Assisted Living
A residential care setting providing personal care assistance, meals, and activities for older adults who need help with daily living tasks but do not require 24-hour skilled nursing care.
Assisted living facilities (ALFs) are state-licensed residential settings for older adults who need help with activities of daily living (ADLs) — bathing, dressing, toileting, mobility, medication management — but whose medical needs do not require the continuous skilled nursing of an SNF. Facilities typically offer private or semi-private apartments, communal dining, social programming, transportation, and on-call personal care aides 24/7.
Costs vary dramatically by state and facility type. The national median in 2023 was $4,995/month ($59,940/year) for a one-bedroom unit per Genworth. High cost states (Massachusetts, Connecticut, California) averaged $6,000–$8,000/month; lower cost states (Missouri, Mississippi, Alabama) averaged $3,000–$4,000/month. Memory care units for residents with dementia typically add 20–30% to base rates.
Neither Medicare nor most health insurance covers assisted living; it is almost entirely private-pay. Medicaid covers ALF in many states through HCBS waiver programs, but waitlists are common (6 months to 3+ years in many states) and reimbursement rates are below private-pay rates, so many facilities accept limited Medicaid-funded residents. Long-term care insurance policies typically include assisted living as a covered benefit when the policyholder meets the benefit trigger (needing help with 2+ ADLs or having a cognitive impairment).
Real-World Example
When a family could no longer safely care for their 83-year-old mother at home after two falls, they placed her in a $5,400/month assisted living facility; her $650,000 in savings was projected to fund 10 years of care before requiring Medicaid planning.