David Stevenson, an assistant professor of health policy at Harvard Medical School in Boston has been studying assisted living facilities and has found, not surprisingly that assisted living facilities are most often located in areas with higher levels of income, education and home values. The findings indicate that people with lower incomes, minorities and those living in rural areas have fewer living options as they age.

Assisted living is generally for people who don’t yet need the full-time care provided by a nursing home, but may need help with daily living. How this assistance is provided differs greatly from facility to facility.

In 2007, there were 11,276 assisted living facilities with a total of 839,746 residential units in the United States, according to the study. Connecticut, Hawaii and West Virginia had fewer than 10 assisted living facilities per 1,000 elderly residents, while Minnesota, Oregon and Virginia had more than 40 facilities per 1,000 older Americans, according to the study.

These findings are most useful from a public policy perspective, Stevenson said. “We need to keep in mind that the assisted living supply isn’t distributed evenly, and that not all individuals would have access to assisted living even if public dollars were available to support it,” he said. Assisted living is an interesting arena because the level of care varies greatly. I have seen residents in assisted living facilities who for all intents and purposes should have been in a nursing home. And I have seen Medicaid-funded residents in assisted living. By and large though this study mirrors what I see daily.

I hate to harp on the same theme but there are affordable things that anyone can do to better plan for your options as you age. Self-responsibility is going to play a larger role in our lives. Whether it is how we take care of ourselves to how we plan for our future financial and overall health. My wife made a decision some 15 years ago to take advantage of a voluntary benefit that her company was offering – something called long-term care insurance. Because she bought young, her premium annually is $500. Yes $500. And she is now, let’s say a bit older. At $3,000-$4,000 a month, most families, low and middle income, can not afford to pay out of pocket for assisted living. However if God forbid my wife does need an extra level of care one day, her insurance is almost like a “get out of jail free” card in terms of her options.

$500 a year is a lot of money when you have to choose between groceries, prescriptions and health care you may never need. So it is a hard choice. But the choice needs to be made sooner in life to make it all affordable and some of that requires a leap of faith to understand that our government can not subsidize this care. Right or wrong, the finances do not add up. We all have to plan for our care.

The results are published in the January issue of Health Affairs.