Assisted Living Program - Is This for Me?

Assisted living programs are found in a housing facility that also provides additional health-related care, personal care, and assistance with activities of daily living.  The goal is to help residents remain as independent as possible in a home/apartment environment. 

What specific care and assistance is provided?

• The care and assistance provided depends on your need for assistance.

• Health-related care means there is a registered nurse or a licensed practical nurse on staff as well as other licensed health care professionals.   This can also include medication set up and administration.

• Assistance with activities of daily living means a variety of household and other basic activities.  This includes shopping, cooking, housekeeping, chores, and transportation.   This can also include personal care help with transferring in and out of bed or a wheelchair, bathing, personal hygiene, dressing, and grooming. 

• Before moving into an apartment with an assisted living program there must be an evaluation to see if the program can provide the care you need.  This is an evaluation of a person’s functional, cognitive, and health status.  If you need more care than the services provide you are not eligible for the assisted living program.  For example, if you are bed-bound or require routine two-person assistance with standing or transfer, you should not be admitted to live in the facility.  

• The program must have 24 hour response staff.

Are assisted living programs regulated?

Assisted living programs in Iowa are certified by the state of Iowa.  Certified assisted living programs must follow rules set up by the state of Iowa under Iowa Code 231C and Iowa Administrative Code 481-Chapter 69. 

• Regulations include a process for filing complaints about care as well as appeal rights for involuntary discharge.

• Certified assisted living programs are also subject to Iowa Landlord and Tenant Law, Iowa Code 562A. 

Be aware:  there are apartment complexes providing additional services to their tenants that are not certified assisted living programs.  There are also other housing options for buying an ownership interest in a unit which may provide assistance services.  This article does not address these housing options. 

What is the cost?

The cost for an assisted living program can vary greatly depending on the size of the apartment and the services a resident receives.  Some facilities charge one rate whether or not you receive all services and some facilities charge a basic rate and add costs for each service you need. 

Can Medicaid help pay the cost of assisted living? 

Medicaid can help pay for some services if you meet level of care requirements and your income and resources are below required limits.  The program for people over age 65 is called the Elderly Waiver program. 

Some assisted living programs will accept Medicaid assistance under the Elderly Waiver program while others will not.  It is very important to check this out before signing an agreement.  Many people use their savings to help pay the cost of the assisted living program.  If your savings run out you may need to find other housing if the facility does not accept Medicaid payments.

Are there other sources to help pay for assisted living?

If you are a qualifying veteran or surviving spouse of a qualifying veteran you may be eligible for a veteran pension that would help with the costs of the assisted living program.  Certified assisted living programs require that you apply for the Veterans Pension if eligible. 

Another possible option is to apply for Housing and Urban Development (HUD) assistance under the section 8 voucher program.  This is a program that helps pay a portion of your rent if your income is low.  Again, some assisted living programs will agree to participate and others do not.  Ask if the program accepts HUD section 8 vouchers to help with rent payments. 

What happens if I need more care than the assisted living program provides?

If you need more care than the program can provide you can either give written notice to terminate your agreement or the facility may give you written notice of involuntary discharge.  For example, you may be medically unstable or you have become bed-bound.

The facility must provide help with a safe transfer out of the program to other housing and care.  Some assisted living programs may be part of a larger care facility that has a nursing home section. 

What should I look for in the agreement?

Review contract terms carefully before you sign any agreement for an assisted living program.   The contract is called the occupancy agreement.  Some things to look for in the occupancy agreement include:

•  Is there a listing of all fees, charges, and rates for tenancy and services?

• Is there a description of services available?

• Are third party payments accepted such as Medicaid or HUD assistance?

• What is the policy if your financial resources run out?

• What is the term of your occupancy agreement and how can it be terminated?

• What are the procedures for involuntary transfer for health or other reasons?

• Are there appeal and grievance procedures?

• What are the billing and payment rules?

• What is the refund policy?

Are there other resources to find out more about Assisted Living Programs?

The Iowa Department on Aging and the Office of the State Long Term Care Ombudsman have information about assisted living programs.  This includes a checklist of questions to ask when looking for an assisted living program and information on complaints about programs.  Their office can be reached by calling 866-236-1430

The Iowa Department of Inspections and Appeals (DIA) is responsible for inspecting and certifying assisted living programs.  They also investigate complaints about care in an assisted living facility.  Their website contains public information about these reports.  It also has a listing of all certified assisted living programs in Iowa.

Department of Inspections and Appeals: (515) 281-4115

Certified Assisting Living Program in Iowa:  http://www.iowalegalaid.org/resource/assisted-living-programs-in-iowa

For legal questions and assistance with your occupancy agreement, benefits programs, involuntary discharge, landlord and tenant issues and other legal questions contact Iowa Legal Aid.

---

Iowa Legal Aid provides help to low-income Iowans. 

To apply for help from Iowa Legal Aid:

• Call 800-532-1275. 
• Iowans age 60 and over, call 800-992-8161.
• Apply online at iowalegalaid.org

If Iowa Legal Aid cannot help, look for an attorney on “Find A Lawyer”   A private attorney there can talk with you for a fee of $25 for 30 minutes of legal advice.

*As you read this information, remember this article is not a substitute for legal advice.