Assisted living or assisted living facilities are residential facilities for individuals with disabilities. These facilities provide supervision or assistance with activities of daily living, coordination of services by outside health care providers, and monitoring of residents' activities to protect their health, safety, and well-being. Assistance may include medication administration or supervision, or personal care services provided by a trained staff member. Assisted living emerged in the 1990s as an alternative to hospice care to continue the care of individuals who are not suitable for independent care, do not require 24-hour nursing care, and are less advanced in age than nursing home care. Assisted living is a philosophy of providing care and services in a manner that promotes independence and dignity. Within the United States, there is no national definition of assisted living. Assisted living facilities are regulated and licensed at the state level in each state. More than two-thirds of states use the term “assisted living.” Some of the licensed terms used to describe this philosophy include nursing home, assisted living facility, and personal care home. Each state licensing agency has its own definition of the term it uses to describe assisted living. Because the term assisted living is not defined in some states, it is a marketing term used by a variety of licensed and unlicensed senior living associations. Assisted living facilities in the United States had a national average monthly rate of $3,261.00 in 2011, an increase of 2.39% over 2010 and 5.99% over the six-year period from 2005 to 2011. Physical models of buildings offering assisted living services vary widely, as do state licensing and definitions. Assisted living facilities range in size from small single-resident homes to very large assisted living facilities serving hundreds of residents. Assisted living facilities fall somewhere between independent care associations and highly specialized nursing facilities in terms of the level of care provided. Assisted living facilities combine independent care, assisted living, and nursing care in a single facility. Individuals living in a new assisted living facility are provided with private housing. There is usually no special medical monitoring facility available at a nursing home, and nursing staff may not be available all the time. However, trained staff are usually on site 24 hours a day to provide other necessary services. Housekeeping is performed: changing sheets, washing items, and preparing and serving food is part of the basic rent and included utilities. Depending on the services advertised, assisted living services may include medical treatment, assistance with bathing and dressing, companionship to meals and activities, toileting and transportation, and insulin injections by a registered nurse. Some nursing homes have a beauty salon on site. Grocery services are also available. Where available, private apartments are generally self-contained; that is, they have private bedrooms and bathrooms, and may include a separate living area or kitchenette. Registered nurses and qualified nurse practitioners are available by phone or email 24 hours a day, to ensure appropriate education and/or guidance for the staff on hand. Alternatively, individual care areas can resemble a dormitory or hotel room with a private or semi-private sleeping area and a shared bathroom. There are usually several common areas for sharing social activities with others, such as a central kitchen or lunchroom for preparing and eating meals. Professionals have defined a person living in an assisted living facility as someone who requires assistance with at least one activity of daily living. The typical resident of an assisted living facility is usually an adult who does not require the level of care provided by a nursing home but would prefer more companionship and needs assistance with daily living. Age groups vary at each facility. There is a shift in long-term care today, with assisted living communities accepting higher levels of care, and nursing homes becoming a place for those undergoing rehabilitation after a hospital stay or individuals who need intensive assistance. Many assisted living communities now accept individuals who need assistance with all activities of daily living. The American Association for Assisted Living reports that the average age of an assisted living facility resident is 86.9 years. Female residents outnumber male residents by 3 to 1. The majority of residents in assisted living facilities are still married or have a partner. The average stay in assisted living facilities is 28.3 months. The residence can help arrange appropriate medical, dental or health care services for each resident. The resident generally chooses his or her own medical or dental care provider. Residents who are temporarily disabled due to illness, injury or convalescence from surgery are often allowed to remain in the residence or return to a rehabilitation center, specialized nursing facility or hospital if the assisted living facility can provide appropriate services. It is important to remember that assisted living facilities are a bridge between living at home and living in a nursing home. However, assisted living facilities do not typically provide the same level of skilled, ongoing nursing care as nursing homes or hospitals. Some newly built facilities have been designed to ensure that services are easily accessible to people with disabilities. Bathrooms and kitchens are designed with wheelchairs and walkers in mind. The entrances and doors are wide enough to accommodate wheelchairs. These facilities are necessarily fully compliant with the Americans with Disabilities Act of 1990 or similar legislation elsewhere. The socialization features of assisted living facilities are very beneficial to residents. The facility usually has a variety of scheduled activities to accommodate residents with varying disabilities and needs. In addition, many assisted living facilities cater to the mentally ill population, primarily individuals with dementia, including Alzheimer's, but also others who do not pose a significant risk to themselves or others. In the United States, state legislation not only specifies the level of care, but also often the conditions that prevent home care in such cases.