Senior Living Options
by Tracy E. Hill, Ph.D.
COVID-19 has changed the world forever. One of the things changed is the way we approach housing options for our loved ones. By now we know that several prominent politicians, WHO and CDC officials have opted for in-home care for their family members rather than community living care. But what is the best option for your family member? We’ll try and break it down for you.
Several factors often precipitate the need for a move. As we get older, those issues may be related to the desire for a lifestyle change (i.e., less home maintenance, downsizing, etc.) or a serious medical condition (i.e., dementia, need for skilled nursing care, etc.). One thing we know for sure—waiting until you really need the new housing is not the way to go.
My mother has dementia. I diagnosed her with mild cognitive impairment back in 2015. At the time, my siblings did not see what I saw, and they didn’t want to hear about it either. Fast forward five years later, mom’s MCI is now dementia and she lost her driving license over a year ago. My brother recently called a sibling meeting to let us know that we should start looking into community housing for Mom. Wait! What?
For the past 18 months, I have ensured that my mother had daily aides come into the home to a) keep her company, b) take her grocery shopping, c) check her blood pressure, d) make sure she takes her twice daily medications, e) do light housekeeping, and f) ensure that there are eyes on her each day. Granted, I also have Arlo cameras in her home, but the cameras cannot do a – e. Why the sudden rush to community housing I asked my brother. He explained that Mom could be on a waiting list for over two years. Although I doubt with the latest pandemic, that would be the case; I was startled and woefully unprepared for this concept. Yet, putting my “psych hat” on as my friends and children would tell me, I realized that my brother was right. It is time to think towards the future.
So, what are the options?
Level 1: Clearly keeping mom at home is her first option. After mom broke her ankle in three places and was released from the hospital, staying home was her priority. I agreed. She loves her house, artwork, neighbors, and friends. So, I had a medical professional come to the house to check it for any potential hazards—rugs that can be tripped over, bathrooms that need shower or toilet bars, etc. and then we made the necessary adjustments. Although my mother moved from her single-family two story home three years ago (at age 80), she still owns and lives in her own one story single family 55+ community home now.
As my mother’s dementia got worse and her ankle got better, I added Arlo cameras (indoor and outdoor) and an aide to come to the house daily for four hours a day. Although mom balked at this, adamantly telling us she did not need any help; privately you could see she enjoyed the company. It was a luxury she could afford. And her insurance paid for it. I still visit mom at least two to three times a week to do her weekly medication management, visit with her and to enjoy her company. The best part of mom in her own home from my perspective? She knows her surroundings, has her friends all around her, can enjoy outings and social events and truly feels most comfortable in her own home. I don’t have to “sign in” to visit with mom, I’m not assaulted by the smells of hospital or other care facilities and the aides are more constant. I know each aide by name and text them frequently if something is amiss and I need them to attend to something specific. Costs are an hourly rate based on the care your loved one needs. The more care (i.e., unskilled care vs. skilled care – nursing, etc.) the more expensive the hourly rate.
Level 2: Independent Living. This concept is for individuals (or couples) who may need more assistance with activities of daily living and do not want to remain at home any longer. My in-laws opted for this after my sister-in-law simply could not handle living with them any longer (due to her parents increased medical needs and her own emotional well-being) and needed help with their daily living (i.e., medication management, shopping, etc.). Of course, they could have opted for Option 1 with aides; however, my mother-in-law required more medical assistance so Option 1 wasn’t an option any more.
Independent living includes senior apartments and other living arrangements whereby there is typically a recreational or social gathering area, and the housing is more adult-friendly. My in-laws moved together into an independent living apartment where the next level care (assisted living) was part of the complex making for an easier transition if needed. Typically, independent living facilities offer maintenance of community areas, more accessible living arrangements (i.e., one floor, elevators, etc.) and opportunities for socializing. Costs are relative to the purchase (or rental) price of the apartment or home.
Level 3: Assisted Living. Assisted living offers next level of care for individuals who need it. Like independent living, assisted living offers simplified living within community lifestyles. However, within this framework, nursing and skilled care is available 24 hours a day to residents. My father-in-law stepped up to this style of living as his wife entered nursing care (see Option 4). In this manner, they could stay within the same living complex even though he had his own independent apartment and she was in a hospital style room downstairs.
This option offers meal plans, social activities, and help with daily living activities as well as staff for various functions (i.e., social activities, nursing, medical, etc.). During the pandemic, this has made assisted living difficult for many as they are stuck in their rooms (or small apartments) without the ability to get out for meals, socialization or any other activity. My mother was directly exposed to COVID-19 by one of her caregivers. She quarantined for 14 days. But within that timeframe, she could still walk around her neighborhood staying many, many feet distance between neighbors while also wearing her mask and taking necessary precautions. I was able to visit her (although I did reduce my visits to limit both of our exposures) and although she was “isolated” and felt it, she certainly had more freedoms than my father-in-law still has today, nearly 3 months in as the infection rates at such facilities soared.
My father-in-law gets meals served to his room or he can choose (pre-COVID) to dine with other residents in the dining room. There are social activities for him to participate in and the facility offers bus service for shopping and other events on occasion. Additionally, the nursing staff checks his daily medication needs, monitors his health and has direct access to his medical chart, doctors and general knowledge of his well-being. What I don’t like is the fact that the facility smells regardless of the time or day, the unskilled and skilled care change daily and weekly and they are overworked and underpaid. I hate having to “sign in” each time and feeling like I’m visiting a hospital or jail rather than his apartment. Costs can be expensive; however much of it is paid for by Medicare or private health insurance.
Level 4: Nursing homes are the last stop before hospitalization, hospice or death. This represents the highest level of care for adults other than being in a hospital or hospice program. Nursing homes offer full time medical and skilled nursing care, OT, PT and the like. Similar to the issues I have with assisted living facilities, nursing homes are no better. My mother-in-law had her own private room and her five children took turns visiting. Yet, with such a small space it wasn’t feasible to have any semblance of family get-togethers. As a volunteer first responder, I have been in many nursing homes with my dog, Sigmund Freud. I’m definitely not a fan which may be why I was so taken back by my brother’s suggestion that mom needs to move to option 3. Nursing homes are the last stop. They represent a serious need for medical and daily living help and care. Costs depend on the facility but typically the theory is that if your loved one needs more than 40 hours of care per week, full time nursing home care may be the less expensive way to go.
You can see that I am not emotionally prepared for my mother to level up from her current situation. As long as she can afford to stay at home, I’ll continue to increase the hours for her aides until such time that she has to move. In the meantime, my brother wants us to start looking for a place for mom. Nose goes and since he is the oldest, good luck explaining this to mom!
I am not endorsing any of these companies but thought you may find some of these links and resources helpful:
- Help with cost calculations: https://www.payingforseniorcare.com/home-care-vs-assisted-living
- Key to Choice(PDF) – A guide to help you assess your lifestyle needs and evaluate the many housing and service options available to seniors. Includes samples of budgets and evaluations. (The East Metro Seniors Agenda for Independent Living Project)
- Steps to Choosing Long-Term Care(PDF) – Guidance for choosing from many types of senior care, starting with in-home services. Includes help determining the right kind of care, how your needs may change over time, your long-term care choices, paying for care, and assessing different facilities. (Medicare.gov)
- Information for Senior Citizens– A comprehensive look at senior housing from the U.S. government’s Department of Housing and Urban Development. Includes links to HUD-approved housing counselors and related government sites. (HUD)
- Housing Associate Directory– A list of not-for-profit senior housing associations across America. Although a reverse mortgage alert – it still offers each states website information.
- The Village: A Growing Option for Aging in Place(PDF) – Fact sheet about the benefits and challenges of the village model for aging in place. (AARP)
- https://eldercare.acl.gov/Public/Index.aspx – Connecting you to services for older adults and families.
- Aging Life Care Association– Provides information about the geriatric care manager field and a searchable database of care managers. (Aging Life Care Association)
- Low-Rent Apartment Search– Searchable database from The Department of Housing and Urban Development. (HUD)
I’d like to hear your story about how you made the decision with your loved one. Email me directly firstname.lastname@example.org to schedule a video chat and get on SSM!
Photo by Marisa Howenstine (CA) @marisahowenstine