Assisted Living as an Alternative

The term "assisted living" is a marketing tool that refers to a large number of different community living arrangements that also offer care.  There is no uniform regulation of these services from state to state.  Some states regulate on the basis of number of residents while other states regulate on the basis of services offered.  Not all states use the term assisted living for these living arrangements.  In the states that control services, some of those states allow very little in the type of services offered and residents in those states must go to a nursing home to receive more extended services.  On the other hand, some states allow assisted living to offer nursing home skilled services under certain conditions.  Obviously the services offered will affect the cost of care and the cost of an assisted living arrangement.  Also in some states assisted living costs includes the cost of long term care services and in other states the cost is charged in addition to room and board.

A large number of operation offering community living with care are invisible to the public.  They are small operations that don't advertise and probably fail to register with their state health department.  Their residents come to them via referrals from others.  For purposes of classification we will call these "board and care" facilities.

These are operations using a residential home and housing residents in bedrooms in the home, sometimes shared with another person.  Dining facilities, living room and bathrooms are shared.  Some of these operations are employer and employee companies but the vast majority are run by the people who own the home and have taken in aged boarders to supplement their income.  Long term care services are usually limited to what the owner operators can handle themselves.  To augment services, a number of these operations will bring in home health agencies to help with medical conditions.

Board and care operations naturally have  lower cost of operation and will charge their resident typically much less than the apartment-based assisted living facilities included in national surveys.  The surveys will not include these providers because they don't advertise, they don't list in the phone book and many have failed to license with their health department.