As you and your loved ones age, you might wonder what are the available options for housing for seniors, and what is the right fit? The good news is that there are several broad options for senior housing and within each option is a spectrum of smaller options to best meet your needs. We will break each housing option down here.
Aging in Place
Aging in place is a broad concept where seniors are able to continue living where they are with some modifications. While seniors can age in any place, this typically means the house that they have lived in for decades. The modifications can be physical modifications to the home to make sure that safety is a top priority, including, but not limited, to grab bars, ramps, safety buttons or pull cords, and any other physical aids that may be needed (walkers, assists, lifts, etc.). Medicare may pay for some of those aids such as walkers, wheelchairs, a hospital bed, etc. Aging in place can also mean having your village in place. A village can be friends, family, volunteers, or organizations. The goal being that help is available. Help can include meals, transportation to appointments, grocery shopping, housekeeping, assistance bathing, and so on. Eventually, your village may be private employees such as home health aides, or if you qualify, In-Home Support Services through Medi-Cal (California’s version of Medicaid). Although we typically see seniors want to stay in their homes, it is not always about the particular house. It may be about staying independent. In those cases, aging in place may mean downsizing to a smaller home that is more manageable, or to an apartment or condominium. It can also mean moving into a senior community or even an independent living community.
Independent living facilities are a good option for active seniors who want to join a senior community, but still want privacy and security in the event of an emergency, but do not require active assistance. The staff at an independent living community takes care of the common areas and grounds, and may offer housekeeping, but they will not be assisting residents with medication or any activities of daily living (ADLs, which include bathing, toileting, preparing meals, medication management, getting dressed, and mobility/ambulating). They may offer meals and dining and will often provide activities and entertainment for their residents as well as a shuttle for transportation to shopping or appointments. Independent living also provides a variety of options for residences, from studio apartments to 2- or 3-bedroom apartments to stand-alone cottages. Residents are allowed pets and guests.
Assisted living facilities are a long-term residential care option for seniors. They often assist with activities of daily living such as laundry, housekeeping, all meals, and daily activities. Assisted living facilities usually charge a base rate for room and board depending on the type of room you choose and a basic level of assistance. Any other assistance over that basic level of care will either result in an increased rate, or a la carte charges for assistance depending on how the facilities are structured. However, assisted living facilities will not be able to provide 24-hour care and medical support. Medi-Cal and Medicare do not pay for assisted living, but some long-term care insurance policies may pay a portion of the assisted living costs.
Memory care facilities are similar to assisted living facilities, but the staff have been specifically trained to care for residents with Alzheimer’s and dementia. In addition, memory care centers are often very secure so that residents cannot wander away from the facility. Some facilities also offer therapy for seniors with cognitive decline. Because memory care is considered a variety of assisted living, Medi-Cal and Medicare do not pay for memory care, but some long-term care insurance policies may pay a portion of the memory care costs.
Residential Care Home (Board & Care)
Residential care homes are typically converted residential homes with six or fewer beds for seniors, either with individual rooms or shared rooms, and there is staff present 24 hours a day. The staff may or may not be medically trained, but they are trained in lifting and assisting residents with all activities of daily living. All meals are usually included, and the cost of board and care is generally a flat rate, regardless of the amount of care needed. Board and care facilities do not have the activities and entertainment of the assisted living or independent living communities, but they have a very small ratio of staff to residents, which usually results in an increased level of care. Medi-Cal and Medicare do not pay for board and care, but some long-term care insurance policies may pay a portion of the board and care costs.
Skilled Nursing Facility (Nursing Home)
A skilled nursing facility, or nursing home, provides 24-hour medical care to seniors, or disabled individuals who require around-the-clock medical care but do not require hospitalization. Skilled nursing facilities may be either for short-term care such as rehabilitation after hospitalization or may offer long-term care for those with a wide variety of medical diagnoses or those who need assistance with their activities of daily living. If someone needs rehab temporarily after a hospitalization, Medicare will typically pay for the skilled nursing facility; however, Medicare will not pay for long-term care. Skilled nursing facilities are typically either private pay or Medi-Cal, and some long-term care insurance policies may pay for part of the cost. To qualify for Medi-Cal to pay for a skilled nursing facility, the patient must qualify financially as well as medically, meaning they must have a medical need for skilled nursing, as prescribed by a physician.
There are many different options for senior living, and we just laid out the major brush strokes. Reach out to your estate planning attorney and request a referral to a care placement coordinator who can assess your options for care and help make recommendations for facilities or necessary care in your area.