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Shopping for Assisted Living

Assisted Living Primer

Assisted Living vs. Nursing continued...

Of course, nursing home regulations are in place to protect residents' rights and ensure that they aren't neglected. Some are not able to make decisions for themselves -- people with advanced Alzheimer's disease, for example. Nevertheless, "sometimes less care is better than more care," Willging says.

"Nursing home regulations were just a disaster," Schurman says, referring to the Nursing Home Reform Act, passed by Congress in 1987. The goal of the ALW, he says, is to come up with regulations for assisted living that ensure high quality, but are more flexible.

In terms of cost, the difference between nursing-home care and assisted living is "really not all that significant," Willging says.

Jones says that although Medicare and Medicaid often pay for nursing-home care -- whereas assisted living is generally paid for out-of-pocket -- those who would be best served by assisted living may not qualify for government support. They would have to pay for either option.

Another key difference between assisted living and nursing homes is that assisted-living facilities offer a more home-like atmosphere. Willging says that "sounds like a hackneyed phrase, but it's really not."

Jones agrees that assisted-living facilities have done a good job of making things feel homier.

Choose Wisely

"You -- the family, the child -- know better than anybody what makes mom happy," Willging says.

Have a talk with her about what she would want in an assisted-living arrangement, and then visit several facilities. Don't just let your fingers do the walking: Some real legwork is in order. "Essentially, you want to look at the facility," Willging says.

To begin with, let first impressions guide you. "You want to be comfortable with both the interior and exterior physical environment," Willging says. Also pay attention to the staff's demeanor. Watch how they relate to the residents. Talk to some of the residents, too. You'll be sure to get an honest appraisal of the facility from them.

"Know what you're expecting, and then ask tons of questions," Willging says.

Once you think you're ready to settle on a place, "read the contract carefully," Jones says. All the services, amenities, and rules should be detailed in the contract. You should pay particular attention to the discharge terms. A resident may be forced to leave within a certain period of time if his or her health deteriorates. A facility's brochure may suggest that residents can stay until they die, no matter what, but the contract may state that they must move out if the staff can't meet their needs. If you're not comfortable with the terms, don't accept them.

Compare the terms of the contract with your state regulations, too. It can be hard to find these regulations because various departments of state government regulate assisted living. In Vermont, it's the Department of Aging and Disabilities; in Florida, it's the Agency for Health Care Administration, and so on. You can find contact information for the agencies that handle assisted living regulations in all 50 states and the U.S. territories at http://www.seniorresource.com/states.htm

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