Choosing the right senior living facility and care for you or a loved one can be an overwhelming process. How do you decide what’s the best fit? And how do you determine the level of care that is needed and provided at care facilities? As care providers and environmental designers in the senior living and care professions we have an intuitive sense not only of the options available to seniors in our communities but also the myriad of services, payment options and social ramifications specific to each housing and care service type.
Unfortunately, when selecting where to live, many consumers of senior living care and housing are not familiar with the full spectrum of options available to them. Often these selections are made under the stress of immediate necessity for care either personally or for a family member. Care providers can help alleviate this stress through educational and public relations outreach that includes a consumer’s guide to choosing senior living options. As designers, we can assist in these campaigns by volunteering to share presentation platforms as well as utilizing informative graphics about the specific differences and services offered with each option. By giving future residents and family members the power to decide the best fit, we can see positive outcomes through more informed residents and family members, higher socially-engaged residents with less stress or fear and fewer vacancies at all levels of senior .
In the rest of this blog, we’ll break down the continuum of care and discuss a couple of main factors to consider when determining the best option for you or a loved one.
Lifestyle + Types of Communities
The first stop on this journey is to decide if a formal senior living community is right for you. There are, of course, numerous options outside of a dedicated senior campus, including remaining in your current home. However, home maintenance may be burdensome or costly and any necessary health care requires arrangement of travel to that care and then often to a pharmacy. With home maintenance services and telemedicine this may become a bit easier but should often be reevaluated as needs and additional challenges may arise. If you decide to consider a formal senior living community, the following outlines what is available to you and the costs associated with each option.
Living in co-housing, condominiums, cooperative apartments, or rental apartments eliminates the need for property maintenance with the responsibility falling on the apartment owners or homeowner’s association. However, these options also do not offer on-site health care, which may be a necessary service for you or your loved one. Some apartments, co-housing and condominiums become “naturally occurring retirement communities” (NORCS) with most residents having reached retirement age. Some have loosely organized into systems of light care provided by neighbors or at least have a social structure that provides neighborly look-ins to assure each resident does not require more acute care.
If you are still able to live on your own but are interested in a more formal senior living community, independent congregate living is another option to consider. These communities are typically managed by a company that specifically caters to the needs and lifestyle tastes of seniors. There are often age restrictions in place, which helps to build a stronger social network and interactions within the community. These communities can take shape as clusters of cottages or villas and apartments. The locales of independent living can vary greatly and offer many opportunities of choice. Urban settings offer an abundance of city life amenities right outside your doorstep while University-affiliated communities may be located near the heart of campus offering many collegiate activities from frequent theater and musical performances to weekly sporting events. The University-affiliated communities also offer lifelong learning options to audit courses and study new topics.
Deciding whether you or a loved one needs daily assistance is a personal decision. If you are unsure, consult your doctor to understand the signs, often subtle, that you or your loved one needs assistance. Assisted living communities are designed and operated to provide care for the activities of daily living while balancing resident independence and dignity. Most offer varying levels of assistance depending on resident needs. As with independent living communities there are a wide variety of locations to choose from to align with your lifestyle. Memory support assisted living offers a variation on assisted living that focuses on dementia and Alzheimer’s. These accommodations offer a higher level of care and support while maintaining a more home-like atmosphere.
When you or your loved one requires around the clock assistance and care, skilled nursing is the best option to fill that need. Sometimes connected within a larger community that offers a variety of care types, skilled nursing provides medical assistance on both a short- and long-term basis. Skilled nursing buildings organized in small households provide a great balance between medical services and a more home-like environment. When the need for assistance is short-term such as after an injury or surgery, skilled nursing facilities are a good fit to provide the necessary rehabilitation to return home. As resident needs increase over time, skilled nursing can also offer the long-term solution to provide the care and socialization that is truly needed.
Of course, costs of care and housing enter any equation when considering a move to a senior living campus. As the care level increases, the costs also rise due to an increase in staffing and operational costs, but the increased care level provides the needed benefit of additional care for the resident.
- Age-restricted independent living costs are not dissimilar to market rate apartments with, perhaps, some added costs to cover additional amenities provided. Generally, age-restricted senior housing is a month-to-month rental agreement sometimes with a commitment to a minimum number of months.
- Cooperative housing requires purchase of a share of the cooperative equal to the percentage of the total building. The resident has a voice in the operation of the cooperative and therefore realizes an asset in the ownership. However, when a sale of the unit is necessary, the cooperative by-laws often require approval of the co-op board of directors.
- Independent living apartments or townhomes on a life-plan community campus generally require an entry fee. This fee can often be substantial, but depending on the contract, a portion of the fee can be refunded once the unit is vacated. Entry fee contracts can vary widely and can offer options based on the amount of the entry fee coupled with the percentage of refund at time of being vacated. It’s important to note, that not included in the entry fees are monthly maintenance fees. Again, depending on the contract, these fees cover building and grounds maintenance and, perhaps, housekeeping services and a meal plan. Often the entry fee contracts will also provide preference for assisted or skilled nursing care for the resident and the entry fee can be utilized for payment for those care services.
- Assisted and skilled care are the costliest forms of housing and services available to the elderly as they include on-staff nursing, full housekeeping, and meals for the residents.
- Fees for assisted living can be either calculated on a daily or monthly basis. Depending on the provider, these fees may include a certain number of assistances with the resident’s activities of daily living or these assistances may be charged to the resident on a “per use” basis. The US national average cost of assisted living is currently about $4,300 per month.
- Skilled nursing is inclusive of health care services as well as full assistance with activities of daily living. The average US national cost for skilled nursing is currently about $8,800 per month for a single occupancy room.
Moving Forward in Your Decision
Now that you’re equipped to consider all the options available and their associated costs, how do you decide? There are many online platforms which provide reviews and ratings for senior living communities. Medicare.gov also provides ratings for communities defined as nursing homes. These ratings include reviews on the overall community, health inspections, staffing as well as quality of resident care. This may help you narrow your search, however one of the best ways to understand the life and culture of a community is to visit and tour a community. Ask if the community has any activities that are open to the public. Many communities have public outreach programs and would welcome the opportunity to showcase their activities and amenities. This would also give you a chance to meet some of the current residents and hear directly from them. If you plan to leave the community regularly for entertainment and activities, take some time to explore the neighborhood at various times of day, just as you may have done when buying a house or renting an apartment.
Deciding where to spend the next years of your life is a significant decision. Just as important as the level of care and cost is to determine the right fit, so is the feel of the neighborhood and sense of community within the care facility. Have you recently helped a friend or family member choose a senior living community? What were the important factors for you?
Dan Schindhelm, AIA