What is Assisted Living?

Assisted Living is part of the continuum of long-term care services that may provide a combination of housing, personal services, and health care designed to help individuals who need assistance with normal, daily activities (sometimes referred to as "Activities of Daily Living" or "ADLs") in a manner that promotes the person's independence.

Assisted Living differs from nursing home care in that Assisted Living does not provide the 24-hour skilled nursing care offered in licensed nursing homes. Nursing homes and Assisted Living communities operate under entirely different sets of rules and regulations. The level of services and/or types of care offered varies widely.

What Types of Assisted Living Residences Exist?

In Michigan, several types of residential communities may fall under the umbrella of "Assisted Living." These types include independent senior apartments, housing with services establishments, homes for the aged and adult foster care homes. They may be freestanding or housed with other options, such as independent living or nursing care. Most residences have between 20 and 120 units, varying in size from one room to full-size apartments. They may be operated by nonprofit or for-profit companies. A description of each type of residential community follows:

Independent Senior Apartments operate under a traditional tenant/landlord agreement. They may offer community events such as scheduled activities or outings. Residents of these communities are usually able to take care of or arrange for their daily needs, just as if they were living at home or in a traditional apartment community.

Housing with Services Establishments (HSE) The HSE has been designed to provide a pleasant, supportive environment, which enables each individual tenant to maintain his or her optimum level of independence. The HSE offers its services to all qualified persons on a non-discriminatory basis, without regard to race, color, sex, religion or national origin. The HSE offers services suitable for persons who are independent, requiring minimal assistance with daily activities but desire the amenities and services of living in an HSE. For consideration of the rent payable under the Rental Agreement, a variety of services may be provided without additional charge. Any additional service elections selected by the tenant should be set forth in a Services Addendum indicating services selected and the cost of said services.

HSEs do not require licensure by the state of Michigan. Many licensed services may be available through outside agencies, such as a home health agency.

A Home for the Aged (HFA) is a supervised personal care facility, other than a hotel, adult foster care facility, hospital, nursing home, or county medical care facility that provides room, board, and supervised personal care to 21 or more unrelated, non-transient individuals who are 60 years of age or older.

Administrators and all staff in supervisory positions must be at least 21 years of age. All staff must go through training to learn how to work with the population for which they are caring. HFAs may provide assistance with activities of daily living. A sufficient number of attendant personnel shall be on duty on each shift to assist residents with their personal care under the direction of the supervisor of resident care.

Communities that advertise or market themselves as providing specialized Alzheimer's care are to provide prospective resident families with a written description of the care and services provided.

HFAs are required to be licensed by the state of Michigan. In 2002, a workgroup convened to amend the current HFA regulations. For updated information, contact MCAL at (517) 627-1561, or the Bureau of Children and Adult Services (BCAL) by logging on to: www.michigan.gov/dhs.

Adult Foster Care (AFC) homes are residential settings that provide 24-hour personal care, protection, and supervision for individuals who are developmentally disabled, mentally ill, physically handicapped or aged who cannot live alone but who do not need continuous nursing care. For purposes of this guide, we will list only those Adult Foster Care communities that care for aged individuals and are licensed for 18 to 20 people. If you would like more information on AFCs that care for developmentally disabled, mentally ill, physically handicapped, or are licensed for less residents, please contact the Bureau of Children and Adult Services (BCAL) by logging on to: www.michigan.gov/dhs.

There must be sufficient direct care staff on duty at all times for the supervision, personal care, and protection of residents and to provide the services specified in the residents' care agreements and assessment plans. In homes with 13 to 20 residents there shall be no less than one staff to 15 residents during waking hours and one staff to 20 residents during normal sleeping hours. Many communities may staff at a higher level to meet their residents' varying needs.

Administrators must have at least one year of experience working with persons who are mentally ill, developmentally disabled, physically handicapped, or aged. Both the licensee of the home and the administrator must complete either 16 hours of training approved by the Michigan Department of Consumer and Industry Services (MDCIS) or six hours at an accredited college or university in an area approved by MDCIS. The licensee or administrator must provide in-service training or make training available through other sources for direct care staff in the following areas: reporting requirements, first aid, CPR, personal care, supervision, protection, resident rights, safety and fire prevention, prevention and containment of communicable diseases. Both the licensee of the home and the administrator must complete either 16 hours of training approved by MDCIS or six hours at an accredited college or university in an area approved by MDCIS.

Communities that advertise or market themselves as providing specialized Alzheimer's care are to provide prospective resident families with a written description of the care and services provided.

AFCs are required to be licensed by the state of Michigan. For more information, log on to www.michigan.gov/bhs.

How is Assisted Living Regulated?

Regulation and licensure of Assisted Living varies from state to state. In Michigan, two types of licensure, Home for the Aged and Adult Foster Care, are available. The rules and regulations vary for these two types of residences. Department of Human Services, Bureau of Children and Adult Licensing  regulates both of these long-term care settings. To find out what the specific licensure requirements are, you can log on to: www.michigan.gov/bhs.

Some communities in Michigan offer services that do not require them to be licensed by the state. These Housing with Services Establishments may offer certain hotel-type services such as food preparation and housekeeping. Other services may be available by contracting with an outside agency, such as home health.

Who Lives in Assisted Living Communities?

Thousands of Michigan citizens live in Assisted Living communities. Characteristics of Assisted Living residents vary. They may be young or old, affluent or low-income, frail or disabled. The typical Assisted Living resident is a female in her eighties - usually either widowed or single. Some residents may have dementia or other memory impairments and may need help facing challenges, such as lack of mobility or incontinence. Assisted Living is an appropriate choice for someone who is too frail to live at home or who wants extra support with "ADLs."

What Types of Services are Offered in Assisted Living Communities?

Assisted Living communities offer a variety of services to residents, based upon individual needs. Some of these services may include:

• Available meal options, including up to three meals a day served in a common dining area
• Housekeeping services
• Assistance with transportation
• Assistance with various ADLs, including eating, bathing, dressing, etc.
• Access to health and medical services (may be in-house for licensed communities, or contracted from an outside organization in housing with services establishments)
• 24-hour security and staff availability
• Emergency call systems for each resident's unit
• Exercise and other health promotion programs
• Assistance with medications
• Laundry services
• Social and recreational activities

Who Pays for Assisted Living?

Costs for Assisted Living vary widely depending on the type of residence and levels of service offered. As a general rule, residents or their families pay the costs from their own financial resources. Health insurance policies or long-term care insurance policies may cover some costs. Michigan also has a Medicaid waiver program that may cover the costs for those who meet certain requirements. However, the number of participants is limited.

When analyzing the costs of Assisted Living, it is important to keep in mind that some residences charge a base rate for some services and additional "ala carte" services can increase the costs substantially. It's important to meet with representatives of the community who can help you understand their cost structure. Click here to find a "cost calculator" that will assist you in determining these costs.

Where Do I Start?

1. Assisted Living Guide
   This Guide is an excellent first step in narrowing your search. Use the Guide to pick three or four communities in your area that offer the type of services you are looking for.
2. Phone Calls
   Call and schedule a visit.
3. Visits
   Visit each of the communities. Click here for a handy checklist you can take along, as well as a set of questions to ask the staff. Take a tour of the three or four communities you have selected and observe how the residents interact with each other and the staff. Don't be afraid to ask questions as you go along.

When you are finished, discuss the results you have found with someone you trust and proceed from there.