Considering Seniors' Assisted Living
People who are considering a move to an assisted living residence need to know:
- what services are offered;
- how often services are provided — e.g., will you get one, two or three meals per day;
- who will be providing the service;
- how much it will cost; and
- any extra charges that may be incurred — e.g. for additional services, such as the operator doing your personal laundry?
Prospective residents may also wish to ask about things such as “Can I bring a pet?” or “Can pets visit?” or “Can I smoke in my unit?”
In addition to the information provided here, many assisted living operators and health authorities offer helpful information about the sorts of things people should consider when thinking about moving into an assisted living residence.
Assisted Living Philosophy
“The philosophy of assisted living is to provide housing with supports that enable residents to maintain an optimal level of independence. Services are responsive to residents' preferences, needs and values, and promote maximum dignity, independence and individuality.”
Assisted living embraces the concepts of resident choice, privacy, independence, individuality, dignity and respect. Residents, with the support of their families and case managers (where involved), determine with the operator the type of accommodation and services they require, all of which is confirmed in a residence occupancy agreement. In this way, assisted living promotes the privacy and self-reliance of people who require help with some day-to-day tasks but can otherwise live independently.
Assisted living operators must provide residents with choices. They must also respect residents’ privacy and personal decisions, and accommodate residents’ right to take risks — provided that those risks do not place other residents or staff in jeopardy. In assisted living residences, staff provide minimally intrusive assistance and support residents to live as independently as possible and manage their own lives, even when assistance is needed with daily activities.
Who Is Assisted Living For?
Assisted living is intended for adults who:
- are able to select and direct the services they need and live safely in a semi-independent environment (for example being able to self-evacuate in an emergency). When residents are no longer able to make decisions that allow them to function safely in assisted living, they must move to a setting that offers more oversight, care and protection, such as a residential care facility.
- do not need the nursing supervision and 24/7 services that are available in a licensed community care facility. Some nursing care can be provided, but only on a short-term basis. For example, residents who are recovering from an illness, who require palliative care or who are waiting to transfer to complex care may purchase nursing care from an operator or a private agency. Residents who meet the criteria may also be eligible for community nursing or rehabilitation services from their local health authority. When residents require ongoing nursing supervision and care, or their needs otherwise exceed the service delivery capacity of the assisted living residence, residents must move to another setting that can provide the additional support.
People with Mild Cognitive Impairments
Some people in assisted living may have mild cognitive impairments— e.g., they might need cues to help them find their suite. However, operators must not house people who cannot make decisions on their own behalf (Community Care and Assisted Living Act, section 26(3)). This means that assisted living residents must be able to make the range of decisions necessary to allow them to function safely in the supportive semi-independent environment of assisted living. For example, residents must be able to recognize an emergency, and to self-evacuate in an emergency.
People with moderate to severe cognitive impairments would not be appropriate for assisted living unless they can still carry out the key areas of function. For those who cannot, operators must develop a plan to transfer the resident to alternate accommodation (a transition/exit plan). The plan includes identifying risks the resident faces and how to mitigate those risks.
An assisted living residence offers three key components: housing, hospitality services and personal assistance services.
Operators must ensure that all three components are:
- provided in a manner that does not jeopardize the health and safety of residents;
- respectful of and responsive to residents’ preferences, needs and values;
- designed to promote maximum dignity and independence for residents; and
- involve family and friends to the extent requested by the resident.
Operators must comply with the provincial health and safety standards in the delivery of assisted living services.
Assisted living includes many types of residences. Assisted living in apartment-style buildings includes private self-contained bachelor, one-bedroom or two-bedroom suites with full or modified kitchens. Accommodation in a home could be a bedroom with a lockable door and an ensuite or shared bathroom. All residences include common dining and recreational space where people can eat together and socialize.
Residences are not required to be wheelchair-accessible however, if a residence is not wheelchair-accessible, the operator must advise potential residents or families accordingly and not house people who need wheelchairs.
Residences with assisted living units include retirement communities, stand-alone assisted living residences, mixed-use buildings with complex care, and purpose-built assisted living residences. Assisted living residences are generally situated near amenities such as shopping, pharmacies, health units, community centres and public transit. Residences are also located in different neighbourhoods, so residents can often remain close to their family and friends.
Campuses of Care
A campus of care involves more than one level of services and supports (independent living or supportive housing, assisted living and/or complex care) in one building or group of buildings. A campus of care allows seniors to age in place by providing a mix of housing and levels of support that address changing needs.
It is quite common for larger assisted living residences to have a combination of publicly subsidized and private-pay assisted living units.
Assisted living operators must offer five hospitality services:
- meals — one to three meals a day. Meal services provide balanced and adequate nutrition for residents; safe practices are followed in meal preparation and delivery; a dietary plan is established for each resident who has food allergies, intolerances, and special or therapeutic dietary needs; and appropriate professional advice (e.g., from a registered dietitian) is obtained for the menu plan and when preparing meals in accordance with special and/or therapeutic diets.
- housekeeping — light housekeeping is provided at a frequency to meet residents’ health and safety needs.
- laundry — laundering of flat linens once a week. Clean laundry is stored in a sanitary manner; linens are changed at intervals necessary to avoid health issues; and if residents do their own personal laundry, equipment is provided.
- social and recreational opportunities — leisure pursuits, social interaction and community involvement.
- a 24-hour emergency response system — provides residents with the ability to summon emergency assistance 24 hours a day.
Hospitality services are provided either through the operator's own staff or through a contract with third parties. Regardless of how the five hospitality services are delivered, operators must comply with the health and safety standards.
Personal Assistance Services (Prescribed Services)
Assisted living operators provide the same types of services people would expect to receive in their own home in the community. Some residences provide only scheduled personal assistance, e.g., bathing. Others also accommodate residents’ unscheduled personal assistance needs, e.g., toileting at night.
Personal assistance service (prescribed services, as set out in the Community Care and Assisted Living Regulation) include:
- regular assistance with activities of daily living, including eating, mobility, dressing, grooming, bathing and personal hygiene;
- central storage of medication, distribution of medication, administering or monitoring the taking of medication;
- management of cash or other property of a resident;
- monitoring of food intake or of adherence to therapeutic diets;
- structured behaviour management and intervention; and
- psychosocial rehabilitative therapy or intensive physical rehabilitative therapy.
By law, assisted living operators must offer help with at least one (but no more than two) of the personal assistance areas. For seniors, the two personal assistance services usually offered are help with activities of daily living and with medications.
Personal assistance services are provided either by the operator’s own staff or through a contract with a third party. Regardless of how the personal assistance services are delivered, operators must comply with the health and safety standards.
Some operators may provide additional hospitality services, such as escorts to doctor’s appointments, washing of personal laundry, and hairdressers. An extra cost may be required by the operator. For more information about what services are offered in private-pay assisted living, contact the operator directly. For publicly subsidized assisted living, contact your health authority case manager.
Types of Assisted Living Residences for Seniors
There are two types of assisted living residences for seniors. Residences where the senior and/or their family pays the cost of housing and services directly to the operator are known as private-pay assisted living residences. Residences where some of the cost is subsidized by the regional health authority are known as publicly subsidized assisted living residences.
Private-Pay Assisted Living Residences
The Assisted Living Registrar has jurisdiction over all assisted living residences in B.C., including private-pay residences. A health authority case manager’s assessment is not needed to enter private-pay assisted living.
Assisted living operators determine eligibility for private-pay assisted living. Operators may seek clinical input (e.g., from a prospective resident’s physician) about whether a person is able to live safely in an assisted living residence. A person may be eligible if they:
- require hospitality services and personal assistance (e.g., help with bathing or medications); and
- are able to make the range of decisions that will allow them to function safely in an assisted living residence, or will live with a spouse who is willing and able to make decisions on their behalf.
In private-pay residences, residents must pay all costs. Private-pay residences may charge a fixed rate for a package of services or on a fee-for-service basis, or a combination of the two.
The ALR does not have information about the cost of assisted living services. Contact residences directly to find out their rates.
NOTE: Some private-pay residences also have publicly subsidized units.
Publicly Subsidized Assisted Living Residences
Publicly subsidized assisted living provides affordable housing and services, generally in the form of apartments, for seniors who have low or modest incomes. A variety of building sizes and units are available in either stand-alone assisted living residences or campuses of care.
A health authority case manager determines eligibility for publicly subsidized assisted living. A person may be eligible if they:
- are eligible for home and community care services;
- require hospitality services and personal assistance (e.g., help with bathing or medications); and are able to make the range of decisions that will allow them to function safely in an assisted living residence, or will live with a spouse who is willing and able to make decisions on their behalf;
- are at significant risk in their current living environment (e.g. falls, isolation, poor nutrition); and
- have agreed to pay the applicable fees for assisted living.
Eligible residents pay a monthly fee of 70 per cent of their after-tax income for rent, hospitality services and personal assistance services, up to a maximum amount. Some operators may charge additional fees for hospitality services such as extra meals. The fee is paid monthly to the assisted living operator, along with a monthly BC Hydro surcharge, and usually includes all services except items such as television and telephone.
Apply for Publicly Subsidized Assisted Living
Access to all publicly subsidized assisted living units is through the regional health authority’s home and community care office. To find out if you are eligible for publicly subsidized assisted living, or to apply, contact the home and community care office in your community. If you already have a home and community care case manager, call him/her to request an assessment.