When Charlie Gould realized it might be time to explore alternative housing options for his 81-year-old mother and her husband, the couple had already tried in-home assistance at their condominium in Boca Raton, Fla.
But some falls and other incidents had concerned Gould, and he wanted to be proactive, providing additional support for his folks before the need became critical.
So Gould, 53, a communications executive in New York City, reached out to Candy Cohn, a senior living adviser with Oasis Senior Advisors in Parkland, Fla.
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Cohn holds the certified senior adviser designation from the Society of Certified Senior Advisors. To earn that certification, she had to pass a rigorous exam and complete an ethics module.
Cohn, who describes herself as “a cross between a social worker and a real estate agent,” helps older adults or their families simplify the transition to senior living by learning about their needs and preferences, providing personalized options and information and even taking future residents on tours of facilities that match their needs.
Typically, a senior housing community will pay a senior placement adviser’s fee if the client decides to live there. A searchable database of certified senior advisers is available here.
After touring three communities with his mom and Cohn, Gould’s opinion of assisted-living facilities was transformed.
“I thought they would be dreary, institutional and sterile,” he says. “But in many ways, they were the opposite. They felt like places I’d like to be when I’m a little older.”
Indeed, today’s assisted-living community is not your grandfather’s nursing home. While communities vary depending on location and price point, many of the newer ones are glitzy and more closely resemble luxury hotels or condominiums than what you may typically think of as senior housing.
Amenities such as pools, on-site salons, chef-prepared cuisine and a full slate of activities are common, and pets are often welcome.
Despite some initial reluctance to leave their home, Gould’s mother and stepfather are now comfortable in their assisted-living community, where they socialize, dine with new friends and enjoy activities such as on-site art shows.
“There are new opportunities for them, and there’s a lower stress level for me,” Gould says. “Once they were in, I slept. It was the first time I had slept in a long time.”
Weighing your assisted-living options
Senior housing facilities come in several forms, each offering services that meet the specific needs of older adults.
Independent living is for residents who don’t require assistance. They live on their own, but they have access to amenities and services such as meals and transportation. Independent-living facilities offer residents the opportunity to socialize and enjoy physical, cognitive and artistic activities to help keep them engaged and active.
Assisted living is for those who need some care, such as help with dressing, bathing or medication management. Residents live in their own apartments but have access to meals, assistance with personal care and 24-hour supervision.
Many facilities offer a full continuum of care, incorporating both independent and assisted living and adding memory and skilled nursing care to the palette of services available to older adults.
As the nation’s population ages and demand for senior housing has grown, so has the number of assisted living units in the U.S.
According to the latest data available from the National Investment Center for Seniors Housing & Care (NIC), the number of assisted-living units increased from 514,000 in 2013 to 714,300 in the fourth quarter of 2023.
Rick Wigginton, chief sales officer for Brookdale Senior Living, a Nashville-based company that operated 647 senior communities in 41 states as of the end of 2024, says the biggest mistake he sees assisted-living residents make is waiting too long to move.
“People bring services into the home to enable them to stay in that home longer, but they don’t realize the cost of becoming more socially isolated,” he says. “If you’re dependent on someone to clean your house, pick you up for transportation or do food prep, you’re making your life smaller.”
Wigginton says that admission standards for assisted living vary from state to state. The process begins with an evaluation by a nurse or other medical professional to determine an older adult’s current and future needs and whether the community they’re considering can meet those needs.
To qualify, a resident typically must require some type of assistance, whether it’s with dispensing medication, bathing, getting dressed or certain other activities.
Assisted living offers older adults safety and security, personalized care, medication management, access to health care, nutritious meals and peace of mind for both residents and their families.
According to the National Institute on Aging, older adults are vulnerable to loneliness and social isolation, which can not only impact their well-being but also increase their risk for heart disease, depression and cognitive decline.
But well-run assisted-living communities can help minimize loneliness through classes, group entertainment opportunities and communal dining.
Family members should consider broaching the topic of senior housing when they notice that their loved ones are challenged by routine activities they used to do easily.
“Some older people become fearful of taking a bath because they might slip and fall, for example,” says Wigginton. “When we recognize that an older person is making different choices because of fear, that is the time to have a conversation.”
Paying for assisted living
Assisted living is not cheap. According to the NIC, the average monthly rent for assisted living in the fourth quarter of 2024 was $6,685 nationally, up from $4,504 a decade earlier.
Wigginton says that monthly fees for assisted living at Brookdale properties range from $3,500 to $7,000, depending on factors including the location, the size of the apartment and the amenities available.
The monthly fee quoted by an assisted-living community is a baseline price only, so prospective residents need to ask about the pricing structure and the cost of additional services they may need, such as personal aides, salon services and meals for guests.
Many assisted-living residents are cash payers, relying on savings or the proceeds from the sale of their home to cover their monthly payments.
According to Lisa McCracken, the NIC’s head of research and analytics, most residents stay an average of two to two-and-a-half years, so savings may be sufficient to cover costs.
Long-term care insurance can also help pay for assisted living, but a policy may be expensive. Premiums vary based on the amount of coverage as well as an insured person’s age and health.
According to William R. Dyess, president of Dyess Insurance Services in Boca Raton, Fla., a husband and wife, each 55 years old and in good health, should expect to pay between $5,018 and $6,325 per year for a joint long-term care policy that covers up to $165,000 and comes with an inflation rider that helps protect against rising costs.
Generally, the older you are when you buy the policy, the higher the premium will be. If a couple are both 65 and in good health when they purchase a policy, for example, the annual premium would range from $7,137 to $12,250 for similar coverage, depending on the insurance company issuing the policy.
Dyess says that a long-term care policy will kick in only when a health care provider determines that someone needs assistance with at least two activities of daily living or has a severe cognitive impairment.
The six essential activities of daily living include bathing, dressing, eating, getting in or out of bed or a chair, using the toilet and controlling bladder and bowel function, according to the National Institutes of Health.
To find a reputable agent, you can search the database at www.ltc-cltc.com/cltc/findCLTC for insurance professionals who hold the Certification in Long-Term Care designation, which they earn after completing a training program and exam.
Although Medicare covers short-term care in a skilled-nursing facility, it does not cover the cost of assisted living.
Similarly, according to the National Council on Aging, Medicaid does not cover the room-and-board portion of assisted-living expenses, but many states offer Medicaid waiver programs that can help cover other assisted-living costs for those who are eligible.
Besides evaluating whether the communities you’re considering fit into your budget, you should take other steps to settle on the best choice.
Find out which agency in your state regulates assisted-living facilities and check its website, which will likely provide a treasure trove of information — including state inspection reports, which can be very telling.
For example, you can find quality and safety information on New York’s adult care facilities here and Florida’s here (click on “Locate/Proximity,” then “Locate Facility”; on the page that comes up next, select “Assisted Living Facilities” in the first field).
Tour each facility multiple times, at different times of the day. Make sure the facility is clean, and ask to have a meal or two.
Review the dining policies as well. Do residents have assigned seating and a designated time to dine, or can they eat at any time? Are the menus varied, with options suitable for people with dietary restrictions? Is there a dress code for dinner? You’ll want to find a community that’s compatible with your loved one’s lifestyle.
While you’re touring, talk to residents and staff — and not just to people suggested by the employee leading the tour. Ask residents whether they are happy and what surprised them the most after they moved in.
Find out how long employees have been at the facility. Lots of turnover may indicate management issues, but consistent staffing will help ensure that employees get to know residents and can provide personalized care.
Meet with the executive director of the community as well as the director of nursing, who oversees the medical care of residents.
Find out whether the facility has programs to integrate your loved one into the social fabric of the community. Wigginton says that Brookdale communities map out the first 90 days for new residents to help them meet new people and get familiar with the activities available to them.
Other communities have “ambassadors” to introduce new residents to others and help ensure they are comfortable in their new surroundings.
Ask whether the community allows prospective residents to have a trial, or respite, stay — a weekend to get a feel for the community, helping you decide whether it’s the right fit.
Luis Serrano, president and CEO of Sunshine Retirement Living, which operates 38 senior communities, advises older adults to consider all types of facilities.
“Don’t just rely on the brand-new community that looks like a fantastic hotel,” he says. “You may be better off in a community that is not as elegant but has devoted employees who really care about you.”
Perhaps the best advice is to be proactive.
“You may not be ready today for assisted living, but come the time when you lose a spouse, you’re living on your own and you start to feel lonely, or you’ve fallen a couple of times — those are not the times to be making decisions,” says the NIC’s McCracken.
Comparing the cost of care
Many older adults prefer to stay in their own home, where they feel the most comfortable. They may be apprehensive about leaving the place where they raised their families and made memories.
To cope with any additional care they need as they age, they may bring in outside help ranging from companions to nurses to specialists, such as physical or occupational therapists. But just as with assisted living, the cost to remain at home, with the necessary support, can be high.
According to the 2024 Cost of Care Survey conducted by Genworth and CareScout, the cost of long-term care services of all types increased over the previous year, with homemaker services and assisted-living communities rising the most.
According to the survey:
- The cost of a home health aide, who provides services including hands-on personal assistance with activities such as bathing, dressing and eating, increased 3%, to an annual median of $77,792.
- Homemaker services, which include assistance with tasks such as cooking, cleaning and running errands, increased 10%, to an annual median of $75,504.
- Costs to reside in an assisted-living community increased by 10%, to an annual median of $70,800 per year.
Especially when you factor in the costs of homeownership — such as principal and interest on a mortgage, taxes, insurance, landscaping and pest control, cable and internet fees, utilities, homeowners association assessments and maintenance and repair costs — staying in your home may be considerably more expensive than moving to an assisted-living facility.
Older adults may also need to pay for retrofitting their home to allow them to age in place.
Note: This item first appeared in Kiplinger Personal Finance Magazine, a monthly, trustworthy source of advice and guidance. Subscribe to help you make more money and keep more of the money you make here.
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