The CICOA Blog

Defining Assisted Living

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This likely is not the first place that you have read about the dramatic increase in the number of older adults as the Baby Boom generation begins to enter retirement.  Over the next twenty years, the number of seniors, those age 60 and older, will double.  One person in five in Central Indiana will be of retirement age.  One might wonder where we will put them all!

As we age, most of us intend to stay in our homes and communities as long as possible.  For some, this means they will look into assisted living.  According to an October 4 list published in the Indianapolis Business Journal,  the “25 largest Indianapolis-Area Assisted Living Facilities” have as a group more than 2,600 units comprised of efficiency, one and two-bedroom apartments.i   Rents started at $650 and up, and there is a wide variety of amenities available, including pools, spas, home health services and memory care.    Some offer resort-style living, while others place more of an emphasis on the availability of healthcare services and the concept of a “continuum of care” community.ii

Many find the concept of assisted living appealing: no more painting the house or mowing the lawn, access to care when and if it is needed.  And, because assisted living is considered a community-based care model, it is part of the overall strategy to rebalance long-term care by making more use of home and community-based services instead of nursing homes.

Finding information about Assisted Living Facilities can be a challenge for the consumer.  There is no standard definition of “Assisted Living”.  One person’s assisted living facility may fit another’s definition of nursing home. A standard definition is important; a facility’s status as a community or an institutional setting has an impact on the services available to residents, and even whether or not the service is covered through Medicare, Medicaid, long-term care insurance or private insurance.

The US Department of Health and Human Services has proposed a rule that would standardize the definition of “assisted living.”   As proposed, to be considered Assisted Living, the following conditions would have to be met.

  • The individual has a lease.
  • Setting is an apartment with individual living, sleeping, bathing and cooking areas, and individuals can choose whether to share a living arrangement and with whom.
  • Individuals have lockable access to and egress from their own apartments.
  • Individuals are free to receive visitors and leave the setting at times and for durations of their own choosing.
  • Aging in place, or allowing individuals to remain where they live as they age and/or support needs change, must be a common practice of the ALS.
  • Leases may not reserve the right to assign apartments or change apartment assignments.
  • Access to the greater community is easily facilitated based on the individual’s needs and preferences.
  • An individual’s compliance with their person-centered plan (in the event that the individual has shared his/her plan or the landlord is also the provider of services) is not in and of itself a condition of the lease.

The proposed ruling is now available for public comment on the web. To read the proposed rule or comment on it, visit and follow the instructions under the “search for a proposed rule” tab, then type CMS-2296-P in the box for “enter keyword or ID”.  Comments may be posted between now and June 14.

And, if you are looking into Assisted Living or other long term care options for yourself or a loved one, here are some helpful links to help you find the program or service that is best for you.


CICOA’s Solutions Guide (online)

“How to Select a Nursing Care Facility”

“Housing:  Retirement Communities”

[i] Indianapolis Business Journal, “Largest Indianapolis-Area Assisted Living Facilities,” October 4, 2010.

[ii]Continuum of Care: A range of services developed and organized to address the variety of needs individuals have as they age. This concept recognizes and considers the availability and extent of short-term and long-term care systems and services in the community and in institutional settings. Included in the continuum of care are residential alternatives, in-home care, community programs, and institutional services.