Living and Care Arrangements

In an ideal world we would all grow old in our own homes, supported by loved ones and die peacefully in bed. In reality, this is rarely the case. Abilities and needs change as one ages. Even for those who can afford full-time support, infirmities may dictate alternative living arrangements. What are the options, and which are most appropriate given one’s circumstances? For a general overview of Assisted Living and Long-term Care options, costs and insurance coverage, Medicare Plans Patient Resource Center is a good place to start. Below you will find additional information and helpful links.

Independent Living for Aging in Place - Most people’s first choice. One lives in one’s own home, be it a house, townhouse or apartment; owned or rented. However, one’s ability to live independently will depend on one’s health, whether one’s home accommodates evolving needs (e.g. ability to climb stairs), one’s support network and financial resources.

As one ages even simple things can become difficult to manage. We recently became aware of “adaptive clothing” for those who have difficulty dressing themselves. Silverts offers a wide range of adaptive clothing at reasonable cost. Sleeping can raise a host of issues and at some point an adjustable bed may be considered. These beds can be expensive, but Medicare or Medicaid can lower your cost, as detailed in Sleep Doctor’s article, How to Get Financial Assistance for Adjustable Beds.

We recently downsized and renovated an aging-in-place apartment. You can find out more and see what we incorporated by clicking here. Additional resources for those hoping to age in place, with or without downsizing include:

For those moving to a senior community aPlaceforMom provides helpful guidance in their article, Helping Seniors Move: Design and Downsizing Tips for Senior Living.

For those seeking guidance about in-home service alternatives, aPlaceforMom’s Home Health vs. Home Care: What’s the Difference? provides detailed information and referrals. Care.com also provides helpful information and assistance in finding in-home care options. Both make money through referrals so be sure to research options thoroughly before committing.

Home Care vs. Assisted Living - For someone needing daily care it can be hard to decide whether they might be better off in an assisted living facility. aPlaceforMom’s article, Assisted Living vs. Home Care: What’s the Difference provides useful guidance.

Continuing-Care Communities - Provide a private apartment or home and an array of personal services (e.g. housekeeping, dining, recreation). These communities also provide assisted living and skilled nursing care when and if needed as one’s abilities/health declines. The continuum-of-care provided by Continuing-Care Communities is wonderful for peace of mind, however the entry price and ongoing costs can be steep. Also, some may be put off by living only among other elderly.

Assisted Living vs. Nursing Homes - aPlaceforMom, a for profit assisted living facility referral service, provides useful resources for understanding and choosing among senior living options. Their article, Assisted Living vs. Nursing Home: What’s the Difference notes that years ago, “nursing home” tended to cover all forms of senior living. Such is not the case today. Here are the differences:

  • Assisted Living - Often designed with individual rooms or suites around shared common areas. A good option for those who are partially independent but needing some support for daily living (e.g. bathing, dressing and/or medication). APlaceforMom’s article 6 Steps for When Parents Need Assisted Living is a good place to start for those considering Assisted Living. It is worth noting that unlike in a Continuing-Care Community, many Assisted Living residents eventually transition to a Nursing Home.

  • Nursing Home - For those needing 24-hour nursing care. Quality can vary dramatically, and many nursing homes are quite depressing places. Be sure to research a facility thoroughly. Medicare.gov provides detailed information on every Medicare and Medicaid-certified nursing home in the U.S. Non-profit homes may provide better care than facilities looking to make money from patients.

Hospice - Hospice is not necessarily a place, it’s end-of-life care, wherever a patient may reside. To qualify for hospice a doctor must state that a patient has a terminal illness and is not expected to live for more than 6 months. Hospice takes a holistic approach involving doctors, nurses, care aides, social workers and spiritual support (if desired). Hospice is all about relief from pain and providing comfort for patients and family members. As with nursing homes, not-for-profit hospice care is preferable - a 2019 report from the U.S. Government Accountability Office found that hospices with the lowest quality scores are most likely to be for-profit. We recommend that those considering Hospice consult ProPublica’s How to Research Your Hospice. Hospice care is generally covered by Medicare for those eligible.

How does one choose? An individual’s physical or mental limitations and financial resources will often dictate the type of living arrangement. aPlaceforMom’s Costs of Elder Care: Assisted Living, Independent Living, and In-Home Care provides useful information on relative costs. Within any category, choices can be difficult. Google search will turn up a host of options including websites that promise ratings, reviews and prices for facilities in your area. Beware advisory sites. They will often require that you speak with a representative who is paid on commission and may be incentivized to channel you towards a more expensive option. As a general rule, not-for-profits are preferable to for-profit facilities. Do your homework, speak with current residents and families if possible, and read all the fine print.

Additional useful information on living options for Seniors can be found on the websites of AARP and DailyCaring.