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              Assisted Living Residences in Massachusetts

Assisted living Residences (ALRs) provide a step between fully independent living and around-the-clock care. It's for people who value their independence, yet need some help with life's daily chores and necessities.  Assisted-living residences are designed to help the infirm, disabled or elderly with tasks such as dressing or bathing while also helping that person maintain maximum personal independence and self-reliance.

Assisted Living is a residential option which stresses privacy, dignity, autonomy, and individuality. They serve as an essential part of the continuum of care that allows elders to age in their communities.  ALRs are not the same as nursing homes and they are prohibited from providing “skilled care.”

Assisted Living Residences across the Commonwealth vary in size and style. They include large apartment-style settings as well as smaller family-style homes. Some ALRs serve fewer than ten residents while others serve over one hundred residents. Some ALRs are operated for profit while others are operated by non-profit organizations. In addition, some are affiliated with religious organizations and some are affiliated with hospitals or nursing homes.  Some ALRs have a section of the building set aside for people who need a specialized or secure environment. These are referred to as Special Care Residences (SCR), and the individual residential units within them are referred to as Special Care Units (SCUs.) Some examples of SCRs are those established specifically for residents with:

  •    Alzheimer’s and related dementia;
  •    Huntington’s disease; or
  •    Mental Health issues or other related cognitive impairments.

Assisted living care is rarely a permanent living situation. Most residents, as they age, will need higher levels of care. Many facilities are grouped together on a shared campus with nursing homes and independent retirement communities so the transition from one care provider to another will be as easy as possible. These are known as continuing care retirement communities, or CCRCs. By grouping these facilities, residents are able to remain in the same location for the latter stages of life instead of moving from one part of town to another.

Standards required by law for  Assisted Living Residences in  Massachusetts

By law, all ALRs in Massachusetts are required to obtain and maintain certification from the Massachusetts Executive Office of Elder Affairs.  To do this, an ALR must meet regulatory standards which were designed to increase consumer protection, while also allowing an individual ALR to be flexible in meeting the needs and desires of residents. These required standards include the provision of:

  • Studio, one or two-bedroom apartments with lockable doors;

  • A newly constructed ALR must have private bathrooms in each apartment. Bathrooms may be shared in some smaller and more home-like ALRs;

  • Kitchenettes within each apartment, or a community kitchen which everyone may use; At least one meal a day including meals with an option for low-fat, low-sugar or low-salt foods;

  • Assistance with bathing, dressing and ambulation for all residents who need this;

  • Housekeeping and laundry;

  • 24 hour a day on-site staff;

  • Personal Emergency Response system or other similar procedures used to signal on-site staff;

  • Individualized Service Plans developed and signed by the resident (and, if applicable, his or her Legal Representative or Resident Representative) and the Service Coordinator at the ALR that document which services will be provided, how often they will be provided,  and by whom;

  • Disclosure of Rights and Services (Disclosure Statement) which outlines those services offered, service limitations, costs involved, termination policy, Special Care Residence policies and procedures (if applicable), and staffing levels;

  • Residency Agreement (Lease/Contract) that details what the ALR will provide to the resident, including the rights and responsibilities of both the ALR and the resident;

  • Self-Administered Medication Management (SAMM) for all residents who need this service.

  • Under the Self-Administered Medication Management regulations, personal care staff may only assist residents with taking medication. For example, they may remind a resident when to take medication and open bottles or other containers. They may not administer any medication. This means, for example, that they may not squeeze eye drops into a resident’s eye, put a pill into a resident’s mouth, or rub medicated cream on a resident’s back. If you need more than reminders to take medication, you will need to find an ALR that offers Limited Medication Administration

  • Optional Medication Service — Some ALRs provide a higher level of assistance with medication through the Limited Medication Administration program (LMA). Under the rules that apply to LMA, a nurse can administer eye drops, apply medicated cream, and place pills in a resident’s mouth. Not all ALRs provide LMA, so if you need or think you will need medication administration; ask to make sure this service is available.

Although all ALRs that are certified by the State will have met these general standards, ALRs throughout the State will still differ from one another in important ways. Although you should be aware of the standards and Resident Rights required by law, the following issues should be seriously considered when you are deciding which ALR is right for you or your family member.

Assisted Living Services

What type of care is provided at assisted living homes? All homes are different, as are individual needs and service contracts. Generally, assisted living arrangements involve help with Laundry, meal preparation, Personal Care.  Daily medications, and Social and recreational planning.

Assisted living is not the right choice for everyone. Also, assisted living isn't generally made available to those who need special care outside of that which a facility can provide. The following are care options not provided or medical situations that don't qualify for assisted living care:

  •    Use of restraints or physical confinement.
  •    Care for chronic health conditions.   
  •    Severe cognitive impairment.

Assisted living depends on a resident's ability to dictate the terms of their own individual care.

Cost of Assisted Living

While Assisted Living is usually more affordable than a nursing home, it can still be expensive.  The cost of Assisted Living varies greatly. The base monthly fee for an ALR in Massachusetts is typically between $3,000 and $5,000, but can be higher depending upon the level of care needed. The variation in the cost is based on many factors, including:

  •    The kind and number of services you need;
  •    The size, design and amenities of the Residence;
  •    The size of the apartment you choose;
  •    The location of the Residence.

Most Assisted Living Residences charge a base monthly fee. This fee may increase, and the amount of the increase, as well how often the ALR may increase the fee, is determined by the terms of the Residency Agreement. It is vital that you read and understand all the terms in your agreement prior to signing it.
In addition, most Assisted Living Residences require an additional fee before you move in.  These initial fees may be called “entrance fees” or “community fees.” They can range from a hundred to thousands of dollars and are usually not refundable.  The monthly fee you pay to live in an Assisted Living Residence will depend on the care you need. The ALR will assess your needs prior to your admission, and will conduct re –evaluations every six months while you live there. In general, the more care needs you have, the higher the fee. The majority of Assisted Living residents pay privately. Medicare, the federal health insurance program for elders and the disabled, does not provide coverage for the costs of Assisted Living. Individuals with long term care insurance policies should inquire of their carrier to determine if they qualify for coverage of any services.
The following subsidy programs are available in Massachusetts to qualified individuals.
Supplemental Security Income – Category G (SSI-G) – This is a rental or room-and board subsidy program administered by the Social Security Administration and Supplemented by the Massachusetts Department of Transitional Assistance. This Subsidy program is only available to individuals who have been determined to need and are receiving medical services from the MassHealth Group Adult Foster Care.  To qualify for SSI-G, an individual must:  Meet all SSI-G criteria;

  • Be residing in a certified ALR in Massachusetts that accepts SSI -G payments for rental or room-  and-board;
  • Be clinically eligible for and receiving MassHealth GAFC services ; and
  • Be financially eligible based on SSI-G income criteria.  SSI-G criteria require an individual and/or member(s) of a couple to meet certain financial guidelines. SSI-G examines, among other things, available assets and monthly income to determine eligibility for the program. Potential ALR residents are encouraged to talk to Social Security directly through the field offices sites.

Not all ALRs accept SSI-G as payment for rent or room-and-board. Potential residents should inquire about SSI-G funding prior to signing a Residency Agreement. This proactive step ensures that if and when the potential resident in the ALR has exhausted all financial resources, financial assistance is available.
Other income qualifying programs - Some ALRs provide reduced rates for moderate income residents. Depending on the agency or organization through which the ALR received financing, the ALR may be required to set aside a certain number of units for residents meeting low income guidelines. You should inquire as to whether the particular Residence you are considering offers reduced rates.

Some other questions you should ask regarding the cost of the ALR:

  1. What services are included in the monthly base rate? Most rates include room, meals, and housekeeping. The services that are offered may be in various packages that are available from the Residence for an additional fee. When considering these prices, think about what services you may need in the future, not just your current needs. Would future costs become too high for you to afford?
  2. For services that are not covered in the base rate or in any special packages, what are the costs and how are they billed? Charges for telephone, cable, newspaper delivery, and salon services are usually billed in addition to your base rate and service package. Make sure you understand what the entire extra "add -ons" may be.
  3. Does the ALR require an initial entrance fee, application fee or deposit up front? Some ALRs may require a security deposit, while others may ask for a large “entrance” or “community fee.” Medicaid-eligible residents may also have to pay these upfront fees. If these are required, you should ask for the purpose of such fees, whether such fees are refundable, and if so, under what circumstances. You may want to ask for an explanation of any up-front fees in writing. Depending on circumstances, it is also possible to try to negotiate these fees.
  4. Is there a limit on the percentage by which the monthly rate can be increased or how often the rate can be raised? All monthly rates, the increases and the frequency of these increases are determined by the Residency Agreement. It is important to understand the terms of your agreement prior to signing it.   Unless specifically noted otherwise, the ALR can raise the rent at its discretion. For example, you may not want to sign a lease believing the monthly rate is $3000 a month and then six months later find out the rate is being raised to $3300 a month.
  5. What happens if I run out of money? In Massachusetts, Assisted Living is based on a residential model; an ALR is not a medical facility. If you are unable to pay the monthly rent, you do not automatically qualify for assistance. It is important to find out how the ALR will handle a situation if you run out of assets and your income does not cover the entire cost of your rent and services. If the ALR makes any guarantees that you can stay even if you run out of money, we recommend you get this guarantee in writing. If the ALR is a GAFC provider, you may want to ask if there is usually a wait for a GAFC-eligible apartment and if you will need to relocate to a different unit reserved for GAFC participants.
  6. How does the Termination Clause in the Residency Agreement affect me financially? Most termination clauses include the amount of notice that must be given to terminate the agreement between you and the Residence. It is not uncommon for the agreement to call for a 30, 60, or 90 day notice period. Most agreements include more specific language on the notice requirements for terminating an agreement in the event of an unexpected death, or a medical emergency which results in the Resident not being able to return to their apartment. Please take the time to read and understand what you are signing.

What to Look for When You're Choosing Assisted Living

Once you or your family member has decided to move to an ALR, how do you go about finding the right one? To find out what Residences exist in the area you are interested in, ask your friends, ask your local Council on Aging, and visit your local library to review newspapers, retirement living guides, and other publications. The Massachusetts Executive Office of Elder Affairs (Elder Affairs) maintains a list of ALRs in Massachusetts which includes their location, the number of units, and a contact telephone number for each. This list may be accessed online at www.800ageinfo.com, a website sponsored by Elder Affairs, or at 1-800-AGE-INFO (1-800-243-4636) or 617-727-7750. Elder Affairs does not recommend specific ALRs.  Once you have a general idea of the setting, services, and price range you prefer, call several Residences in the location you’re considering. You may want to ask the following preliminary questions to help you narrow your search:

  •    What is the size of the Residence?
  •    What types of living units are available?
  •    What is the monthly fee?
  •    Do you require a deposit?   If so, how much?
  •    What services do you provide?
  •    What services are included in the monthly fee?
  •    What services are extra?

Plan to request a brochure, a price list, a copy of the Residency Agreement (which may be called the “lease” or contract), and the Disclosure of Rights and Services Statement so that you can review those items during your selection process. Read the Residency Agreement Closely, paying special attention to cost, services provided as well as what services are not provided, and the criteria and costs for termination of the agreement.

It is to your advantage to tour the Residence that you are interested in. Initially, it is advisable to call and schedule a tour, which is usually given by a marketing representative. If possible, try to make a few visits at different times during the day. You may wish to have lunch or dinner at the ALR in order to try the food and see what the service is like, as well as participate in an activity or social event to meet and talk with current residents and staff.

You may also wish to inquire as to whether an ALR offers respite or trial stays. Some ALRs may allow a potential resident to move in for a short period of time to see whether or not he or she would be happy living there. This provides you or your family member with the opportunity without signing a long-term contract to see what it would be like to live at the ALR. If you are interested in an ALR which is not yet open, visiting will be impossible. If the management company of the ALR you are considering manages another ALR in the area, you may want to visit that ALR to get an idea of how that company operates them.  
­When choosing an assisted-living facility for yourself or a loved one, it's important to know what to look for and what questions to ask when visiting different homes. As we've learned, assisted living comes in many different forms, and, like about everything else in life, some are better than others.

Some questions to ask yourself or your guide when visiting:

  1. Do the residents seem happy? The faces of the residents will be the best advertisement for a   good, attentive and well-run facility.  If residents seem withdrawn, forlorn or antisocial (or too social, depending on your personality), that facility may not be the one for you.
  2. Is the residence clean, neat, secure and well designed? Again, it will only take a cursory examination to learn a lot about the maintenance and professionalism of the home. Are hallways and stairways easy to navigate and well lit? Are there handrails in the bathrooms? All of these factors will affect safety and comfort, especially considering your stay may last many years.
  3. Are pets allowed?
  4. How many common areas are there? If there are few places to mingle, there may be few chances to form new relationships.
  5. Is transportation available to residents? Make sure you know whether the home has a shuttle or is near a bus line. Some assisted living homes charge parking fees for residents and visitors. Others provide (sometimes at a charge) transportation to and from religious services.
  6. What is the facility's policy on what personal belongings the resident can bring? In some cases, residents may be able to bring household furniture such as chairs, sofas or bookshelves, while in other cases the living quarters may be furnished or too small for bulky items. Many times, on-site storage is available for any items that won't fit in the room.

If you're considering a roommate so that you can cut costs (or simply for the camaraderie), check the size of the rooms and the design of the living arrangements. It'll be harder to get off on the right foot with your new roommate if you're constantly stepping on his or her toes.
Think about these matters before you start your search, and you'll be more likely to know you've found the right facility when you see it.