Adult Family Home or Assisted Living? Finding the Right Long-Term Care

Choosing the right long-term care setting for your loved one is a big decision. Assisted living and adult family homes each offer unique benefits, but how do you know which is the best fit? This guide outlines the key differences, costs, and care options to help you make the best choice for your loved one’s needs—now and in the future.

What’s the difference between an adult family home and assisted living?

There are many times in which a loved one and their family are at a fork in the road regarding senior care. Will an assisted living retirement community or an adult family home be the right choice? As you are making your decision, the following questions can help guide you:

• Is your loved one safe to stay in his/her own private room with no supervision for extended periods of time (meaning up to about 8 hours)?

• Is your loved one able to use a call button, willing to wear a call button on their wrist or around their neck, and of clear mind to know to press the button if there is an issue with a fall or being ill?  

• Will your loved one’s health remain stable without daily or even weekly health monitoring?

• Does your loved one have the energy and desire to socialize and take part in the activities and offerings of an Independent/assisted living community?  

• Is your loved one able to navigate the building without supervision or assistance?  Can they independently walk or propel their own wheelchair in the building and get to where they need to go?

• Can your loved one use the toilet safely and appropriately?

• Can your loved one initiate activities on his/her own without needing cueing or prompting to do so?  

If you have answered YES to these questions, there is a good chance that your loved one would enjoy the benefits of a  larger, more active community.

On the other hand, if you have answered no or it’s borderline if your loved one can manage all of the above, the adult family home is the better choice for now and into the future.  

The offerings are vast at many independent/assisted living communities.  It helps to visit a variety of communities, take a tour, have a meal and review the activities the community offers.  Some communities even offer short respite stays where a person can stay and give the community a try. The range of communities is wide and so are the offerings. Some of the most wonderful communities in our greater King County area offer educational opportunities with speakers such as doctors, scholars, historians, world travelers and others who will come and provide engaging programming. 

Some also have salt water pools, personalized exercise programs and work out rooms, yoga, pilates and sit and be fit classes.   There may be gardening opportunities, crafting and art groups or spaces to work on such projects, Book club, walking groups, birding groups, movies in a theater, weekly van trips to shopping, and longer outings to parks or events around the area may also be available.

If your loved one is excited and enthusiastic about these offerings and you have answered YES to the first 6 questions, the independent/assisted living retirement community is likely a good place to land.   

The table below summarizes the primary ways adult family homes and assisted living communities differ:

Factor	Adult Family Home	Assisted Living Community
Supervision	24/7 care and supervision by caregivers.	Residents must be safe alone for extended hours.
Call Button Use	Not required—caregivers provide hands-on support.	Must be able to use a call button independently.
Health Monitoring	Regular monitoring of health changes.	Limited health monitoring unless requested.
Social Engagement	Smaller setting with personalized interaction.	Large group activities, outings, and amenities.
Mobility Needs	Staff assists with mobility and transfers.	Residents must navigate the building independently, or pay extra for escort services.
Toileting Assistance	Caregivers provide full support as needed.	Residents should be able to toilet independently, or pay extra for toileting assistance at scheduled times.
Lifestyle & Activities	Home-like environment with small group engagement.	Wide variety of social, educational, and fitness programs.
Best Fit For	Those needing full-time care and close supervision.	Independent seniors who enjoy social activities.

Is there anything else I should factor in as I decide between assisted living or an adult family home?

Understand that as we all age, things can and will change, and as time goes on there may be a need for a higher level of care.  Before moving into an independent/assisted living setting think about the stability of your loved one. Have there been multiple falls or a major fall with injuries? What about hospitalizations, frequent needs to see an MD, frequent medication changes, or changes in energy level?  In other words, do things seem to be changing?  If yes, a move to the independent/assisted living community may only escalate the changes and the decline, so that may not be a good choice and only too soon would the client have to move again to a higher level of care.

When one moves into an independent/assisted living community, the ideal client will move in and be independent, utilize the services and enjoy a social community life. The ideal client may have needs that come up and as these needs arise, the community can support them (for an added cost) with the help of “assisted living,” including support with dressing, toileting and med administration. However, at some point, the risk of this person being alone in their room may be too high and the community will often require that the family bring in 24/7 private duty care from outside of the building if the client wishes to stay. The cost of this service is more than most people can sustain long term, therefore moving to an adult family home is the best choice at this time. 

Some communities offer a memory care section of the building which can be of great help if dementia takes hold and the client needs care and activities geared towards this condition.  There is closer supervision and activities that are specific to the level at which the client is able to participate.  While there is closer supervision, frequent fallers or folks needing a higher level of care without dementia, would not be a good fit. An adult family home is a better choice in these situations.  

What are the costs of assisted living vs. adult family homes?

Initially when moving into an independent/assisted living community, the fees are fairly reasonable and in the greater King County area, fees generally start around $4,000/mo for a small apartment, up to $9,000/mo for a larger (sometimes even two bedroom/two bathroom) apartment. The fees vary widely from building to building. Typically two meals daily are included, as are all activities. Most of the assisted living communities will also have a one-time move-in fee. It is usually non-refundable and may be from $2500 up to $40,000. Understanding and evaluating this fee before making a decision on a residence is important.  

The exclusive communities in our King County Area that offer continuing care (from independent living to assisted living to memory care and skilled nursing) can cost $1 million+ to buy into. There are agreements in place that do allow for some of this money to be returned to your heirs upon your passing, but know that you are buying into a very exclusive setting and should never have to move out of the community due to increasing needs. You may have to move apartments to different areas of the community to meet your needs, but you don’t need to move out of the community.

Long term care insurance policies come with different stipulations depending upon your policy.  You will have to talk with your insurance holder to see what is covered.  Sadly, there are fewer and fewer assisted living communities that will accept Medicaid, although there are some.  If you know Medicaid is on the horizon, only go into a community that will accept medicaid so you are not forced to move due to finances.  

As a general rule, clients' care needs will increase over time and assisted living can support and assist with these needs to a point. However there may come a time in the assisted living setting when the management feels it is too risky for this client to be alone in their own apartment and will require you to bring in outside help.  The adult family home is well set up and prepared to manage a client's increasing needs and the adult family home will typically add staff if the clients needs increase.  If needs have increased and the ability to live in a larger community is becoming more challenging, finding the right adult family home may be the next step. 

What medical support and staffing do adult family homes provide?

The adult family home is prepared to manage the care through the client’s life.  Most adult family homes can manage diabetic care, dementia care and mental health care.  There are classes that adult family home providers are required to take in order to care for these situations. Most homes do have these credentials. Unless the adult family home is a nurse-owned home, most adult family homes have a nurse delegator who handles teaching the staff how to administer each client’s medications correctly. The nurse delegator is not an emergency nurse and is not available 24 hours in a day, unless the home has a special arrangement.  

Some homes are owned by nurses, so it may be possible that the home does have a nurse available 24/7. Adult family homes are very familiar with hospice and an adult family home is an ideal place for a person on hospice.  The client will get close personalized care and will be checked on frequently. The assisted living community is usually not the best setting for hospice.  When a client is in their own apartment in a large community, the staff may not check on them as frequently as they would in a smaller setting.  If there are enough family members to stay with the client on hospice in assisted living, it can work out well. But if not, the adult family home would be a better choice.

Can my loved one stay in assisted living long-term, or will they have to move?

This is the big question!  Not having a crystal ball, it is impossible to know how a loved one will age: will dementia become an issue and will your loved one need to go to memory care?  Will falling be frequent, making it unsafe for your loved one to stay alone in their apartment?  We don’t have the answers to these questions, however when safety is a repeated  concern, most assisted living settings will ask the family to bring in a private duty caregiver to protect the client from falls and keep the client safe. This cost, on top of the cost of the assisted living community, is usually not something that most people can afford for a long term and this is the time when many families seek out an adult family home to keep the client safe and the costs manageable.  

How do I choose the best senior care setting for my loved one’s needs?

A senior care advisor is a very good resource to help you determine the very best setting for your loved one.  As an RN working with geriatrics in many settings in King County for the last 33 years, I have had a lot of personal experience with different communities and am skilled at finding you just the right place for your loved one to thrive.  In addition, I belong to a professional organization called ASRP which stands for Association of Senior Referral Professionals of Washington.  We all follow the legal guidelines for assisting elders and families find safe and ideal living settings. In addition to the education that ASRP offers, I frequently tour different adult family homes and assisted livings, continuing care retirement communities and memory care communities, so I have a good sense of familiarity with many settings and often after meeting someone and their family, I’ll have a really clear idea of where their needs can be best met and that the client and family will feel at home in that setting.

Reach out if you have any questions about what long-term care solution in east King County might work best for your loved one.