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Getty CreativeAssisted living communities are a popular choice for older adults who wish to live independently but need some help with activities of daily living (ADLs), such as bathing, eating, dressing or moving from a bed to a chair. These residences vary significantly in size, accommodations, costs, amenities, care and services. With such a wide selection, it may be challenging to choose the best assisted living community for you or a loved one.
The following assisted living statistics and facts may help you make an informed decision when choosing an assisted living community.
“Overall, the supply of available beds in assisted living is greater than the demand,” says Marcy Baskin, vice president of Senior Care Authority, an elder care consulting franchise headquartered in Petaluma, California. “However, that [balance] varies regionally, [and] we expect the supply-demand ratio to change as the baby boomer population ages. The number of assisted living locations is increasing while [the number of] skilled nursing facilities (SNFs) for long-term care is decreasing. SNFs are moving more toward rehabilitation services for people needing short-term stays that are often covered by Medicare.”
“To determine assisted living availability, one needs to consider not only the number of communities, but also the number of beds they provide,” says Baskin. For example, the average number of beds per community in California is 20 while the average number of beds per community in New York State is well over 100, but California is home to far more facilities than New York.
In some situations, moving to another state with more assisted living availability could make one’s housing less expensive. However, such a move requires careful consideration.
“There are important factors to consider, such as family and friends in that location,climate, geography [and the availability of] medical practitioners and services,” says Baskin. “Moving to assisted living in and of itself can be overwhelming, and moving to assisted living in an unfamiliar town or city compounds that potential hurdle.”
The national monthly median cost of assisted living in 2023 is $4,774, according to the Genworth Cost of Care survey. However, costs can vary significantly by city and state. For example, the monthly median cost of assisted living in Phoenix in 2023 is $4,217 while the monthly median cost in Washington, D.C. is $6,310 and the monthly median cost in Boise, Idaho is $3,804 [4] .
Meanwhile, costs for levels of care required by residents are typically additional line items invoiced separately from monthly rent. They have the single greatest impact on total costs of assisted living, says Baskin.
“As a loved one declines and needs more care, this [shift often] translates into higher monthly fees,” she says. Baskin recommends working with a senior advisor for help navigating the many details and costs of assisted living before entering into an agreement with a community.
Monthly assisted living costs tend to be the most expensive in the following states:
| Most Expensive Assisted Living | |
|---|---|
| Alaska | $7,246 |
| Rhode Island | $7,242 |
| Massachusetts | $6,896 |
| New Jersey | $6,891 |
| New Hampshire | $6,422 |
Meanwhile, monthly assisted living costs tend to be the most affordable in the following states:
| Most affordable Assisted Living | |
|---|---|
| Missouri | $3,183 |
| South Dakota | $3,554 |
| North Dakota | $3,598 |
| Kentucky | $3,658 |
| Mississippi | $3,713 |
| Utah | $3,713 |
| Source: Genworth Cost of Care Survey | |
“Since assisted living is generally a private pay [industry], it’s typical for low- to middle-income families who don’t have long-term care insurance to lack the financial means to pay for assisted living, which creates a greater demand for Medicaid assistance,” explains Baskin.
Medicaid is administered by each state, and each state’s regulations vary. “In some states, there are few options [available] for Medicaid covered assisted living costs, which forces someone needing care to move to a skilled nursing facility (which is more commonly covered by Medicaid),” says Baskin.
States where the highest percentage of residents rely on Medicaid are listed below.
| Highest Percentage of Residents Relying on Medicaid | |
|---|---|
| Connecticut | 66% |
| Maine | 50% |
| Alaska | 49% |
| Oregon | 47% |
| North Carolina | 43% |
States where the lowest percentage of residents rely on Medicaid include:
| Lowest Percentage of Residents Relying on Medicaid | |
|---|---|
| Louisiana | 0% |
| Alabama | 1% |
| California | 2% |
| Pennsylvania | 2% |
| West Virginia | 2% |
| Source: National Center for Assisted Living | |
When searching for an assisted living community, it’s important to ask about the staff-to-resident ratio, advises Baskin.
“Care needs and state regulations are the primary drivers of staffing ratios,” she explains. “For example, an assisted living facility where residents mostly need help with ADLs like bathing, grooming and dressing may have higher staffing ratios (fewer staff available to support more residents) than a community that serves higher acuity residents with services like memory care.”
The typical resident lives in an assisted living community for two to three years, many of whom then move to a skilled nursing facility. Communities may also discharge a resident because they:
“Occasionally someone moves home if they run out of funds or the family decides to provide or hire care at home,” says Baskin. However, in-home care provided by private agencies is expensive.
“The cost of 24/7 home health care provided by a licensed in-home care agency can be significantly higher than assisted living,” says Baskin. “If someone does move home, families often need to supplement hire care (by physically providing care themselves) to reduce costs.”
“Care provided in assisted living is based on an assessment of an individual’s needs,” says Baskin. “While many conditions are characteristic of adults in their eighties (and older), someone with a dementia diagnosis, for example, could be considerably younger than the typical resident in their eighties.”
A younger person in assisted living may have a physically debilitating disease, such as Parkinson’s disease or multiple sclerosis, requiring assistance with many ADLs. “We’re seeing more people in their seventies requiring assisted living or memory care than in the past,” adds Baskin.
Regionally speaking, western states are home to the most assisted living communities (40%), followed by the south (28%), the midwest (22%) and the northeast (8%) [2] .
“Developers and investors continue to pour money into assisted living [communities], so the number of locations and beds are increasing every day,” says Baskin. “The main issue is affordability, which is the major barrier to finding assisted living for many families.”
The life-changing decision to transition to assisted living is complex, says Baskin. “The emotional, physical, financial and even spiritual toll it can take on an older adult (as well as their family) isn’t a small challenge,” she adds.
At the same time, moving to an assisted living community can mitigate other challenges many older adults face as they age, such as feelings of loneliness and isolation and an increased risk of falls and other injuries, says Baskin.
“As an adult child, relative or friend of someone requiring assistance and support, it’s good to be armed with facts, as well as compassion for the difficulty someone might face when navigating this significant transition,” she adds.
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Deb Hipp ContributorDeb Hipp is a freelance health and medical writer and editor who lives in Kansas City, Missouri. She is a former investigative reporter with more than 25 years of experience as a journalist and writer. She specializes in health and wellness, medical aging, long-term care, caregiving, retirement and a variety of other health and retirement topics.
Alena is a professional writer, editor and manager with a lifelong passion for helping others live well. She is also a registered yoga teacher (RYT-200) and a functional medicine certified health coach. She brings more than a decade of media experience to Forbes Health, with a keen focus on building content strategy, ensuring top content quality and empowering readers to make the best health and wellness decisions for themselves.