An assisted living residence is a type of care center for senior citizens who are no longer able to live independently but do not require the 24/7 care provided by a nursing home. The typical assisted living resident may need help with things like preparing a meal, taking a shower, or managing medications, but is otherwise able to live without care and supervision. In Texas, assisted living facilities (ALFs) are known as personal care facilities. Facilities caring for four people or fewer do not require a license; those taking care of five or more people must seek licensing through the state.
The first assisted living residence opened in the 1980’s. This was a time when several social trends converged. First, people were living longer and staying healthier. Second, families were more frequently separated by many miles so that no one was available to meet the care needs of a senior relative. Finally, nursing facilities were still perceived as crowded institutions that did not allow for privacy or dignity. ALFs provided an atmosphere that was more like an apartment complex than a hospital. Most people in ALFs had private rooms or apartments. ALFs also provided opportunities for socialization and outings.
ALFs currently provide homes to over 1 million United States residents. Of those, slightly less than half suffer from diseases that cause cognitive impairments such as Alzheimer’s or vascular dementia. In Texas, there are currently 830 licensed personal care facilities and over 4000 facilities that are unlicensed.
Assisted living facilities offer residents a private apartment or room and three balanced meals per day. In addition, they provide help with common physical needs such as keeping track of medicines, showering or bathing, dressing, and toileting. Depending on the rules in each state, some facilities provide heavier care, such as helping people transfer from their bed to their wheelchair and even feeding residents.
Most facilities figure costs by charging a basic rental rate. They then add on “points” depending on how much assistance the resident requires. Each point costs extra money per month. For instance, a woman who lived in a studio apartment and only needed help with medications would pay less than a woman who lived in a studio apartment and needed help with medications, bathing, dressing, and eating.
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For instance, in Austin, Texas, ALFs charge an average of $1500 per month for room and board alone. Once you figure in the services most people need, that cost goes up by about $500 per month. These costs are still less expensive than the costs of nursing homes which, in the Austin regions, charge an average of $3000 to $4000 each month.
Throughout the United States, approximately 90% of ALF residents pay for their care from their own assets and resources. Texas was among the first two states to approve laws for a Community-Based Alternatives program which allows Medicaid to help pay for the cost of assisted living care. Over 20,000 Texans have taken advantage of this program.
Many people wonder when their loved one needs more care than an ALF can provide. Most states have not set any clear guidelines. Texas is one of the few that does have such guidelines. By Texas law, ALF residents must be able to comprehend instructions given in an emergency and must be able to self-evacuate in the event of a crisis. For instance, someone who is so confused they cannot understand which exit to use would not be appropriate for ALF care in Texas. Texas guidelines also state that ALF care is not appropriate for anyone who needs to be supervised and cared for 24/7, or for anyone requiring invasive procedures like medications delivered through a PICC line or catheter or tube feeding.
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