A: Essentially, assisted living facilities take care of people who cannot live alone and do not need twenty-four-hour skilled nursing care. The residents need help with the activities of daily living. Yes, I know this is a generic definition, but since the definitions and standards vary from place to place, it is the best I can do.

Why assisted living? If an older adult needs help with bathing, cooking, shopping, etc, he or she has three choices—relying on family or friends, hiring a home health aide, or moving to some residential community that has care available. Here is where it gets tricky, though. Some independent living communities have supportive services such as community meals, housekeeping, and linen service. Still other independent living/retirement communities allow you to pay extra for a home health aide to provide services within their community—then they look like assisted living facilities. Some assisted living facilities allow you to bring in a nurse for additional care—then they look like nursing homes. So, it all becomes a blur.

Here is how I look at it. If your family member needs some help with activities of daily living but is safe at home, can get in and out of his or her house easily, has plenty of social interaction with friends, family, and neighbors, then a home health aide is fine. If, however, the person is socially and physically isolated, lonely, and/or bored, or is unsafe at home, or needs more care, it is time to look at residential care.