Guide to Senior Housing Options

Senior housing is a hot topic, in part because older Baby Boomers are driving demand for more and better options. Even if you plan to stay in our own home, it’s a good idea to know what’s available in case your situation changes. First we’ll cover resources for living safely and comfortably at home. Then we’ll look at options for residential senior living.

Aging in place: The preferred choice for most seniors

Most US seniors want to live at home. A 2014 AARP survey found that 87% of adults age 65 and older want to age in place. A familiar setting is often the best option, and there’s a growing array of options for getting help at home.

Home safety adaptations are necessary for most seniors. Many home-care companies and fire departments offer home-safety checklists and, sometimes, in-person evaluations. These can identify fall hazards, the need for new smoke and carbon monoxide detectors, and proper lighting for safety. You may need to install grab bars, ramps, and other safety items.

Personal emergency response systems can be literal lifesavers. Look for systems with wearable call buttons that include automatic fall detection.

Family caregivers can make aging in place possible. Be aware that intensive caregiving often takes a toll on the caregiver’s health and finances, according to data from the Caregiver Action Network. For this reason, any family caregiving plan should include support from delivery services, hired caregivers for part-time and respite care, and community-based adult day programs.

Concierge services such as grocery delivery, house cleaning, and errands can help you avoid traffic and save time.

Home care providers should be on your resource list even if you don’t think you’ll need them. It’s inevitable that something will come up – an illness or bad weather, for example—that disrupts the normal routine and creates a gap in at-home care. It’s far less stressful to interview agencies now about short-notice care than it is to scramble for it at the last minute or to do without.

Live-in caregivers can be a boon if you want to live at home, need round-the-clock help or company, and don’t have family members who can provide that level of help. Trustworthiness and a good match of personalities are the key elements that make a live-in caregiving arrangement work.

Community programs at senior centers offer some variety, social opportunities, and a break for caregivers. In most communities you can find at least one weekday adult day program or drop-off respite care program that includes a hot meal, fitness and arts programming, and safe supervision.

Remember to check references and online reviews before you hire help. Ask about rates and payment methods, too. Some providers are certified by Medicaid or the VA. Others may charge sliding-scale rates based on your income.

Residential options for seniors

For some of us, there comes a time when living at home is too difficult or costly compared to the residential care alternatives. For others, turning over home maintenance tasks, meal preparation and housekeeping to someone else is appealing after years of those responsibilities. Either way, there are residential senior living options to suit most lifestyles and all levels of care.

Before you start visiting senior housing communities, consider how important it is to you to stay in the same community for as long as possible. Some, but not all, senior communities provide what’s called a “continuum of care.” That means that residents can move from one level of care to another (from assisted living to skilled nursing, for example) on the same campus without having to make a major relocation or leave familiar surroundings. This can be the best option if you have a progressive illness or want to minimize disruption if your health status changes.

Independent living

Also called senior apartments, retirement communities, active adult communities, age-restricted communities

Independent living communities can be suburban apartment complexes, city-center towers, or entire mini-villages of cottages and townhomes, all catering to residents of a certain age. These communities often provide opt-in meal plans, some landscaping and home maintenance, and an array of social, creative, and fitness options on-site and through group outings. Most such communities welcome residents’ pets, but may have size, breed or weight limits. These are typically private-pay communities because there are no or very few health and personal care services provided.

When looking at independent living communities, ask about parking for residents’ vehicles, group transportation options, meal plans, housekeeping services, and recreational opportunities.

Assisted living communities and private care homes

Also called personal care homes and private care homes

These communities are designed for residents who are mostly independent and in good health but need help with daily activities such as bathing, dressing, or getting around. The typical arrangement in a large assisted living facility is an apartment-style unit with a kitchenette or full kitchen and a patio or balcony. In a private care home, residents have their own bedrooms (and sometimes their own bathrooms) and share common areas in a converted single-family home with on-site caregivers. There’s usually a call button in each resident’s room.

In assisted living, you can expect daily meals and snacks, weekly housekeeping and linen laundry, regularly scheduled group transportation to local shops, home maintenance, medication management, personal care, and mobility help. Some communities also take care of residents’ personal laundry, and many allow small pets. Some offer furnished or partially furnished units while others are entirely unfurnished. Long-term care insurance, Medicaid, or the VA Aid & Attendance Pension may cover some assisted living costs.

When you visit assisted living communities, ask about activities, menu options, transportation schedules, laundry services, utilities, and personal care assistance. You may also want to ask if there are guest suites available to visiting friends and family.

Skilled nursing homes

Also called long-term care facilities, skilled nursing facilities, rehabilitation centers

Seniors who need daily care from a nurse or therapist, and those who have complicated or advanced health conditions, may fare best in a skilled nursing home. These homes are staffed by certified nurse assistants overseen by registered nurses, and there may be a physician on call. In addition to meals, housekeeping, and help with personal care and mobility, nursing homes provide ongoing management for residents’ chronic health problems such as diabetes or heart disease.

Not everyone who moves into a nursing home is there for the long term, though. Many people spend a few days or weeks in a nursing home for rehabilitative care after a hospital stay. During this time, their medication and daily healthcare needs are taken care of while they get physical therapy, speech therapy, or other treatments to help recover from a serious illness, fall, or stroke. For seniors in a continuum of care community, the move to rehab and back is often just a matter of moving across the campus or to another wing of the facility.

Like assisted living, Medicaid and the VA Aid & Attendance Pension may cover the costs. Long-term care policyholders are covered, although there may be payment limits. In some cases where very specific conditions are met, Medicare may pay for a short nursing-home stay after a hospitalization of 3 days or more.

When you visit nursing homes, you may be under time pressure to find a suitable place before a loved one is discharged from the hospital. Make as much time as you can to talk to the staff, taste the food, read the most recent inspection report, and see how the residents appear to be doing. You can also check with your state’s nursing-home inspection agency to see if the facilities you visit have good records.

Memory care

Also called dementia care, Alzheimer’s care

Memory care is a specialized form of skilled nursing care. People living with dementia need proper support to maintain their social ties, handle daily tasks, and remain safe. In addition to all the services and care that a nursing home provides, memory care communities have added security, such as digital code locks on exit doors and fully enclosed outdoor areas, to prevent residents from wandering. Social and craft activities tend to focus on memories and familiar faces, and maintaining a regular routine can help reduce resident confusion and stress. Medicaid, VA A&A benefits, and long-term care typically cover memory care.

When you look at memory care facilities, ask about their staffing (the ideal is consistent, familiar faces), social and memory activities, food and hydration protocols, and physical activities. It’s also a good idea to ask about the community’s pain-management and behavior-management policies. Some people with dementia become physically aggressive or reactive, sometimes due to untreated pain, and it’s important to find a community that will treat the cause of the behavior while also maintaining patient, resident, and staff safety.

Knowing your options—aging in place, independent living, assisted living, skilled nursing, and memory care—should make it easier to choose the best housing option for yourself or someone you love. Take all the time you can to do your research, check reviews and references, and ask questions before you make your decision.

Casey Kelly-Barton

Casey Kelly-Barton is an Austin-based freelance writer whose childhood was made awesome by her grandmothers, great-grandmother, great-aunts and -uncles, and their friends.