Alternatives to Assisted Living

There comes a time when some older adults begin to think about where to live if and when they need long-term care. For many, the thought of downsizing and moving into an assisted living facility (ALF) seems like a good plan.

Assisted living facility (ALF) offer apartment-style living, 24-hour supervision, meals, transportation, health services, and a variety of social and recreational activities. The communities also have a variety of housing options, from independent living for residents who need minimal assistance with daily living activities to specialized memory care units for residents with Alzheimer’s disease and other dementias.

For residents with chronic health conditions, assisted living facilities (ALF) have licensed health professionals, such as registered nurses, physical therapists, and speech therapists, to provide different levels of skilled nursing services.

The costs to live in an assisted living facility (ALF) vary, depending on the type of services and long-term care residents need. Medicare does not usually pay for assisted living, but Medicaid or Veterans Affairs benefits may pay for some personal care services. So, residents pay for assisted living by long-term care insurance or by their personal assets.

While assisted living facilities (ALF) may appeal to some older adults, others are considering alternatives to assisted living. And, one alternative that seems to be trending is staying at home with the help of live-in caregivers.

Getting Assistant Living Benefits at Home

Many older adults are reluctant to move from their home to live among strangers at an ALF. Yet, they would not mind having the same benefits offered by assisted living communities. Seniors who want to stay in their homes as they get older, commonly known as “aging in place,” are turning to live-in caregiving as an alternative to assisted living.

Family members are usually the first caregivers. However, some people do not have adult children or other relatives living nearby and rely on friends or paid housekeepers. Live-in caregivers are the best choice for adults who need help with housecleaning, grocery shopping, laundry, and other household chores. Seniors also don’t have to eat alone since live-in caregivers prepare nutritious meals and help seniors to eat if they have difficulty feeding themselves.

What’s more, seniors with live-in caregivers do not have to wait their turn for assistance, as seniors in ALF do when one caregiver must attend to multiple residents. More importantly, live-in caregivers are usually trained and certified home health aides or nursing providers. So, seniors can get help with medication monitoring and certain medical needs.

Seniors are not the only ones that benefit from having a live-in caregiver. Family members are also relieved to know that their loved ones are not living alone, but living with someone helping them to live independently in the comfort and security of their own home.

Residential Care: Almost, but Not Quite, Like Home

Residential care homes, also known as board-and-care homes, house seniors who cannot live alone, yet do not need around-the-clock nursing care. In some ways, a board-and-care home is a cross between living at home and at an ALF. For one, residential staff provides meals and housekeeping services, like an ALF. Some homes provide personal care and nursing care services. Unlike ALF units located on multi-acre campuses, board-and-care homes are located in residential neighborhoods. The homes usually have from two to 10 residents (maybe more depending on state regulations), instead of the hundreds of people that can live in an assisted living community.

However, there some disadvantages of residential care:

1. Recreational activities are limited within the home. Unlike a senior with an in-home caregiver who can provide transportation to where an older adult wants to go, transportation for seniors in residential homes is usually limited. So, seniors with outside interests and hobbies may not have transportation to get to places of interest on a regular basis.

2. Privacy may be a concern for seniors who share a room or share common spaces within the home.

3. The staff-to-client ratio may be higher than ALFs, but staff members and residents may not get along due to personality conflicts or other issues that come with living in tight quarters.

4. Medical staff are not readily available should an emergency occur in the home.

5. Residents may have to pay out-of-pocket costs since Medicare does not pay for room and board or personal care. A Medicare Advantage plan, Medicaid, or long-term care insurance may pay for personal care assistance and other supportive services. However, some homes may not accept payment from Medicaid but may accept payment from a Veteran’s Affairs benefit program.

Continuing Care Retirement Communities

Continuing Care Retirement Communities (CCRCs) offer seniors the opportunity to buy or rent apartments, condominiums, villas or houses and choose their level of care as they age in place. CCRCs appeal to baby boomers and seniors planning their long-term housing needs and future plans, according to CBRE’s report on the retirement communities.

CCRCs have several housing options for residents. For instance, active seniors who do not need help with daily living activities can live independently while older adults with health needs can move into assisted living sections where they can secure caregiving services. Skilled nursing care is available for seniors who need continual medical care, while some CCRCs have memory support care and other special care arrangements.

Potential residents should keep in mind that CCRCs have different types of contracts, with the most expensive being a life-care contract that provides unlimited assisted living and medical services. The modified contract offers limited services while a fee-for-service contract means residents pay for the type of service they want, such as assisted living or skilled nursing care.

In addition to the contracts, some CCRCs charge entrance fees that range from several hundred thousands of dollars up to $1 million. According to a 2018 CBRE report on senior housing and care, a CCRC’s upfront entry fees and monthly services fees are too expensive for more middle-class seniors. So, upper-middle-income seniors who can sell a home are more likely to be able to pay the entry fee.

While CCRCs provide a wide range of health care services, social and recreational activities, potential residents should conduct extensive research on CCRCs to determine the affordability of this type of retirement community.

Costs for board-and-care homes are not as readily available as those for ALFs, so potential residents should determine whether this type of housing is cost-effective and will meet their needs.

Continuing Care Retirement Communities

Skilled Nursing Homes

It’s possible that no matter where seniors live, at some point they may need daily skilled nursing care. Doctors typically order this type of care for their patients after a hospital stay. To receive nursing or therapy care from trained healthcare professionals require some older adults to move into a skilled nursing facility (SNF).

SNFs are not permanent places to live since the average stay in a nursing home is 835 days, according to the National Care Planning Council. Those who receive short-term rehabilitation care after being discharged from a hospital stay an average of 270 days in the nursing home, the report said.

Medicare Part A pays for skilled nursing care in a skilled nursing facility (SNF) for specific conditions on a short-term basis, if certain conditions are met. Residents may have to pay out of pocket if their doctor recommends services that Medicare does not cover or get services more often than Medicare covers.

Depending on the type of treatment needed, older adults with live-in caregivers who are trained and certified nursing providers may be able to receive skilled nursing services at home to avoid moving into a skilled nursing facility (SNF).

So, it all adds up to this, older adults have several alternatives to assisted living, including remaining home and aging in place. And, it’s never too late to start planning for the future and deciding on long-term

Source Links:
https://health.usnews.com/best-assisted-living/articles/does-long-term-care-insurance-cover-assisted-living
https://files.asprtracie.hhs.gov/documents/aspr-tracie-ta-long-term-care-statistics-6-27-17-508.pdf
http://cbre.vo.llnwd.net/grgservices/secure/U.S.%20Seniors%20Housing%20_%20Care%20CCRC%20Report%20-%20June%202018.pdf?e=1595355976&h=4c7abec9bf6935504d6ebe6a8773730d
https://www.kiplinger.com/article/retirement/t037-c000-s004-ccrcs-raise-financial-questions-for-retirees.html
https://www.medicare.gov/coverage/skilled-nursing-facility-snf-care
https://www.medicare.gov/Pubs/pdf/10153-Medicare-Skilled-Nursing-Facility-Care.pdf

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