What is an assisted living community? An introduction

Dick Fleming

My wife Barbara and I are in the midst of doing on-site assessments of assisted living communities in Tucson. According to the Pima County Council on Aging (PCOA) [1], there are about 35 assisted living facilities in greater Tucson. We have screened 20 and will visit about a dozen we feel are “SaddleBrooke qualified” – to gather information for publication of a report in October. Several friends have expressed confusion about the differences among the various senior living choices and in our research we have found terms that need clarification as well. This article outlines several of these terms in preparation for our October report, Top Assisted Living Communities in Tucson. The report will be provided and delivered free to SaddleBrooke and SaddleBrooke Ranch residents who request it. The content of the report is expected to be of value for at least two years. If you have interest in this topic it is suggested you retain this article as space will not be available for it to be reprinted with the October report.

Senior Living Residential Choices [2]

Continuing Care Retirement Community (CCRC): Is part independent living, assisted living and skilled nursing home. CCRCs offer a tiered approach to the aging process, accommodating residents’ changing needs. They are suitable for seniors seeking the option to live in one location for the duration of their life. They are the most expensive of independent and long-term care options, requiring substantial entrance fees as well as monthly charges. Splendido is an example. Another example is the highly-regarded Spring Harbor at Green Island official.

Independent Living Community (IL): Independent living is for seniors who are able to live without help but prefer to be with other people of similar age and interests. Home maintenance is over, meals and local transportation services and many other activities are provided. Most independent living communities are monthly rental; some have a buy-in option. The independent facilities we are visiting with assisted living arrangements have a wide range of activities similar to those found in SaddleBrooke.

Assisted Living Community (AL): The assisted living choice is made when medical or memory or aging issues reduce one’s ability to stay in their own home. If one has manageable health issues, such as just a need for a wheelchair, it may be best to first find an independent living community that can then provide a smooth transition to the assisted living stage when needed. All assisted living facilities provide a variety of room choices and sizes, three meals a day, local transportation services and a variety of activities to stimulate one’s physical and mental wellbeing. They provide privacy and autonomy and are able to provide increasing levels of health care services as one’s needs dictate. All communities we are visiting are on a monthly rental basis.

The focus of our report is on assisted living communities. Confusing matters, these communities are often integrated with independent living facilities enabling one to obtain CCRC-type multi-level care living without the CCRC up-front investment. For example, one can transition in some facilities from Independent Living (IL) to Assisted Living (AL) to Memory Care (MC) to Hospice (HS). The availability of these resources is noted for each assisted living community in our report. The lesson to be gained here is to select a community that best fits your long-term perspective for living an affordable life, the longest and fullest. Some assisted care facilities, like The Parke Assisted Living, (www.theparke.net) provide their residents with a number of different activities, as well as opportunities that will enable them to socialize with other people during their time there. And this is something that can help them to lead the rest of their lives in the best way possible but all whilst having the necessary assistance that they may need.

Complicating matters further, there are different types of assisted living communities. Our report has developed its own shorthand for these: Traditional (Trad), in which those in assisted living are segregated from others; Comingle (Comngl.), where independent living and assisted living residents live in one integrated community sharing the same resources, and Neighborhood (Neigh), communal, small home-like settings where several assisted living and memory care residents live together.

It is positive though, that there are more courses becoming available to enrol you for your rcfe administrator training, because it means there will be more of these assisted living services becoming available for those that need it. If we were to undertake another case study in a few years time, we would see this impacting on the overall care scheme provided by different assisted living providers.

Level of Medical Care Assessments

Level of Care Assessment: Each assisted living community is required by the state of Arizona to conduct a level of care assessment prior to residents’ acceptance. Each has their own unique assessment tool – one can’t fail the assessment as its only purpose is to establish the care one needs – and cost of that care. The assessment takes into account the physical, cognitive and social needs of the individual. Levels of care assessment are periodically remade to confirm the current level or to determine the need for additional services. Monthly rates are adjusted accordingly. The lesson to be gained here is to plan forward for care costs as your level of care need progresses so you will be financially able to stay in your preferred community.

Core Elements of Level of Care Assessments [3]

Activities of Daily Living (ADL): ADL’s are series of basic activities performed by individuals on a daily basis necessary for independent living. Whether an individual is capable of performing these activities on their own provides a comparative measure of their independence. There are five ADLs: personal hygiene, dressing, eating, continence and transferring.

Instrumental Activities of Daily Living (IADL): IADL’s are actions that are important to being able to live independently but are not necessarily required activities on a daily basis. There are seven IADLs: basic communication skills, transportation, meal preparation, shopping, housework, managing medications and managing personal finances.

Why are ALs and IADLs important? Levels of care assessments include them to determine care levels and costs. Importantly, eldercare financial assistance programs, such as long term health care insurance, use the inability to perform a number of activities of daily living as eligibility criteria.

Levels of Care in Assisted Living Communities [4]

The level of care factors largely determine the cost of care based on the skill and time required to attend to the resident. These costs are a significant factor in the overall cost of assisted living. There are no federal or state regulations regarding levels of care, making them local facility determined, or the qualifications of assisted living administrators or caregivers. The lesson to be gained here is to determine the professional qualifications of the executive director, supervisory staff and of the key staff – their length of service, turnover rate, being important.

The following definitions have been provided by the Arizona Department of Health Services, arranged by level of care provided and licensed at each facility. When visiting a community, inquire about the Arizona State licensing they have for each of these care levels.

Personal Care Service: Assistance with activities of daily living that can be performed by persons without professional skills or professional training and includes coordination or provision of intermittent nursing services and the administration of medications and treatments by a skilled nurse. (All communities we have visited provided this service – some charge for portions of it).

Supervisory Care Service: General supervision, including daily awareness of resident functioning and continuing needs, the ability to intervene in a crisis and assistance in the administration of prescribed medications. (This and Medication Management are the major cost drivers for levels of care service).

Direct Care Service: Programs and services, including personal care services provided to persons who are incapable of recognizing danger, summoning assistance, expressing need or making basic care decisions. (i.e., Memory Care).

Licensing of Assisted Living Facilities

There is no Federal or Arizona rating system for residential facilities, such as independent or assisted living, as there is for hospitals and nursing homes. However, the state does license assisted living communities. All facilities in our report are state licensed. Be aware! All rating systems that are on the Internet for independent and assisted living communities are essentially self-rated or ratings provided by paid sponsors. Do not use them in your assessment. The Arizona Department of Health Services, Division of Licensing conducts an extensive audit before a license is issued. The state then performs follow-up audits on an unscheduled basis, called surveys. Survey deficiencies and dates for each facility are provided in a database that can be searched at http://azdhs.gov/licensing/index.php#azcarecheck. The lesson to be gained here is to do your due diligence for each assisted living facility you may have interest in. Satisfy yourself with their quality through their state performance assessment.

Other Services Provided in Assisted Living Communities

All Assisted Living communities we visited include housekeeping services in their basic room price; each also has extensive programs and services such as wellness, transportation, arts and crafts, education programs and exercise activities. All facilities have or arrange for on-site physical and occupational fitness and rehab. Some have visiting medical doctors or nurses come on-site, minimizing medical transporting.

Assisted Living Financial Services

All assisted living facilities we will have visited are self-paying out-of-pocket. Each community provides some form of financial assistance, usually through a third-party financial “concierge” service. These services generally include review of one’s assets to pay, such as: line of credit, real estate, veteran benefit and life and long-term health care insurance, presumably for a fee.


[1] Pima Council on Aging – PCOA.org

[2] Retirement Unlimited – RUI.net

[3] Paying for Senior Care – PayingforSeniorCare.com

[4] Arizona Department of Health Services – AZDHS.gov