing home applies for assisted living facilities. NCAL offers a Consumers Guide with suggested questions and a cost estimator to capture and total all costs.

Pay particular attention to how each facility handles the “red line” between medical services they do and don’t provide, how they charge for them, the medical referral process, and what medical could trigger a move from the facility.