Choosing housing for older adults can be tricky because of all the different nomenclature used. When clients call an Aging Life Care professional, they usually have no knowledge of how each type of housing differs, or worse, they think a nursing home is the only real option for their loved one.  

Kira Reginato, an experienced Aging Life Care Manager with over three decades of experience, offers valuable insights into navigating this complex topic. 

This guide will help families understand the various housing options available for seniors and provide practical advice to make informed decisions.

Understanding Housing Options

1. Age in Place

• • Description: This option involves remaining in your current home, and making modifications to accommodate needs which may accompany getting older. It offers familiarity.
  • Ideal For: Seniors who are relatively healthy and independent and who want to preserve familiar surroundings and social connections and maintain their lifestyle for as long as possible. 
  • Considerations: Can your home be adapted to meet future needs (e.g., shower access, ramps instead of stairs, burners that turn off automatically)? Can you maintain the home and yard? Do you have a support system in place for assistance with daily tasks? Can you afford necessary modifications or in-home care?
  • Costs: Vary widely depending on the extent of modifications needed, in-home care services required, and property taxes. 

2. Independent Living 

• • • Description: Independent living communities offer a hotel-style experience with weekly housekeeping, meals, and a sense of community. They do not require a license and often provide transportation and activities. Assistance with personal care must be hired privately.
    • Ideal For: Active seniors who seek a supportive environment without intensive assistance.
    • Considerations: Do you have funds to stay here and hire care if needed? Can you accept the fact that you may need to move to another home?
    • Costs: Vary depending on amenities and structure of the home, and some may have a move-in fee.

3. Assisted Living / Residential Care Facility (AL or RCFE)

• • Description: Licensed and monitored by the Dept. of Social Services, assisted living facilities provide help with daily activities, such as bathing, dressing, and medication management. They offer housekeeping, meals, laundry, activities, and personal care. Accommodations vary from apartments to private or shared rooms.
  • Ideal For: Seniors who need some assistance but want to be free of day to day chores like shopping, meal prep and cleaning.  
  • Considerations: Do you wish to be in a setting where you’re around people who may be healthier or frailer than you are?  Can you afford to remain here for several years? Ask to speak to at least one family member who has a loved one living there now.
  • Costs: Most require a one-time move-in/application fee, and rent is charged per month. Some long-term care insurance policies help pay costs. Ask about rent assistance programs for low-income individuals or if assets are running low.

4. Board and Care Homes

• • Description: These are smaller-scale assisted living homes (6-10 residents), also licensed by the Dept. of Social Services and are often family-run businesses. They provide similar services to larger assisted living facilities, including housekeeping, meals, laundry, limited activities, medication management, and personal care.
  • Ideal For: Seniors who prefer a more intimate, home-like environment. Good option for those requiring more supervision and 1-1 assistance throughout the day or night.
  • Considerations: Sometimes these facilities have less privacy and fewer amenities. Ask to speak to at least one family member who has a loved one living there now.
  • Costs: Most charge a move-in fee, which is usually less than what a corporate assisted living home charges. Rent is month-to-month, and extras may be added on, such as costs for incontinent supplies or transport. Some long-term care insurance policies may help pay costs.

5. Assisted Living with Dementia Care

• • Description: These facilities are licensed and monitored by the Dept. of Social Services and are required to have a plan of operation to serve those with memory impairment. They provide the same services as standard assisted living but with additional staff training and secure walking areas for residents with memory loss and cognitive impairment.
  • Considerations: It’s important to observe how staff treat existing residents and to ask about their number of years experience in dementia care. Ask/observe the availability of activities and programs so residents are engaged. Ask to speak to at least one family member who has a loved one living there now.
  • Ideal For: Seniors with dementia or other cognitive impairments who require specialized care.
  • Costs: Rent is charged month-to-month, similar to other assisted living facilities. Most charge a move-in fee, and extras may be added on, such as costs for incontinent supplies or transport. Some long-term care insurance policies may help pay costs.

6. Post-Acute Care (Skilled Nursing Facilities or Rehab Center)

• • Description: Licensed and monitored by the Dept. of Health Services, these facilities provide 24-hour skilled nursing care, rehabilitation services such as physical, occupational, and speech therapy, and full personal care.
  • Ideal For: Seniors recovering from surgery or illness who need intensive medical care.
  • Considerations: It is difficult to remain long term in this setting as most post-acute facilities are geared for short term rehab stays. Do you have an advocate to help get your needs met as a resident and also help with your discharge?
  • Costs: Medicare covers costs only if there is a skilled care need. Medicaid pays for room, board, and services for those who cannot pay privately but finding a bed that is covered by Medicaid is arduous. Some long-term care insurance policies help pay costs.

7. Continuing Care Retirement Communities (CCRCs)

• • Description: CCRCs provide multiple levels of care, up to four. Levels may include independent, assisted, memory care, and skilled nursing. They offer housekeeping, meals, laundry, activities, medical appointments, medications, and personal care.
  • Ideal For: Seniors who want to age in place with varying levels of care available as needed.
  • Considerations: Do you have the assets to afford this option? Is being able to remain here forever what you wish? What is the reputation for each level of care? Ask to speak to at least one resident who lives there now.
  • Costs: Most have a large buy-in fee, month-to-month rent, and a contract to sign. Sometimes the move-in fee can revert to the estate.

 

Involving Aging Loved Ones in the Decision-Making Process

It’s essential to involve aging loved ones in the decision-making process to ensure their preferences and needs are respected. Here are some steps to facilitate this:

1. Open Communication: Initiate honest conversations about preferences and fears regarding housing. Include cost considerations so a budget can be formed that is realistic.
2. Inclusion in Research: Explore housing options together, or better yet, visit many and then bring your loved one to visit your top two or three choices. 
3. Respect Autonomy: Honor their choices, even if they differ from yours, and empower them to make decisions.
4. Consult Professionals: Seek advice from Aging Life Care Managers, sometimes referred to as geriatric care managers, or local senior placement companies. 
5. Regular Check-Ins: Keep the conversation ongoing as needs evolve.

 

Nine Things to Consider When Evaluating Your Home for Aging in Place

Before exploring external housing options, you may wish to evaluate if the current home is suitable for aging in place. Here are nine key considerations:

1. Accessibility: Assess how easy it is to get in and out of your house or move between floors. Consider safety features like non-slip flooring, grab bars, ramps, and widened doorways.

2. Proximity to Medical Services: Ensure that you have easy access to medical professionals and facilities. This proximity is crucial for regular check-ups and emergencies.

3. Availability of Services: Check if  grocery and supply shopping is nearby and/or if delivery service is available.

4. Support Networks: Evaluate the types of support networks you have nearby, such as family, friends, or community groups. A robust support system can significantly enhance your quality of life.

5. Outdoor Safety: Determine if you can walk outside safely. Look for well-maintained sidewalks, walking paths, and areas where you can walk with friends.

6. Home Maintenance: Explore options for assistance with yard work, cleaning, and repairs.

7. Technology: Utilize smart home devices for security, communication, and convenience.

8. In-Home Care: Research and prepare for services for assistance with daily living activities. There may be a four-hour minimum required. 

9. Emergency Preparedness: Develop a plan for emergencies, including medical alerts and evacuation procedures. 

Beyond Housing: The Role of Aging Life Care Managers

Navigating elder care can be overwhelming. Aging Life Care Managers offer invaluable support by:

• Creating Personalized Care Plans: They assess needs and preferences to curate a plan promoting well-being.
• Coordinating Care: They can manage appointments, in-home care, and medication, ensuring seamless care.
• Providing Emotional Support: They guide and support seniors and their families through the decision-making process.
• Trusted Referrals: They offer expert guidance, leveraging deep knowledge of local resources and service access to find the ideal care solution. Their commitment to ethical standards ensures unbiased recommendations tailored to your specific needs.

Finding an Aging Life Care Manager To find a qualified Aging Life Care Manager, visit the Aging Life Care Association’s website at aginglifecare.org and use the “Find an Aging Life Care Expert” tool.

Kira’s reflections, “Embrace the journey and don’t be afraid to seek support when needed.”

Navigating Housing Options for Seniors

There are many things to consider when choosing the best place to call home, including cost, location, amenities and services, safety, and comfort. 

Finding the ideal housing option for seniors can be a complex and overwhelming task. By understanding the available options and seeking guidance from professionals like Aging Life Care Managers, you can ensure a smooth transition and continued well-being for your loved one. We hope this guide empowers you to make informed decisions for a brighter future. 

About the Author: Kira Reginato, BA CMC founded Living Ideas for Elders and is an Advanced Professional Member of the Aging Life Care Association.  As an Aging Life Care Manager and consultant, Kira has served hundreds of older adults and their families in a variety of settings, including hospitals, residential care facilities, skilled nursing places, hospices, Alzheimer’s adult day care programs and Meals on Wheels. She enjoys public speaking and published, Tips for Helping Your Aging Parents . . . Without Losing Your Mind, now in its third edition.

 

Disclaimer: This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association® and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.