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Elder Care FAQs
Question: What's the difference between elderly housing and assisted living?
Answer: In Massachusetts, "assisted living" means a residence that offers a combination of housing plus support services, like help with bathing and dressing, meals, housekeeping, etc. Five years ago, the state passed a law to regulate assisted living residences (ALRs), and today there are more than 100 such facilities regulated by the state. Some have less than 10 residents, some have as many as 100 people.
By law, ALRs have to meet certain standards: bedrooms must have doors that lock; new construction must have private bathrooms for each apartment; every resident must have access to a kitchenette or cooking facilities; each person must get at least one meal a day, and anyone who needs it should get help with bathing, dressing, walking and supervision with medications; all residents must have housekeeping and laundry services; at least one staff person must be in the building at all times; all apartments must have some kind of emergency call signal; every resident must have a service plan describing what assistance they are to receive; and all residents must have a written contract that explains their rights and responsibilities. Some residences may try to use the term "assisted living", but if they are not registered with the state, they are not truly assisted living.
When comparing homes, ask what services the monthly rate covers. Some basic fees only cover room, meals and housekeeping, and services like personal care are extra. Find out what "extras" cost, like phone or cable TV. You are allowed to bring in services you want that the ALR doesn't provide, but you will have to pay for them yourself. Ask about the little details, such as who controls the heat in your apartment, and are pets allowed in the units? If you need skilled home health care, who do they use to provide it, and who pays for it?
You can ask to see a history of the monthly rates since the ALR opened, and ask what rules determine how much rates can rise in the future. If an ALR has boosted its rates in the past, it could do so again. Decide if you can afford such a rate increase. Unlike in a nursing home, residents who run out of money in an ALR cannot expect Medicaid to pick up the costs.
Every ALR will give you a residency lease to review. If you find it vague or hard to understand, ask the facility to answer your questions in writing, and make the response part of the lease agreement. Find out what rules they use to determine if you are too "frail" to be cared for in the ALR, and what the appeal process is if you disagree with their decision. Get a list of complaints that have been filed by residents over the past couple of years.
When visiting an ALR, try to talk to several staff people to see how they treat you. Find out how the staffing changes at night? Is there are active resident's council? Are they involved in planning the week's activities? Can you get meals when you want, or only at given times?
To check the track record of any ALR, or to see if it is a registered home, call the Elder Affairs assisted living ombudsman at 1-800-AGE-INFO. Ask them to send you a copy of their publication: Assisted Living in Massachusetts: A Consumer's Guide.
