Living Arrangements for Aging Seniors

March 25, 2014 - By the NCPC

Author: Thomas Day

Understanding the Various Living Arrangements

Senior housing options can be confusing to someone who has never approached the subject before. Often the definition of a particular senior housing term is dependent upon the person writing about the subject. The reason for the confusion is that most retirement care and senior housing arrangements provide overlapping services among the various categories. And depending on the state, a commonly accepted term for retirement living in one state might be licensed for somewhat different services in another. Or a state might use a different descriptive title for the same services under a commonly accepted title in another state.

Some writers put undue emphasis on certain arrangements such as continuing care retirement communities or independent-living, when only a small part of the over age 65 population is using such arrangements. By far, most people over age 65 are living in their own homes or rental homes and the great majority of Americans who are receiving eldercare are living in their own homes.

Living in Your Own or Others' Homes

Most adults would prefer to age in place—that is, remain in their home of choice as long as possible. In fact, 90 percent of adults over the age of 65 report that they would prefer to stay in their current residence as they age. One-third of American households are home to one or more residents 60 years of age or older.

Care in the home provided by a spouse or a child is the most common form of long term care in this country. About 73% of all long term care is provided in the home environment typically by caregivers who receive no compensation for their labor.

The supervision of care or hands-on care from informal caregivers is limited to activities that don't require a skilled background. Lifting , bathing, dressing, diapering, toileting and helping with walking can be a challenge to family caregivers because they don't have the proper tools or are not trained in this area. Or the children of elderly care recipients may have difficulty dealing with cleaning messy bottoms or bathing their parents. Another problem may be handling errant behavior from dementia or depression.

In large urban areas where neighboring families have lived together in an apartment complex and grown old together, there is a possibility for residents in the complex to band together and watch out for each other. This might also include limited caregiving services for neighbors. But it more likely would include helping neighbors with such things as light housekeeping, shopping, companionship, medication reminders and transportation.

Special Retirement Settings

Retirement communities are very popular with people 55 and older. Many of these communities are built in resort areas where climates are warmer. Community living arrangements typically include recreational amenities for the elderly. In contemplating a move, it may be wise to consider retirement communities that have the availability of care services, should the need arise in the future. Some retirement communities provide what might be called supportive care. This might be help in the form of prepared meals, housekeeping services, transportation, planned events, and reminder services.

Seniors only apartments allow seniors to rent in a community with people their own age. Senior renters may be individuals who have owned a home or have been renting all of their life but desire to move to a community that supports a senior lifestyle.

Living in Communities with Support for Eldercare

Independent living or congregate housing communities are residential communities for older adults who want an enjoyable lifestyle free of the worries and trouble of home maintenance. They are similar to apartment, condominium, or single-family developments except that they provide special services, including tight security—an important consideration for many residents. These communities may offer linen services, maid service, handyman help, transportation and even help in getting around the facility as long as it doesn't require a major commitment from the staff. Almost all independent living facilities offer a meal program which might include 2 or 3 meals a day, typically served in a common dining area.

Assisted living is exactly as it says – living in an apartment or facility where you receive assistance with daily personal needs. Residents remain independent while receiving assistance as needed with personal care, medications, transportation, housekeeping, meals, and other daily living needs. Assisted living facilities offer a less expensive and often more desirable arrangement to a nursing home. This type of housing is designed for those people who have some care needs, but don't have the physical, medical, or mental impairments that require a nursing home.

Assisted living definitions vary from state to state. Each state has its own licensing requirements and regulations for these types of facilities. Thus they may be titled something different from "assisted living" and offer varying degrees and types of services depending on state law. "Assisted living" is a catchall term used by the industry to describe this type of housing.

The structure of assisted living facilities can range from a dwelling that looks like a home in a residential area where the caregiver is the owner and single proprietor, to a large, apartment-style building staffed with many employees. The care style is different in these two types of properties.

The board-and-care type of assisted living in a residential area, with three to eight beds provides a homelike environment and closer association with the other residents. Each resident has his or her own room and bathroom. Living room and dining areas are commonly shared with other residents. With little support staff in these smaller-bed facilities, you need to be mobile enough to get yourself around, and some care services may be limited.

In contrast, large assisted living facilities may be staffed with 24 hour nursing care, have a help desk, provide an activities staff, provide counseling, provide a memory care wing, provide education classes, group activity, entertainment and handicraft programs and provide large private apartments. Arrangements are sometimes made for home health agencies, therapists, or visiting doctors for residents' needs. Transportation, excursions and field trips are also available.

No matter the size, assisted living facilities offer individual choices, independence, and the security of not being alone.

Continuing care retirement communities--sometimes called life care communities--have been around for over 30 years. These are typically exclusive upscale retirement complexes for people with a sizable down payment such as $200,000 and the ability to pay monthly fees of anywhere from $1,500-$3,000. They are almost exclusively built and maintained by nonprofit organizations -- principally religious denominations.

The original concept for CCRCs was to guarantee the residents a permanent retirement living arrangement where they would never have to move. If the need for care in one of these communities were to arise, the community would furnish, at no additional cost, home care, assisted living or nursing home care.

Almost all communities still offer the continuum of services all the way from independent living, to home care services, to assisted living or eventually to a nursing home. These care service wings or buildings are always located on the community campus.

Nursing Homes

Nursing homes provide a cost-effective way to enable patients with injuries; acute illnesses or postoperative care needs to recover in an environment outside a hospital. Nursing homes also serve chronically impaired individuals who are not expected to recover and who will typically die in the nursing home. About 91% of the 1,650,000 US nursing home residents are over the age of 65.

Nursing homes serve two kinds of residents. The first are those who have been discharged from the hospital for rehabilitative care. Medicare pays for a limited time for this kind of nursing home care.

Second are residents who may suffer from chronic physical or mental disorders or they may simply be feeble and unable to move about, bath themselves, or provide their own meals. Medicare does not pay for their type of care, but Medicaid typically will pay. These people are often referred to as "long term care" residents.

Veterans Nursing Homes are generally available to active duty veterans but some states have beds for people who served with the reserves or National Guard and the spouses of veterans. The majority of these homes offer nursing care but some may offer assisted living or domiciliary care. Generally there is no income or asset test. Most veterans in most states would qualify.