In Wisconsin, there are more than 4,000 assisted living facilities and 60,000 beds — and they range in size, price, specialities and level of medical care.
Assisted living facilities oversee key questions about your or your loved one's care: admissions, staffing levels and the availability of a nurse, among other things.
Here are the basics about assisted living in Wisconsin, and what those facilities are designed to do.
What's the difference between a nursing home and an assisted living facility?
Nursing homes are designed for people who, because of their health conditions, need 24/7 access to nursing care.
Assisted living facilities were initially designed as a more independent alternative to a nursing home. Mostly, they are intended for people who need assistance with "activities of daily living," which are defined as bathing, eating, getting dressed, using the bathroom, walking and getting in and out of bed.
However, assisted living is admitting people with more complex needs over time .
Across Wisconsin, there is a wide range in the level of medical care offered at assisted living facilities. Some employ a nurse full-time, and advertise the ability to manage wound care, feeding tubes, sliding-scale insulin, complex medication lists or dementia-related behaviors, among other examples.
What are the different types of assisted living facilities?
The state splits assisted living facilities into three categories.
Community-based residential facilities:
- Common traits : Community-based residential facilities are the most common type of assisted living facility in Wisconsin. The majority admit older adults and people with dementia, and over one in three admit people on hospice care. Some facilities cater to more specific populations, such as adults with disabilities or mental illnesses.
- Nursing and other services : These facilities can admit people who need up to three hours per week of nursing care, with exceptions. Often, that’s for people on hospice care or who have temporary injuries and illnesses, like wounds.
- Commonly marketed as : Memory care , advanced care, enhanced assisted living, or just "assisted living"
- Number of facilities in Wisconsin : 1,549
- Average number of residents per facility : 22 residents, but facilities range from five to 151
Residential care apartment complexes:
- Common traits: Residential c are apartment c omplexes are designed for people who can live safely in an apartment unit with a kitchen, but want or need access to 24/7 emergency services.
- Nursing and other services : These facilities provide up to 28 hours per week of "supportive, personal and nursing" services, or more in some cases. That covers services like meals, housekeeping and laundry or help bathing, getting dressed and with basic nursing care. These facilities do not include memory care .
- Commonly marketed as: Retirement community, or just "assisted living"
- Number of facilities in Wisconsin: 366
- Average number of residents per facility: 48
Licensed adult family homes:
- Common traits: Adult family homes are small, more residential settings that commonly admit residents who have developmental disabilities, mental illnesses and traumatic brain injuries. Less often, they admit people with dementia, terminal illnesses and or physical disabilities, among other conditions.
- Nursing and other services: These facilities offer up to seven hours weekly of nursing care. These facilities only admit up to four residents at a time, and those residents might rely on the facility to assist them in getting to work or to a medical appointment.
- Commonly marketed as: Group homes or community homes
- Number of facilities in Wisconsin : 2,143
- Average number of residents: These facilities only admit three to four people at a time.
How much does assisted living cost in Wisconsin, on average?
Generally speaking, the higher someone's need for care, the higher the monthly bill.
That's true both for people who pay out of pocket, and people who are enrolled in Medicaid. During admission, facilities are required to provide a detailed list of services, and what they cost.
Prices vary greatly from one facility to the next.
Facilities often charge for different levels of care that increase as someone needs more services. Or example, a facility could move someone to a higher level of care, and charge more, when they begin needing help to manage medications or use a mechanical lift to get out of bed.
The state provides data on average low and high monthly rates:
- Community-based residential facilities: $4,604 to $6,951 per month
- Residential care apartment complexes: $2,775 to $4,611 per month
- Licensed adult family homes: $4,074 to $11,028 per month
Do Medicare or Medicaid cover the cost of assisted living in Wisconsin?
Medicare, the government health insurance for adults older than 65, does not cover the cost of assisted living.
Medicaid , the federal program for people with low incomes, does cover assisted living costs for people with high enough health needs. Wisconsin's most common Medicaid long-term care program is called FamilyCare .
To qualify, the person needs to have spent most of their financial assets. The process of enrollment — and finding a facility that accepts Medicaid — begins with contacting your local Aging and Disability Resource Center.
Assisted living facilities are not required to accept Medicaid, and many don't.
It is not always easy to find out whether certain assisted living facilities accept Medicaid. Managed care organizations oversee contracts with facilities, as well as day-to-day case management for people enrolled in Medicaid long-term care programs in Wisconsin.
What is the admission process for assisted living in Wisconsin?
It's up to facilities to gather information about the potential resident, then make a determination about whether they can care for them. That includes their medical diagnoses, need for nursing care and ability to use the bathroom, walk and eat independently, among other things.
It's important for a facility to have a full picture of the resident's needs before admission, to make sure they are prepared to care for them.
Keep in mind that the person who makes admissions decisions won't necessarily have a health care background.
For people enrolled in Medicaid-funded programs, such as FamilyCare, there is a separate "assessment" process that takes place before finding a facility. It's called the Long-Term Care Functional Screener , and it's used to gauge someone's health needs to determine if they qualify for Medicaid long-term care coverage.
Even if you qualify for Medicaid coverage through that screener, you still need to undergo an admissions process at the facility where you end up living.
What are 'individual service plans,' 'service agreements,' or 'care plans'?
These are documents that say what someone's needs are, and how staff will meet them. All Wisconsin assisted living facilities are required to create one once a new resident is admitted.
For example, the plan might specify that, to manage someone's dementia and diabetes, staff will help them use the bathroom every two hours, bathe twice per week and eat a low-sugar diet.
That care plan essentially acts as a contract between the resident, the facility, and their legal guardian if they have one. Per state regulations, facilities are required to keep care plans on file, accurate and updated as someone’s needs change — then, follow them. If not, the state can issue a fine.
Are Wisconsin assisted living facilities required to have a nurse or medical professional on staff?
No. Assisted living facilities are not required to employ a nurse or any medical staff, as is required for nursing homes.
However, some assisted living facilities advertise 24/7 access to a nurse and the ability to care for residents who have health issues that only a nurse can address.
Even for those facilities, though, that doesn't always mean there will be a nurse in the building at all times. In some cases, the nurse only works part-time.
It's also common for assisted living facilities to admit residents who need a nurse's care, but rely on a traveling nurse to care for them. That's common for people who need help with catheters, wound care, or hospice (the end-of-life service covered by Medicare).
How much training or education are caregivers in Wisconsin assisted living facilities required to have?
Very little.
Most staff members who work one-on-one with residents in Wisconsin assisted living facilities are called "resident aides," "resident assistants" or simply "caregivers." They are not required to be certified nursing aides (CNAs), which is standard for caregivers in nursing homes.
Each of Wisconsin's three types of regulated assisted living facilities has its own training standards.
At the most stringent level, for community-based residential facilities, staff must take nine hours of state-standardized training in fire safety, first aid and choking, medical emergencies, and hygiene for health care settings before starting the job.
State regulations say those facilities must train staff in a list of other tasks, like understanding residents' "physical, social and mental health needs." However, there are no required training hours, nor is there any required curriculum. The state does not proactively monitor how facilities meet the requirement.
Assisted living facilities commonly oversee people's medications, which can include narcotics, antipsychotics and blood thinners, among other complex drugs. To become qualified to give people their medications, staff need to take additional state training.
How much are staff paid to work in Wisconsin assisted living facilities?
The average caregiver in a Wisconsin assisted living facility is paid $15.40 per hour, according to federal data as of May 2023. The job is entry-level, meaning staff receive most training on the job and don't need health care experience.
Wages range from $13 to $21 an hour.
Do assisted living facilities in Wisconsin have to meet staff-to-resident ratios?
No. State regulations give assisted living facilities the power to decide how many staff members are needed to meet residents' needs.
However, facilities are still expected to have enough staff to care for residents. If the Wisconsin Department of Health Services determines a facility is unable to care for residents given its staffing levels, it can issue a fine.
In contrast, this spring, the federal government issued a requirement that nursing homes employ enough staff to provide 3.48 daily hours of care per resident.
How do I know if an assisted living facility is good? Where can I find out if a Wisconsin assisted living facility has complaints or fines?
Anyone can read recent results of state inspections of assisted living facilities. Those public documents are available online through the Wisconsin Division of Quality Assurance .
The Department of Health Services' policy is to tour facilities every two years. However, it prioritizes inspecting facilities that have received complaints. In 2023, 90% of the surveys the department conducted were triggered by complaints.
The state employs 49 surveyors for its approximately 4,000 assisted living facilities and their 60,000 residents.
How can I look up more information about assisted living facilities in Wisconsin?
The Wisconsin Department of Health Services keeps a list of all assisted living facilities in the state. The list shows how much a facility costs, whether it accepts public funding (Medicaid), how many beds are in the facility, and other information:
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Cleo Krejci covers higher education, vocational training and retraining as a Report For America corps member based at the Milwaukee Journal Sentinel. Contact her at CKrejci@gannett.com or follow her on Twitter @_CleoKrejci . For more information about Report for America, visit jsonline.com/rfa .
This article was written with the support of a journalism fellowship from The Gerontological Society of America, The Journalists Network on Generations and The Commonwealth Fund. The organizations played no role in the reporting, editing or presentation of this project.
This article originally appeared on Milwaukee Journal Sentinel: What to know about assisted living in Wisconsin: admissions, cost, services, and more
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