Oprah once wrote in her magazine, “I’m grateful for every age I’m blessed to become.” While many people may not like the idea of getting older, there can be a lot to look forward to, such as retirement, grandkids, and the wisdom that comes from living a long, healthy life. It’s all about perspective. We should view healthy aging as a privilege, accompanied by a realistic and clear-eyed view of the many changes that come with aging—many of which are actually quite enjoyable.
One of the aspects of aging that changes for many older adults is physical needs. Time will slow us down; we will likely lose muscle and balance, and may become ill more frequently. This kind of change can be hard to take for many older adults who are accustomed to being active and independent. They sometimes need a loved one to step in and help them better understand their options. This could mean changing or modifying their living situation. If you have a loved one approaching this big decision, you could help them tremendously by getting up-to-date on the senior living options to consider. This article will outline the most common options, as well as some new ones, and provide the details for each. At the end, there is a comparison worksheet that breaks down the services and amenities you can expect from each option.
55+ Independent Living or Retirement Communities (IL)
If your loved one is very active and sociable, they might enjoy living in a retirement community. These communities are usually either multi-story apartment buildings or a community of attached cottages or unattached small homes available only to adults over 55 years old. The residents who live in these communities do not need daily care or assistance. Individuals who live in IL communities are typically vital and healthy people who choose a more convenient and social lifestyle. The communities offer amenities that make residents’ lives easier, such as landscaping and snow removal, maintenance, meal service, transportation, housekeeping, laundry services, and more. There are usually many opportunities to socialize both in the community with pools, gyms, restaurants, clubhouses, and offsite with group outings and trips.
Many of these communities fit within a Continuing Care Community—see below.
Market-rate IL communities can be expensive. The American Senior Housing Association estimates the rent for an IL community can cost between $1,500 and $6,000 per month. There are also affordable housing communities geared towards older adults who are on fixed incomes. These HUD-financed communities usually charge rent based on income. There are also federal housing vouchers that seniors can apply for to help with rent. These vouchers can be used at any IL community that accepts them.
Assisted Living Communities (AL)
These communities offer residents assistance with activities of daily living such as bathing, dressing, eating, and mobility assistance. ALs also offer limited healthcare such as medication management and medical equipment needs like oxygen tanks. Most ALs provide several levels of care so that residents pay for only the care they need and then add additional care as they need it. If you are concerned about your loved one’s safety and security, ALs typically feature emergency pull cords in apartments and safety alert pendants for residents to wear. These communities usually include many of the amenities that IL communities feature so residents can enjoy the same conveniences and benefits.
ALs usually charge a monthly base rent and then a fee for the level of care your loved one needs. Depending on the community, the care levels are priced by the day or by the month. According to Genworth, the national median cost of ALs is $4,300. It can be extremely challenging for low and even middle-income older adults to afford an AL facility. In some states, there is a Medicaid Waiver program to help pay for AL care. Colorado‘s Medicaid Waiver pays an average of $4,000 per month. The level of benefits and the eligibility requirements vary by state. If your loved one is a veteran or a spouse of a veteran, they may qualify for aid from the U.S. Department of Veterans Affairs. Although the VA does not pay AL rent, it may cover some of the services provided. Known as Aid and Attendance (A&A), this benefit is a monthly, needs-based payment above and beyond a VA pension.
Memory (Dementia) Care
Unfortunately, the need for communities that specialize in memory or dementia care has increased in the United States. According to the Alzheimer’s Association, an estimated 5.8 million Americans ages 65 and older live with dementia or Alzheimer’s disease. By 2050, this number is projected to rise to 14 million. Brain diseases call for a very specialized living environment. Safety and structure are the most important features of any memory care community. Older adults with dementia are often confused and exhibit behavior issues that can be dangerous for themselves and others. 24-hour care is necessary, as well as locked doors and emergency services. But that doesn’t mean that adults with memory issues can’t enjoy life. The best memory care communities offer a full schedule of activities geared towards stimulating residents’ brains and bodies. Some AL communities also offer memory care in the same building.
Memory care can be very expensive. AARP reports that it adds another $1,000 to $4,000 to the monthly rent rate. Medicaid waiver and A&A will pay for some of the AL aspects of memory care, as will Medicare.
Skilled Nursing Communities (SNF)
SNFs (or nursing homes) are licensed communities that offer a full range of health care services, including basic and skilled 24-hour nursing care and rehabilitation therapies. This could include physical, occupational, and speech therapy. More and more, these communities operate as a step-down unit for hospitals in terms of the medical care available. Older adults who need to recuperate from surgery or illness may be admitted to a SNF for a short stay. Of course, if and when your loved one needs long-term care, a SNF would also be appropriate. Amenities are still relevant in a SNF and can include meals, housekeeping, laundry, transportation, activities, and more.
The national median monthly cost for a private room in a SNF is $8,821. The payment methods discussed above could be used to pay a portion of this cost, but in most cases, residents will need to cover some of the expense with long-term care insurance, Medicaid, or their own savings. There are also organizations that specialize in advising families on Medicaid qualification processes.
Continuing Care Retirement Communities (CCRC)
Sometimes called Life Plan Communities, CCRCs are designed to enable older adults to age in place by providing a range of senior living options, often in the same building. If your loved one chooses to move into a CCRC, they may avoid having to move multiple times as their health changes. These communities offer IL, AL, memory care, and SNF services all in one location, as well as all of the amenities that residents would want and expect from communal living. This option would give both you and your loved one a little peace of mind knowing the decisions were made as to where your loved one will live for the balance of their lives.
Some CRCs require a “buy-in” fee as well as monthly charges for residents. Entrance fees can range between $100,000 and $1 million. Monthly fees generally range between $3,000 and $5,000. Additional fees may be charged for amenities and services like dining services, transportation, housekeeping, and social activities.
If your loved one wants to stay in their home—to age in place—there are services to help them do that. You can find both personal home care and skilled home health care professionals to come to them weekly or daily if they need it. Personal home care generally means an aide provides household services such as laundry, cooking, cleaning, and running errands. Skilled home health care refers to a level of care that requires medical training, including IV insertion and management, occupational and physical therapy, and pain management. The aide could also order and manage medications and other medical equipment they may need. To stay home, certain modifications to your loved one’s home may be necessary to stay safe. This could include grab bars in bathrooms, a ramp down porch steps, a chair lift for flights of stairs, or wider doorways and lower counters for wheelchairs.
Other Housing Ideas
Recently there has been an intriguing explosion of new senior living options popping up in the United States.
- Adult care homes are appearing in neighborhoods. These are single-family residences very similar to the houses surrounding them. Each home houses up to 6 older adults in a “family-living” setting. Residents receive some daily care based on their needs and meals from the home’s administrator but otherwise live on their own.
- House sharing is the new “Golden Girls” movement. To stay at home, older adults ask friends (or others) to move into their home to share expenses and the daily upkeep of the home. Or, they might rent out a room to a college student in return for help around the house. Either scenario would keep your loved one home longer, as long as they didn’t need medical support.
- The Village Movement is also taking hold. An excellent example in Colorado is A Little Help (www.alittlehelp.org). This volunteer model may include help with daily living activities such as grocery shopping, pet walking, and housecleaning.. Each member pays a membership fee which may be based on a variety of different inputs. A Little Help, for example, has a very simple pay what you can model.
- Co-housing is a cluster of single-family homes located around shared outdoor and indoor space. These clusters are intentionally kept small so that there is a sense of closeness and community. Every resident has a say in how the community is maintained. Similar to IL communities, only people over 55 are permitted to live in senior co-housing communities. These communities are great for active adults because they are similar to retirement communities in that they do not offer services for daily activities or medical care.
- Multi-generational housing is not a new concept. For generations, families have come together to take care of each other. These days this concept can take the form of in-laws suites, garage apartments, or tiny homes in the backyard for your older loved one, while kids and grandkids live in the main house. This option may involve bringing in personal home care or medical home care for the older adult.
Should your loved one move or stay at home as they age? It is a big decision, and there is a multitude of options. Aging is a vital stage of life that should be enjoyable for your loved one. When looking at senior housing, it is imperative to consider not only the present but also the future.
The Basics of Senior Living
|Feature||Independent Living||Assisted Living||Memory Care||Skilled Nursing||Skilled Home Health Care||Personal Home Care|
|Rent or Buy?||Both||Rent||Rent||Rent||N/A||N/A|
|Assistance with Daily Personal Needs (dressing, eating, mobility)||No||Yes||Yes||Yes||Some||Yes|
|Feature||Adult Home Care||House sharing||Village Movement||Co-Housing||Multi-Generational Living|
|Rent or Buy?||Rent||N/A||N/A||Rent or Buy||N/A|
|Assistance with Daily Personal Needs (dressing, eating, mobility)||Some||Maybe||Maybe||No||Some|