n assisted living residence is a facility designed for senior citizens or persons with disabilities who need help with some activities of daily living (ADLs). These people may need assistance with things like managing their medications or taking a shower or bath, but they do not need the 24-hour care and supervision provided by a skilled nursing facility. In Texas, assisted living facilities (ALFs) are licensed as personal care facilities. By Texas law, facilities that provide services to 4 or fewer people do not need to be licensed; facilities that have a census larger than 4 do require a license.

The first ALFs opened in the 1980s, when the United States was dealing with an aging, but basically healthy, population who did not have family nearby to help meet the few care needs they did have. These people resisted going into nursing homes, which at the time offered only limited privacy and personal choice. ALFs usually provided people with private rooms or apartments; social activities and outings were available but not mandatory.

ALFs currently provide homes to over 1 million United States residents. Of those, slightly less than half suffer from diseases that cause cognitive impairments such as Alzheimer’s or vascular dementia. In Texas, there are currently 830 licensed personal care facilities and over 4000 facilities that are unlicensed.

An assisted living residence provides customers with a room and with three nutritious meals every day. In addition, the facility also provides staff to help with activities of daily living. Common needs include help managing one’s medications, performing personal hygiene tasks such as bathing, getting dressed, and going to the bathroom. Some residents may also need help with activities such as transferring from a wheelchair and eating.

Most facilities figure costs by charging a basic rental rate. They then add on “points” depending on how much assistance the resident requires. Each point costs extra money per month. For instance, a woman who lived in a studio apartment and only needed help with medications would pay less than a woman who lived in a studio apartment and needed help with medications, bathing, dressing, and eating.

In Austin, Texas, the average base cost to live in a personal care residence in $1500. When you include assistance with care, the cost rises to about $2000. This is still less than a skilled nursing facility which typically charges anywhere from $3000 to $4000 per month.

Although some 90% of ALF residents nation wide pay for their care out-of-pocket, Texas was one of the first two states to pass legislation allowing Medicaid to cover the cost of an assisted living residence through its Community-Based Alternatives program. This program helps over 20,000 Texans who would not be able to afford assisted living care otherwise.

Texas has also set standards to determine when an assisted living residence is no longer an appropriate placement for an individual. In order to remain in an ALF in Texas, patients must be able to understand emergency instructions and assist in their own evacuation in the event of a fire or other emergency. ALF care is also no longer appropriate if a resident needs 24-hour care and supervision or requires invasive procedures such as tube-feeding or IV medications.

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