There are many different senior living options and they each provide a different benefit and/or service for a senior citizen. They can also be titled as the same but licensed to offer completely different services depending on the respective state they are located in and the licensing they have or do not have in place. Because if they are providing any type of care or physical assistance at all they are governed by their state’s Department of Health. The licensed follow the regulations in which that Particular community is licensed for. What licenses they applied for and what they received. This is why one assisted living can allow wheelchairs and another assisted living in the area can not allow them. If they are not licensed then they provide housing and amenities and a separate agency brings in home health care services like an independent living community. The unlicensed communities are a different ballgame and I’ll go into that below. These very confusing and overwhelming details for someone who knows nothing about senior living, has a family, a full time job and is now their parents caregiver. It is so important for these reasons and so many others you will learn about as you read on will help you to understand how important it is to have the right senior living advisor guiding you through this maze. This will be crucial in your quest for the right community. A salesperson at a community may offer you some information and/or advice but keep in mind they are selling their company, their services and blatantly or quietly steering you away from their competitors. While I am not an expert on every state’s regulations and my experience is primarily based in the Northeastern part of the country. I have worked with over 10,000 families in approximately 40 states across the United States and Canada. In the end It will break down to what state you are in and then what each community is licensed to provide. Do you have the time to call every single community listed in your Google search? You may pull up close to 100 options in your area. You will have to call everyone to weed out what is not applicable and then go through the touring process.
Let’s start with the simplest of options and work up from there.
Adult Day Programs – Often referred to as adult day care. I don’t particularly like the slang term. This is often a medical module program. A medical model means there is a nurse, doctor or care professional (depending on your state) on their staff. The attendees need assistance while there, they offer memory care adult day as well. Which is very popular in the Northeast and most US cities. Each program is different. There are private pay adult day programs, insurance funded programs, Medicaid only, private pay only, English, Italian, Asian, Russian speaking centers etc. Based on the area’s demographic makeup will typically determine what’s available in your area. While there they will usually (based on their licensing) provide a social worker, a nurse, the manager, sales/marketing on staff In addition to their home health aids and dietary staff members. Each center may be different but will be similar in most regards. Most offer transportation to and from home, breakfast, lunch and a social calendar. Insurance covered programs will decide how many days a week the senior can attend. For the private pay it will be about how many days you want to go and how many days a week can you afford. They range from $90 to $150+ per day. Hours a typically in line with school hours 8am-3p or 4pm.
Senior Centers – are basically local social groups run by the seniors in those groups. They are crucial for any community in many ways. They are mostly funded by the city or state, local veteran and such organizations as well as privately owned. They meet weekly, they go on trips, excursions, they have a very active social calendar, meetings, parties, holiday events, senior living and health related companies bringing them gifts, meals and more to allow them time to address the group and let them know what their services offer. They keep very busy. Some seniors go once a week some centers offer two, three, four or five day options each week. If your loved thrives in this setting you will notice they are down/ depressed on the weekends when they are closed. If this is not a free center then it really comes down to how many days do they want to go and how many days can they afford to go.
Senior Citizen apartment buildings – Don’t we all have that one building in our community you drive by and the front of the building is lined up with seniors talking and relaxing on their fold out chairs. They are city or privately owned apartment buildings. For the most part they offer no services. If it is a city owned building, there is most likely an income bracket you need to fit into. It is typically a lower income bracket and/ or a lottery type system. If privately owned the rent is a little friendlier/lower than other apartments in the area. Perhaps a space smaller and seniors over the years referred one another. Over time they became primary senior populations. They look out for each other, have one over for coffee & swap family stories. One tenants daughter might look in on a tenant with no family and look out for them a bit. Maybe a card game or some social aspect they arrange on their own besides or just sitting outside. Those that need assistance pay for or their insurance has a home health aid come in just as they would in their home.
In Home Care Home Health Aids & Companions – An in home health aid service in your home for a certain amount of hours per day and a certain minimum amount of days per week or full time 24/7. For some this is about how many hours/days your insurance approves for you in particular. For others it is what you can afford. For those seniors with strong assets you will pay and you will pay dearly, more than you ever estimated in your mind. If you have not had a bad experience with a home health aid/agency you have heard one from another that has. Unless you are that 1 in 100 that finds a sweet, caring, trusting home companion or home health aid (aka HHA) you are more than likely getting mediocre services or a complete nightmare depending on where you live and the pool Of HHAs available to any given company. Another important reason you should be with a reputable company (which is not always the solution) a referral from someone that has worked with that person. A company will drug test and run a criminal background check. The current national shortage of health care workers is not going to improve this situation anytime soon. Fortunately there are many companies owned and operated by some very good people though you may be pressed to find one in your area. Those with a good aid usually know when they have hit lotto in that regard. A great aid, an amazing companion and a good person who treats your mom, dad or loved one with the Respect & Dignity they not only deserve but how they would treat their own Parent. When a senior needs assistance with ADL’S (activities of daily living) grooming, dressing, toileting, showering, medication reminders or administration, light meal preparation, escorts to medical appointments. When a senior chooses to live at home it is a rare occasion that insurance covers 24/7 home health aids for you. Those seniors will rely heavily on their loved ones when their aid is not there. An approved aid by your insurance company can range from 4 to 8 hours a day 3-7 days a week as the average. A privately paying senior will begin aid service at $24-$27 an hour!! An hour!! If you require a 24/7 HHA with you, you will need to supply them a bedroom and when they sleep you will need to hire another aid. (I will go into further detail on this in the future.)You still of course have to buy your food, now buy the aid food, utilities etc. Basically your still paying for each bill individually on top of the aid. Make sure to invest in a top surveillance system you can watch at anytime. Hidden or not. Besides needing to know how they are treating your loved ones, this will be key to knowing if your loved one has fallen when alone, leaves the stove on, is in danger or is about to wander out their homes.
Residential Care Homes – These are homes that look like homes that me and you live in on any given block. It will vary in each state how many people can reside in one house but it is typically 6-14 people at the maximum. This home will offer a visiting doctor, a nurse during certain hours, a social worker or house manager and staff to run the house. In some cases a nurse, a doctor, a social worker will own and run the house. These homes require an assisted living license. Residents live in a home like environment, they sit on their porch, in their yards, they have meals in the dining room, watch TV in their living rooms in a smaller setting when compared to larger facilities. Some homes care for a frailer population. Some specialize in memory care. They are typically lower in cost than larger assisted living communities. I Recommend double and triple checking the reputation of each home you’re looking into or again have the right senior advisor assisting you. Finding a good residential care home is not an easy task. In the metropolitan NY area it’s almost impossible to find. Staten and Long Island have a handful. In other states there can be 5 on one block. It will vary depending on how easy the state made it to license and operate them. Costs can begin at $2400-$6000+ per month. Keep in mind when they look like your home, they will have stairs. Which can be a huge issue for some.
Retirement Communities – aka 55+/ Village type living- min of 55+ yrs These are communities in where you purchase your home, you pay a monthly maintenance fee to maintain the grounds. A clubhouse, social gatherings usually arranged by a group of people that live there or depending on the size of the development and how much they want to be involved in your daily life they may have extensive social opportunities. Some equipped with a life alert type system. Depending on where you live and how active your community is you should consider some things. Are you healthy and active and plan to live there for many years? Because if not, is it worth it? The resale value is not great and because the older live there, people pass away, they need higher care and have to move etc. in these types of communities you are not showing your house to all the buyers. Your home will only appeal to a small percentage of the pool of buyers looking because the majority can not afford it or does not want it and there will likely be 4 other homes for sale just on your block at the same time. Not a lot of demand in some states. If you are a very independent and not a very sociable person what is the benefit really moving from your home to this? These also depend on the state but in the Northeast range from $500,000- $850,000+ purchase( plus the maintenance fees, cable, phone, utilities etc. ) In other states these “village” type set ups can be life saving for active seniors living their best lives. Sadly in NYC area and other across the country the senior has to sacrifice living near their families and move to a state that offers them.
Independent Living Communities- 62+ yrs and older but they are not licensed communities and so it’s up to each owners discretion on age. In most independent living communities the building provides your housekeeping, laundry and/or a laundry room to do your own, maintenance, recreation program, parties, excursions an executive director, front desk concierge and Most will offer a la carte services and some will provide all of your meals and some you can make your own, some you can buy a breakfast plan, lunch or dinner. Some will offer a kitchenette, some a hot plate. There are some that even offer a memory care area. It is so different in every independent living and so it will be important to research them carefully if considering. They are not licensed so they answer to no one. This can be a great thing and not so great depending on the community, who owns it and yes, who runs it! Because they are unlicensed they provide zero assistance for anyone that lives there. They can call an ambulance for you. They may bring in a visiting doctor and or a nurse service to take vitals once a week/month they all will vary. If you need help from a home health aid your insurance will provide as they do in your home or you will pay to have one from an outside agency, or an agency who’s office is in the building and they pay rent to be there. Hence the term Independent living with on-site services. Some communities have mastered this advantage. One in particular I work with in NYC has over 21 home health care agencies each specializing in a different care needs they can call on for you. They can range from light help with just showering and go to up ventilator care. Remember they are not licensed so they do not have the strict restrictions that assisted living communities do. No one governs them. I have seen some of the downsides of Independent living with some families and I have helped families at nursing home levels of care live in independent living because they had a very different quality of life and their family had no restrictions on being with them. While At the height of the pandemic when people could not see their loved ones in person and relied on window or zoom visits in the licensed care facilities. The residents living in independent living communities were for the most part gathered in their dining rooms months before assisted livings were. Their families could go into their moms apartment and the sales teams were walking by you all day every day with tours showing them the building. As you can see each independent living building is very different from the next.
Assisted Living Communities- You have executed a residency agreement upon admission but you basically have a month to month tenancy and with 30 days notice in most communities you can move out and not owe them any money but for the time you were there. Age typically beings at 62. More and more communities are accepting as low as 55yrs old now. Some can even accept a senior in their early to mid 50s depending on their licensing and the care needs of the prospective resident. Higher acuity communities will hold an EARL license to support and provide care to the enhanced / higher care need residents. While two assisted living communities can each have an EARL license, one community may provide higher acuity care services than the other. One may offer services that include a hoyer lift while another may not feel comfortable providing that care. One community may accept you with higher wound care needs than the other. It will vary as some communities are more comfortable with their nurse and may have more confidence in their home health aids than others. Some do not want to take the risks of higher are. Assisted living communities are unable to care for seniors that require a skilled nursing level of care. such as a sliding scale diabetic, a ventilator, a feeding tube and many more diagnosis. They are not licensed to care for those seniors. Can you see now why some independent living communities take advantage of their No-license status. The department of health governs all assisted living communities. While this has so many advantages it also like everything else has its downfalls. The Dept of health decides important aspects of your daily life in assisted living communities, right now more than ever before. Pandemic related illnesses, The worst flu in years coming our way, Mycoplasma bacterial infections. This list is endless these days but in my opinion a lot of their focus is misguided. In January the Dept of health mandated assisted living communities to fill out a 15+ page application for a resident requiring certain equipment like hospital bed. Now the doctor has little to no say. 1 in 10 people are now approved to have one in a facility. Previous to January it was 8-9 in 10 as the only one to ever deny them was their insurance company and coverage related reasons for the most part. In my opinion they have bigger things to worry about these days like infection control but who am I.
Memory Care Communities– sadly the memory impaired communities residents are entering at younger ages every year. 45+ yrs old with the average age between 62 and 85. A memory care community is a licensed assisted living community and varies in each state. In NY a facility with a secured memory care will have a SNARL license. It is a special needs license. In Some states a community is entirely made up of memory care. NY not so much. I was the sales leader in the largest memory care facility in the metropolitan area. Which was still only two floors in an assisted living community that had three other floors that were not memory care. There are more every year popping up in our surrounding states though and very popular across the country. Up until the last 5 or so years it was a struggle to fill your memory care and keep it fill. In addition to the Baby Boomers coming our way, Times are changing and we may see quite the opposite set up in the years to come. Most memory care floors are located in an assisted living community. When you walk into memory care you are in a whole other community within that building and separate from the assisted living residents. It should primarily be set up that way for many reasons most importantly you hold a SNARL license because you have met the requirements of the Dept of health to have that secured environment. This is separate from assisted living residents who do not have restrictions when it comes to just walking out the front door for air. A memory care resident walks out the front door for air they are not capable of understanding where they are or how to get back to their floor and are instantly at serious risk for elopement. A memory care community typically has its own staff, it’s own dining rooms, it’s own recreation program and a secured environment where they are safe. Up and down in elevators and into large lobby’s is very overwhelming for most memory care residents. They should have the freedoms to walk around and even outside in the adjacent courtyards depending on how each building is set up, in a safe and secure environment where staff is with them or supervising them at all times. Their meal times are geared to their needs, their activity calendar will be specific to who lives there and things they enjoy doing.
Respite Care – Respite is a short term stay. It can be a a weekend to few days to a few months. Depending on where you are staying for your respite will determine your costs. Independent, Assisted & Memory care living are typically the minimum of 30 days depending on your state and what facilities are offering it. Most will charge you an extra fee per day until you leave or convert to a permanent resident. Rehabilitation though not a long term solution is not technically considered a respite stay. Some organizations may offer respite stay to caregivers. If it is not being offered as a free service then you are paying for it and maybe a little bit more but they are setting you up furnished and bring clothes and toiletries. Either way, it’s a short term stay.
Rehabilitations– Rehab is a short term living arrangement to provide you physical, occupational and speech therapy services following your medical situation. There is acute and sub acute rehab care. Acute care is a intensive rehabilitation for seniors who have suffered a debilitating illness or injury. A candidate for Acute care would be someone who had a surgery, a heart attack, stroke, pneumonia, COPD and other debilitating illness’s. You can typically withstand 3 hours of therapy 5 days a week. You are improving your quality of life by being provided constantly moving goals. Your stay is shorter as you will meet your goals sooner here. Sub Acute care is intensive therapy for seniors who cannot withstand the longer therapy Acute care offers. Your whole care team is working together to achieve frequent short term goals. These are critically Ill seniors. Therapy will be 2 hours or less each day. The focus is on regaining strength, mobility, and long-term functionality over the course of therapy. A combination of physical, occupational and speech therapy will typically deliver results. Their therapy can also include holistic and respiratory therapy. A candidate for Sub acute care would be someone with terminal illness, A GI tube, intensive wound care, long lasting major stroke issues, cancer, severe malnutrition or eating disorders. Sub acute care allows seniors to take their time to recover. In the NY & surrounding areas and in most states you are entitled to rehab after 3 consecutive nights in a hospital. You enter either rehabilitation options from a hospital, almost never to rarely from home. You are most often (insurance varies) entitled to 100 days a year for rehab services under your Medicare insurance. Nearing the end of your rehab stay your social worker assigned to you at rehab will discuss with you the discharge process, what your living options are and how they can help you get to a care facility or have the services you need set up and ready for you to return home. Some seniors can not return home and are not assisted living candidates and will need a nursing home bed. These seniors require a skilled nurse available 24/7. They will move from the short term rehab bed they are in to a long term bed whether in that facility’s long term bed area or another facility’s long term bed.
Skilled Nursing Facilities – AKA Nursing Homes- A nursing home. Many families I have worked with over the years think they can just place their aged relatives in a nursing home. What they never knew was not everyone is a candidate for a nursing home and you get there via a hospital stay. To be a true nursing home candidate interprets to you needing a nurse at your disposal 24/7. Such as a ventilator patient, a feeding tube, a sliding scale diabetic and the list goes on. Keep in mind if you live in a nursing home you can still have a medical emergency that will require you to go to the hospital then rehab in some cases and then back to skilled nursing.
Hospice & Palliative Care – Hospice care is a type of care that focuses on a terminally ill patient’s pain, symptoms and attending to the emotional and spiritual needs at the end of someone’s life. While hospice care provides you food and water hospice care prioritizes comfort and quality of life by reducing pain and suffering. When you decide on hospice care you are no longer going for tests, you are not going to hospitals for that hospice related illness. It is a comfort measure through end of life. There are hospice houses but keep in mind assisted living is your “home” and hospice care comes into most communities and the patient is able to go through end of life in their respective communities, in their homes or in a hospice house. Palliative Care is for someone living with serious Illness at any stage. It is comfort measures through the Illness while hospice is brought into the mix during the final weeks/stages of someone’s Illness. 5-23% of people graduate from hospice alive.
CCRCs and FFSCCRCs – Offer of a little of everything. CCRCs are continuing care retirement communities. As with all we’ve read about above it has its pros and some serious cons. In some parts of the country this is a very popular senior living solution. FFSCCRCs are fee-for-service continuing care retirement communities. These communities offer residents all levels of care. Some seniors seek these facilities out and when I probe them as to why the most common response is “I’ll never have to move again.” Weeeell, not necessarily. Most CCRCs require that admissions move seniors into their independent living accommodations not directly into assisted living. They prefer that one ages into that care when needed. Just like they may to the memory care or skilled nursing services on campus and it is their definition of continuum of care. There are generally very high entrance fees that can range depending on location from $150,000-1,000,000+ .Each company’s contracts will read differently but most will offer a percentage of that entrance fee back should you move in the future or pass away. In the event of death it is arranged for your family to receive. Again every company is different some will offer 50-80% back and they will all have different terms and conditions. Here are some of my feelings on them. What happens if the company goes bankrupt? Are you getting the entrance fee back? Let’s go back to when a senior says “I’ll never have to move again.” It feels quite opposite. You move to independent living, you settle in. Your entrance fee by the way is just that, you still have to pay monthly for apartment rentals possibly a la carte services like a meal plan etc. You have friends there now. Mary’s your best friend now. You dine with them, socialize with them, spend your holidays with. One day you fall and break your hip or more commonly and under diagnosed your hip breaks and so you fall. After rehab it seems you now need assisted living. Goodbye Mary, I’m being packed up and I have to move to the assisted living building. Now you are paying the monthly fees, the rent and the care fees. You settle in, all new staff. Staff and new neighbors have to begin to get to know you and vice Versa. You try to make new friends and begin again. A year or two later you now have a feeding tube and that requires skilled nursing. You are packed up and moving again to the nursing home portion of the campus. Nursing home level of care is a much higher fee. Now here you are at end of life and the staff is unrecognizable, you do not know any of the patients. End of life seems to me to be much more lonelier than you imagined and as you lye there and reflect you realize you’ve moved 3 times since you moved in. That’s an awful lot of moving for someone who paid a half a million dollars plus monthly fees (equivalent to fees in an assisted living community) only assisted living didn’t have that huge entrance fee.
There are a few other options becoming more popular amongst the younger generation of seniors trying to keep their head above water during a pandemic with inflation going through the roof and their paychecks getting a $50 increase this year to help offset this for them. Isn’t that so nice of social security. Some seniors these days are choosing options such as cohousing, living on cruise ships or sadly shelter.
Whichever option you need and/or decide on, Please do your research or consult with an advisor Like myself. Be careful of what you click on in your search. You may think you’re calling a community but a service is about to attempt to assist you in the search. Some will be invaluable to you and some are just trying to make a buck..
I hope I have brought answers for some and shed light for others.
Thank you so much for reading through my first weekly Senior Care & Living options blog. Amm
Senior Care & Living: 101 