How is the total cost of assisted living residency really determined?
Many senior living options exist today, making it difficult to decide which option is best for your loved one.
As you search for the right assisted living community, you may be overwhelmed by the various contracts, services, and fees. And you've probably noticed that many assisted living communities withhold detailed pricing information and staffing policies. They often require you to provide your contact details before discussing fees and services.
Weighing your choices carefully is worth the time and research it takes. When you’re informed, you can make a confident decision that meets your objectives.
At The Birches Assisted Living and Memory Care, we consider it essential to be transparent about our prices and care options—and we put all this information on our website in detail. In our contracts, we disclose everything that is not included with rent, along with our policies on admittance and discharges.
During your research you will inevitably see pricing from online directory sources displaying the average monthly cost of assisted living for various communities. But the pricing listed on these directories are just the base pricing.
Assisted living facilities provide living options for older adults who need assistance with daily tasks, nursing care, housekeeping, meals, and more. Every assisted living community prices its services and care differently.
Assisted Living Cost Factors
In general, the cost of assisted living is primarily determined by the following cost factors:
- Care and assistance services
- Staff quantity, experience, and longevity
- Base rental fee
- Community fees and ancillary costs
To help you weigh the significant pricing differences you will encounter in your research, we have prepared this guide to navigate the many factors that go into choosing an assisted living community and to explain how the fees and services are structured and calculated.
1. Care and assistance services
Care needs should always take top priority. Accurately assessing the amount of care needed is and one of the most difficult to understand.
Most assisted living communities use a level-of-care approach based on a resident’s care and needs. The level of care is usually based on the number of activities of daily living (ADLs) with which a resident requires regular assistance.
Most communities bill residents based on the level of care, which isn’t always the best approach to cost efficiency and transparency.
The levels-of-care model of assisted-living payment has three to seven levels into which various services are grouped. Each tier allows for a certain amount of care hours per month.
For example, residents who need very little care would be placed in the lowest level of care, which would be the least expensive. Conversely, residents requiring significant care, are placed in the highest level of care.
The major drawback with the levels-of-care model
The major drawback with the levels-of-care model is that a residents monthly bill could increase unexpectedly when the resident suddenly requires a higher level of care.
Suppose one assisted-living community says the monthly cost around $5,000, and another says it will be around $6,000. Suppose you prefer the higher-cost facility but ultimately choose the lower-cost community because it will save $12,000 per year. However, after your loved one has lived in the lower-cost community for a month, you get a call saying that your loved one needs more care than originally thought and they need to bump her up to another tier. Now it will cost over $6,000 per month, more than the other facility you liked better to begin with.
Be aware of the “all inclusive” component.
Another drawback with the levels-of-care model is that you might pay for a service a resident doesn’t want or might not receive. It’s common for each of these levels to include an “all inclusive” component: for example, assistance with showering.
The levels-of-care model includes shower assistance seven days a week. But what if the resident wants to shower only four days a week? In most communities, you are charged regardless of whether you use the assistance. Be sure to inquire about what exactly you will be charged for each month.
The level of care is determined during a process called a needs assessment.
The level of care is determined by a community staff member during a process commonly called a needs assessment. A needs assessment must be completed before a resident can move into a community.
Most assisted-living communities have a staff member evaluate your loved one’s cognitive and physical health—typically, their behavioral and mental condition; what medical and special support needs they might have; and how well they manage daily activities safely, including personal health and hygiene.
Points are awarded for each of these areas. The number of points corresponds to the level of care required, which determines the monthly care and assistance fee. The more points awarded, the higher the level of care deemed necessary and the higher the cost.
However, under this system, residents with diagnosed medical conditions likely pay more for care each month, even if they do not require a high level of daily care. Some facilities automatically add extra points for specific diagnoses—and may not reevaluate for a year.
Communities set their own point systems.
It is important to remember that communities set their own point systems and often incorporate three to seven levels of care. This practice is not regulated, so facilities tend to make recommendations from the needs assessment that align with their business needs rather than your loved one’s care needs.
Questions you should ask during the needs assessment
What are the qualifications of the person doing the needs assessment?
How often are team members able to check on residents?
What is the plan for executing this care?
How often will the care plan be reassessed?
Are there skilled team members available to respond to emergencies?
Who will administer medications?
What is the standard procedure for monitoring residents?
Getting an accurate understanding of a resident’s care and assistance is crucial to determining the final cost of assisted living.
At The Birches, we don’t use the levels-of-care model in Assisted Living
Here’s why. Each resident is unique and should not be grouped into a level for care. We believe the more thorough, clinical, and detailed the assessment, the better the plan of care and account of the cost. This allows us to create customized care and wellness plans that look different for every resident.
If we have a resident who wants assistance with showering but not every day, we don’t invoice them for daily showers. We simply note in the resident’s care and wellness plan that they only want two showers per week and set the cost per shower.
We detail this in our monthly invoices, so there’s no guesswork for families and residents. Our team also evaluates those care and wellness plans every month, allowing us to adjust if a resident needs more or less assistance.
We also don’t use a point system. Instead, we rely on our detailed, clinically based assessment process.
We believe point-based assessments tend to be subjective, which could unnecessarily drive up the cost of a resident’s monthly care. For example, a resident may have had an off day during the assessment and needed just a bit more assistance with daily tasks than usual.
Our director of nursing will visit your loved one in their home to assess their mobility and memory; what medications they take that might have side effects or carry a fall risk that staff would need to be aware of; and other needs they might have, however big or small.
We also ask for detailed information from your loved one’s doctor and talk to the rest of the family, caregivers, and therapy partners to make sure we have a thorough and complete picture of your loved one’s daily living needs—including assistive devices, chronic illness monitoring, special diets, medication management, and assistance with bathing and dressing.
Once the needs assessment is completed, we use our gathered information to develop a customized and comprehensive wellness plan.
Although some assisted living facilities do not use such a detailed evaluation process, we have found that conducting personalized and clinical assessments best determines residents’ needs and the success of their transition to assisted living.
Medications are another essential factor to consider if you’re trying to find an assisted living community for your loved one. Under the levels-of-care method, many communities say that medication reminders are automatically included.
However, this often means that a certified nursing assistant (CNA) simply reminds your loved one to take their medication. The CNA isn’t allowed to dispense the medicine or deliver it. They are also not licensed to assess signs, symptoms, and reactions to taking a medication like a licensed nurse.
At The Birches, if a resident needs assistance with medication, we go beyond a simple reminder. Our nurses, licensed and experienced, can monitor and administer the medication and communicate directly with the family and physician if there are concerns.
This is a benefit because our nurses get to know our residents and their routines. For instance, if a resident takes blood pressure medication but says they feel dizzy, our nurse will not dispense it because of safety concerns. Our nursing team will check the resident’s blood pressure, and they’ll know immediately if it’s in the resident’s normal range. If necessary, they’ll call the resident’s doctor to determine the next step.
2. Staff quantity, experience, and longevity
The staff-to-resident ratio is vital to understand when making comparisons between communities.
An assisted-living community’s care team has an incredible impact on residents’ lives. Yet the staff-to-resident ratio is often overlooked when comparing communities. It is important because fewer care staff can mean that residents must wait longer for assistance or care.
Be sure to ask the communities you visit about the ratio of staff to resident and how they adjust their ratios. Be sure to ask what type of staff they include in that ratio. The included staff should be a part of the care team, not building maintenance or cook staff.
At The Birches, we do our best to make sure every resident receives the assistance and care they need when they need it.
Our staffing ratio is a significant distinction when comparing communities. At The Birches, we prefer to overstaff rather than risk being understaffed. We staff according to our resident’s care needs, not just based on the number of residents in the building.
Based on the aquity in our building, we generally staff about 1:12 residents, meaning that there is one dedicated care team member for every 12 residents needing hands-on routine care.
And just as important, we adjust the staff-to-resident ratio at different times of the day. For example, if many of our residents need help bathing and most prefer to bathe before breakfast, we schedule more team members at that time to accommodate this.
How long has the current care team been with the community?
Although it is crucial to consider financial and practical care aspects, it is also important to remember that you are looking for a community to be a home for your loved one.
When you visit an assisted-living facility, you should ask about the staff’s experience and working history. Include the executive director and the director of nursing in your inquiries. You will be surprised by the amount of turnover in the senior living industry.
Why staffing is important to us
The longevity of our management, leadership team, and their team members means more consistency for our residents. Rather than a revolving door of leaders who each make decisions differently, we have the same caring people putting residents first, year after year. There’s no pendulum effect, where one year we do things one way, and the following year we completely reverse course. This would be unsettling for residents and that’s the last thing we want.
After all, if you are going to put your loved one’s mental and physical well-being in the hands of a team of professionals, it is understandable that you want to be reassured about their experience and commitment.
Many communities dislike talking about their staff because they have a high turnover rate and must manage with relatively new or inexperienced caregivers.
Although it can be challenging for new communities to retain quality employees who are invested in both the community and the residents, this can also be an indicator of issues in the operations of the facility.
The Birches has an employee retention rate of 89 percent.
Our retention rate is 89 percent, which is almost unheard of in communities like ours. Across our staff community—from resident assistants and CNAs to our culinary department—we have team members who have been with us for more than 20 years.
When an assisted living community has high turnover rates among staff members, there’s little opportunity for residents and staff to connect. The Birches is our residents’ home, so we want it to be familiar, comforting, and safe.
The Birches team members are our greatest assets.
To our residents, the team members at Birches are their best friends, counselors, handy helpers, beauticians, and even detectives when they are called on to help locate misplaced items. Our team members truly care for our residents like their own families.
Having team members who stay for years means our residents get to know them. They connect with staff and build wonderful relationships that feel like family—like home. Each day, they see familiar faces who care for them, not just as a resident but as someone they genuinely respect.
Our residents are comforted by seeing the same caregivers each day rather than a rotating pool of unfamiliar faces. Our team members genuinely know and care about each of our residents—they know their life histories, quirks, passions, and worries.
This kind of trust means that sometimes residents divulge concerns to a team member that they have yet to share with their family. This gives us a chance to be proactive in caring for our residents, especially if there’s a safety concern.
3. Base fee (monthly “rent”)
In short, this is the monthly “rent” once a senior lives in the assisted-living facility. The cost varies depending on the size of the residential unit and whether the senior lives alone or has a companion. Most base fees include utilities, basic housekeeping, maintenance, and some meals.
Various room sizes and floor plans are available in assisted-living communities. Each community varies in its private apartment options, but most offer studios and one- and two-bedroom apartments. Some communities offer furnished apartments but usually allow older adults to bring personal items and furniture.
4. Community fee
The community fee is usually a nonrefundable, one-time fee that you pay when your loved one moves into their assisted-living community. It might be called an entrance fee, an admission fee, a facilities fee, or another name. It is generally used to cover the costs of medical assessments, preparing the apartment, and carrying out community improvements.
The Birches will waive our community fee if your loved one moves into our community from another community within 30 days of their first tour.
We also offer a partial refund of the community fee if you need to end your loved one’s lease within the first three months of their moving in for whatever reason. Your loved one’s new home here must meet their needs, so it is important to us that this fee isn’t a barrier to your finding the right place for you to call The Birches home.
At The Birches, we use the fees to reinvest in our Birches community, what the current residents need, or the latest trend that would benefit residents. For example, because the visitation restrictions brought about by COVID-19 made it challenging for our residents to see their families especially through winter that first year in 2020.
We constructed a “luxury window box”—a small add-on to our main building, complete with microphones and headphones—that allowed up-close visits in a safe setting, separated only by a single pane of glass. Our staff disinfected both sides of the box after each visit, and most importantly, our residents never stopped visiting with their loved ones throughout the pandemic.
Mary Ferguson, director of sales and community relations at The Birches, commented on how well the luxury window box was received by residents and visitors alike.
“Being able to see each other is so important,” she said. “The idea of sitting across from each other feels much better than being so separated, and the booth allowed visitors to sit inside all winter long, socially connect, visit with their grandkids safely, not isolate from their loved ones, and not be outside in the cold.”
5. Ancillary costs
It is a matter of personal choice if you want to pay for additional services such as assistance with ADLs, resident-escorted services, and personal hygiene products.
What else do you need to know?
The importance of the dining experience
When comparing costs, few consider the quality or variety of meals an assisted-living community provides. Our bodies need a nutritious, balanced diet. This is especially true for seniors with physical ailments or health concerns.
A balanced diet helps seniors stabilize their medications and maintain healthy body weight, and it decreases the risk of heart disease, diabetes, high blood pressure, and other ailments.
Low-quality food can result from several factors, including insufficient staff, inadequate food preparation training, or a lack of concern for dietary standards.
A facility’s food standards may be low because of a small or poorly planned budget. Because fresh and nutritious food is such a considerable expense, many corporate-run facilities look for .ways to reduce costs, and unfortunately, the food budget is the easiest place to start.
Our menus are not dictated by a corporate office.
Unlike many corporate-owned assisted-living facilities, our culinary team does not order in bulk to prepare meals for several buildings. The culinary team at The Birches selects the best and freshest foods, ensuring an appealing variety of menu choices for our residents.
Our philosophy has always been, “Food is an essential part of life, and we make it something to savor.” For older adults, eating is not only an essential activity for life maintenance but also a great pleasure, and the desire to eat one’s favorite food becomes a motivation to get out of bed, socialize with friends, and increases their quality of life.
We hope you found all this information helpful.
With more than two decades of experience in the assisted living industry, we at The Birches Assisted Living and Memory Care community will be happy to answer any other questions you may have.
It is important that you find the right home to suit your loved one’s tastes and needs. Feel free to call (630) 789-1135 or contact for more assisted living pricing.