What's included in the cost of assisted living?
Typically, the base fee and other up-front costs of assisted living include the following:
- Housing (rent and utilities)
- Three nutritious meals a day, plus snacks
- Help with activities of daily living (ADLs)
- Housekeeping and landscaping services (to reduce household responsibilities)
- Programming and activities
- Care coordination
- Transportation to medical appointments
Assisted living costs for couples
It's common for an assisted living community to add a second-person fee to the bill for couples who live in the same assisted living apartment. The national median cost of this fee in assisted living is about $1,200 per month, per A Place for Mom's proprietary data. Beyond the second-person fee, your loved ones may be charged differently depending on their individual health issues and assistance needs.
If your loved ones are planning to live together in assisted living, it's a good idea to ask prospective communities how they approach fees for couples and whether they offer a couple's discount.
Assisted living pricing models
While some assisted living communities charge a flat, all-inclusive fee, others use an a la carte or tiered approach.
All-inclusive
In these communities, the monthly fee includes room and board, care services, and all other services and amenities. Costs don't change if a resident's needs change over time — as long as the community offers the level of care they need.
A la carte
These communities charge a base fee and add or remove services as residents' needs change. For example, if your loved one temporarily needs extra assistance with eating or bathing because of an illness or injury, their costs will be higher during that time. Common add-on services include:
- Medication assistance
- Physical or occupational therapy (provided by a third party)
- Beauty shop or other personal grooming services
- Parking
- Pet rent
- Internet
- Laundry
- Some transportation
Tiered
These communities offer different levels of care at different price points. For example, a lower tier might include help with three ADLs, while a higher tier may support help with five or more ADLs. This approach offers predictable costs while also enabling residents to receive a higher level of care without moving.
Cost transparency in assisted living
Most states require assisted living communities to provide prospective residents with written disclosure of their fees, services, and residency agreement before admission or upon admission. However, specific requirements vary by state.
"Families are sometimes surprised by charges they weren't expecting," says A Place for Mom's Niki Gewirtz, who has more than 20 years of experience in the senior living industry. "It's important to understand your loved one's assistance needs and that they can change over time." Someone who didn't need much help in the beginning may get injured and need more help for a short period of time. "The community will charge more for providing more assistance during that period. But the fees weren't hidden," Gewirtz explains.
Questions to ask about the cost of assisted living
To avoid being surprised by changing fees, ask about a community's pricing model up front and have a good understanding of your loved one's assistance needs.
"There are two basic factors that dictate what an assisted living community will cost," says Gewirtz. "The apartment itself — whether it's a studio or a two-bedroom — and the additional care fees. It's not uncommon for families to underestimate how much assistance their loved one requires, whether it's help with medication, showering, or remembering to eat."
Gewirtz explains, "A nurse in an assisted living community will typically do an assessment when a resident moves in and again about 30 days after move-in. That's what determines the level of assistance someone needs."
Ask the following questions to learn more about how a prospective assisted living community approaches pricing:
- How much does assisted living cost per month?
- Is this cost all-inclusive?
- If the cost isn't all-inclusive, what's included in the base rate?
- Are there a la carte options to add to the base rate? How much does each of these options cost?
- Are there pricing tiers for different levels of care?
- Is there a move-in fee or community fee? If so, how much is it? Is it due all at once, or can we pay for it over time?
- Does the cost increase annually?
- How much does pricing vary by floor plan?
- What happens if my loved one's care needs change and they need to move to a higher level of care?
- What happens if our family can no longer pay?