Downsizing seniors have more housing options today than ever before. Here’s a quick guide to understanding industry terminology and the differences between the numerous senior living options available.
Continuing Care Retirement Communities (CCRCs)
Continuing Care means forever, but at additional expense as you need more care, and not necessarily on the same premises. The terms “pay-as-you-go” and “a la carte” are definitions used for programs at Continuing Care Communities. There is usually an initial entrance fee, and then the additional care you receive is priced as it is provided. A prorated portion of the entrance fee is usually refunded depending on the length of time a person resides in the community.
Continuum of Care Communities
A Continuum of Care community provides various levels of care under one roof on a lease basis in combination with a monthly fee for the level of care needed. Typical living arrangements include Independent Living, Assisted Living and Memory Care in an apartment type setting within the same community. Unlike a CCRC, there is no entrance fee. However, because this a lease arrangement, forever is not necessarily guaranteed in the same way as care needs change. Skilled nursing is typically not part of a Continuum of Care community as is generally the case with a CCRC.
Lifecare means care forever on the same premises (excluding acute care) with no increase, except for the yearly inflation increases. Lifecare is a form of Continuing Care, but it takes it one step further. It is usually referred to as the “extensive care plan.”
Many people think of Lifecare as a form of long-term care insurance. You may pay a higher entrance fee than in a Continuing Care community, but the financial security of knowing that once you are in you won’t have an increase in your medical costs as long as you live can be reassuring. A person must be able to live independently upon moving in and must pass a physical exam given by a professional at the community.
There are refundable entrance fee packages available, but the entrance fee is usually more and is prorated according to the time a person resides in the community. Some Lifecare communities also offer a “continuing care” contract option for those who would rather pay as they go.
Assisted Living Communities
Assisted living communities are appropriate for individuals who are unable to function in an independent environment, but who don’t require the level of supervision and care provided in a skilled nursing community. Most residents need some assistance with Activities of Daily Living (ADLs), such as bathing, dressing, grooming, housekeeping, and medication monitoring. The staff oversees these things as well as offers social activities and outings for shopping or doctor appointments. Residents are free to come and go as they please and have access to in-house amenities, such as salons and whirlpool tubs.
These types of communities are private pay and vary in price. They are rented on a month-to-month basis, although some may require a lease. Apartments are small and sometimes include a kitchenette with a microwave and small refrigerator.Meals are provided in a common dining area, usually three times daily.
Independent Retirement Communities
Independent retirement communities are not licensed and offer a variety services. They usually have a minimum age requirement and rent from month to month. The key here is that they are “independent” retirement communities, meaning they DO NOT provide medical care. Most will arrange for independent home health services to come in if needed temporarily; however, when a person is required to have ongoing medical care, they will no longer be eligible to live in the community.
Independent Retirement Communities typically offer full kitchens, some meals in a common dining room, housekeeping, paid utilities (except telephone and cable), laundry facilities, 24-hour staffing, and private areas for tenant use. Since these communities are not licensed, they can charge whatever the market will bear and are not subject to uniform regulations like licensed communities. Some are affiliated with churches, schools, and other community programs.
Skilled Nursing Communities
Skilled nursing communities are known historically as “rest homes” or “nursing homes.” Residents at these communities are typically unable to live independently and need more medical assistance than assisted living communities will provide.
Skilled communities offer 24-hour nursing care, assistance with bathing, feeding, grooming, physical therapy, occupational therapy, and other medically necessary services. A nursing care community can be a temporary arrangement while someone is recovering from surgery or a stroke, or it can be permanent if a person is going to need ongoing medical care and/or supervision. Levels of care in nursing communities can vary from unit to unit within the same community, some offering more or less services than others. There are no age requirements for living in nursing communities; therefore, persons of any age with chronic illnesses or injuries may also reside there.
Many skilled nursing communities have added a section designed specifically for dementia patients and their special needs. Some Lifecare and Continuing Care Communities have also added special Alzheimer’s care. These areas are typically secured and require a code for access in and out for the safety of those residents who have a tendency to wander. All specialized units are different, so it is important to ask questions and tour the entire community to get a feel for the overall care provided and services offered.
Planned Adult Communities
Planned Adult Communities are characterized by clusters of apartments and condominiums or single-family homes built around a core of services and amenities. Residents can own their own property and must abide by the covenants, codes, and restrictions administered by a governing body which deals with the policies of the community facilities, property requirements, charges and assessments, and provisions of the association of homeowners. In some parts of the country, these types of communities are promoted as recreational and are located on golf courses and lakes.
Condos, Townhomes, and Duplexes
If a person would prefer to live in a multi-generational environment and not in an exclusively senior community, but needs maintenance-free living, there is the option of a condominium, townhouse, or duplex. Downsizing from a large home with a large yard to a duplex with a small yard may prove to be a helpful transition for a person who is still able to care for a household, but who may not have the stamina or desire to care for a large home and/or acreage.
With some private housekeeping assistance and lawn care provided, many empty nesters find that this transition is less stressful than an immediate move to a retirement community. It is not considered specifically a “senior” community option, but one that certainly should be considered if a person is in good physical and mental health.
Subsidized and Low Income Housing
There are a variety of senior complexes throughout the country which offer subsidized rent. Most of them are multi-level apartments, and while they do not include the lavish décor of the Lifecare and Continuing Care communities, they are typically well-maintained and affordable. Some are subsidized through HUD, while others are operated by non-profit organizations and property management companies. There are often waiting lists to get in, and once you are called with an available opening, you must make a decision quickly. If you do not accept it in a timely manner, your name will go back to the bottom of the list.
Specific advice when touring long-term care facilities
- Visit the facility on different days and at various times, including mealtimes, taking note of nursing staff levels.
- Talk to members of the nursing staff about how long they have worked there.
- Ask the nursing community administrators about staff-to-resident levels.
- Get a copy of the most recent state survey of the facility to learn if it has been cited for deficiencies.
- Ask if the facility has a plan of care for each resident and if it is revised continually.
- Contact the local ombudsman organization and ask them about specific long-term care facilities in the area.