Is assisted living the right choice?(book excerpt - Consumer Reports Complete Guide to Health Services For Seniors)(Excerpt)(Buyers Guide)

Perhaps you've been worrying about Mom lately. Her arthritis keeps her from taking care of the house, and she has so much trouble reading fine print that you wonder how she can keep track of her medications. Some days she doesn't feel like eating, and even a daily phone call leaves you more concerned than reassured. Mom says she'll never set foot in a nursing home, but every day you drive past an assisted-living facility, and its tidy buildings and manicured grounds look like an appealing alternative.

Assisted-living facilities offer a relatively new way to care for seniors who can't manage on their own. A cross between an apartment building with services and a nursing home, these facilities offer residential units, which sometimes include a kitchen, housekeeping services, meals, transportation to doctors and activities, and various levels of personal assistance--all for a monthly rental fee. The brochures for assisted-living facilities highlight independence, support, and communal activities for the frail and disabled elderly.

With the number of people who will need help with activities of daily living projected to increase by 51 percent in the next 20 years, assisted living is in a growth mode. The number of licensed facilities--built by independent chains like Sunrise, hotel chains like Marriott and Hyatt, and individual entrepreneurs--has increased 30 percent since 1998. Some communities now have many facilities to choose from, although rural areas may have few or none.

Today more than 500,000 people live in places loosely called assisted-living facilities, where the average age is 84.Most residents require help with at least three activities of daily living, such as eating, bathing, toileting, dressing, and walking. One industry survey found that nearly half of residents suffered from mild dementia or early to midstage Alzheimer's disease. Nearly one-quarter of facilities have special Alzheimer's units.

Assisted-living facilities are not substitutes for a nursing home. Many do not admit or keep residents who need ventilators or catheters, or help with continence problems. About 36 percent of all residents eventually go to a nursing home because the assisted living facility cannot accommodate their increasing needs, and 2 percent go to nursing homes because they have exhausted the means to pay for care.

The price of care at an assisted living facility can exceed $4,000 a month, depending on the size of the unit and amount of personal care needed. The financial arrangements are usually different from those of continuing-care retirement communities (CCRCs), which may require an entrance fee ranging in the hundreds of thousands of dollars. CCRCs offer a continuum of residential arrangements from independent living units to assisted-living and nursing facilities (see "Spectrum of Available Care," page 28).

PROMISE VS. REALITY