Assisted living is a term that is unsatisfactory for many elderly, for they consider assisted living as loss of independence and being neglected by caregivers and family. However, today’s assisted living communities are a far cry from the nursing home of yesteryear. Assisted living communities, and yes — community and not a facility — are built to provide independence to its residents, providing care and services so as to be independent as long as possible. With the advancement of medical care in today’s society, many elderly do not have acute conditions that require a skilled nursing facility with 24-hour nursing care, but have chronic conditions, such as arthritis, diabetes or obesity, that require some assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Activities of Daily Living consists of basic self-care needs. These include bathing, dressing, grooming, eating, transferring and toileting. Instrumental Activities of Daily Living consist of activities to live independently. These are housework, yardwork, meal preparation, medication management, money management, shopping and transportation. That is the basic role of an assisted living community — to provide “assistance” to a resident in the area of ADLs and IADLs. Besides covering the ADLs and IADLs, assisted living communities also provide activities to enhance a resident’s quality of life, such as wellness programs, exercise programs, social events and outings.
Though the role of assisted living communities are basically the same, there are differences among assisted living communities within Wisconsin, dependent on their licensing, number of residents and level of care allowed. In Wisconsin, there are several types of assisted living communities: Adult Family Homes, Residential Care Apartment Complex and Community-Based Retirement Communities.
Adult Family Home (AFH) is defined as a place where two to four adults, not related to the owner, receive care, treatment or services above the level of room and board. No more than seven hours per week of nursing care may be provided to the residents. In most instances, Adult Family Homes are usually occupied by those with physical or mental disabilities. But in the last few years, several AFHs have been built in the area to house the elderly and those with dementia. The cost of Adult Family Homes is usually more significant than the other types of assisted living communities.
Residential Care Apartment Complex (RCAC) provides a resident (tenant) with an independent apartment that is homelike and residential in character and provides: room and board, up to 28 hours per week of supportive care, personal care and nursing services. Those entering an RCAC must be their own person, and be able to make their own decisions. Tenants are able to cook in their own room, but are also offered different meal plans for those who do not wish to cook. The level of care needed by the tenant will determine the cost above room and board. Many tenants start as “independent,” and can be added upon as assistance is needed. There are two types of RCAC classifications:
Registered: All tenants need to pay privately. If a tenant is unable to pay privately, they will be given a written notice to vacate. Certified: Tenants begin residency as private pay, but can go to public funding (medical waiver) if they run out of funds. Most RCACs require a 1-2 years of private pay before being able to apply for public funding. The negative aspect of an RCAC is the inability for care to go over 28 hours per week. In these cases, the tenant will be asked to leave or request that Home Care services be provided to offset the extra care needs. Also, most communities are able to offer one-person assistance for transferring. If a tenant needs a 2-person assist, sit-to-stand or a Hoyer for transferring purposes, the tenant will be asked to leave or request Home Care services.
Community Based Residentiary Facility (CBRF) is a place where 5 or more unrelated people live together in a community setting. Services provided include room and board, supervision, support services and may include up to 3 hours of nursing care per week. The CBRF usually is a home like environment, where a resident will have their own bedroom with either a private half or full bathroom. Residents are encouraged to utilize the entire building as their home. Three meals a day are provided to the residents, and is included in the room and board. Cost of care is determined by the level of care, and is an additional cost above room and board. There still may be transferring restrictions, such as no sit-to-stand or Hoyer. CBRFs do not have different classes like RCACs, but may be private pay only. However, most CBRFs in the area take public funds, but request 1 to 2 years of private pay before being able to apply for public funding.
Dementia care: Many CBRFs have a dementia unit connected to their community. They have special activities that adhere to those with dementia, and will care for those who are considered advanced. Residents of the dementia unit will go to the assisted side of the community for social events. In other CBRFs, their entire community handles dementia care and are considered Stand Alone Dementia Communities.
Note: Some CBRFs indicate they do take care of dementia, but if they do not provide 2-person assist, a sit-to-stand or Hoyer, they are only willing to care for mild cases of dementia.
There are some assisted living communities being built that are a mixture of a RCAC and a CBRF. They provide a studio or 1-bedroom apartment with a full kitchen or kitchenette, and provide 2-person assist, sit-to-stand and a Hoyer. These communities will also have a separate dementia unit (CBRF), to allow residents to age in place within their community. But in most cases, these newer communities are private pay only.
Though assisted living communities are basically the same in providing ADLs and IADLs, the types of assisted living communities are very different based on licensing and regulations. This makes the process for a senior or family looking at assisted living so overwhelming. Most people would not consider buying a home without a realtor, so if you are looking for assisted living for a loved one, consider working with a Senior Living Advisor. A Senior Living Advisor will help you navigate the different types of assisted living communities that would best fit your loved one’s preferences based on care, finances and location.