George is a 74-year-old with moderate Alzheimer’s disease, chronic arthritis and diabetes. His wife, Mary, is 72 and in relatively good shape, with no major health conditions. As his Alzheimer’s progressed, George began wandering away from home in the middle of the night and getting lost. The police were called several times to help find him and bring him home safely. He also developed a habit of turning on the stove to cook and then forgetting about it.
Eventually, it became apparent that Mary could no longer care for George at home, but moving to an assisted living community and leaving his wife of 43 years to live in their home alone was out of the question. Both George and Mary would likely experience some depression due to this separation, and George’s confusion and dementia-related behavioral issues could possibly worsen without Mary by his side. Their adult children struggled to devise a way to get George the care he needed, without tearing their parents apart.
Many families face this problem and are unaware that most senior communities can accommodate couples who wish to live together. Independent living communities, assisted living facilities, nursing homes and memory care units typically offer options for couples to live in the same residence, while each receives and pays for the care they need. Fortunately, Mary and George’s family did their research and found them a combined assisted living and memory care residence in the area where they could live together in the same apartment.
Senior Living Options for Couples
Making the move to a senior living community is always a major life change, but when a couple can make that move together, the decision becomes a little easier. “In many cases, particularly when a couple has been married for many years, the ability to live together can make or break their decision on whether or not to move to an assisted living facility,” says Marissa Kirby, Executive Director at Brookdale Northridge in California.
Fortunately, couples can choose from various apartment layouts in different types of senior housing, including studios, one-bedrooms, two-bedrooms and even suites. Most have the amenities of an upscale condo: lake and garden views, fully loaded kitchens or kitchenettes, private bathrooms, hand-held showers and full wheelchair accessibility. Couples can choose the apartment size, features and levels of care that are right for them.
A Functional Assessment Is the First Step
To ensure both spouses receive the care they require in their new home, their individual needs should be evaluated. This can be done by a physician, social worker, geriatric care manager or the senior living community the couple is considering moving into. Having a general idea of these needs will make it easier for the couple to rule out certain types of long-term care facilities right off the bat. For example, if both spouses need some assistance with activities of daily living (ADLs), then an independent living community would not be a good fit. A good rule of thumb is that the spouse who needs the highest level of care will typically dictate which type of senior living facility will be able to accommodate the couple.
Once the couple has decided on a community that can meet their general needs, a staff member should conduct a thorough assessment of each of them prior to move-in. This evaluation determines the level of care each spouse requires, the corresponding services they’ll need and the costs of such care. Kirby says another follow-up assessment should be conducted 30 days after move-in and typically every six months moving forward.
Senior Housing Costs for Couples
Senior living costs for couples can differ greatly depending on the type of care setting they need and the levels of assistance each spouse requires. Cost estimates can be especially tricky when one spouse requires more care than the other. For example, George’s needs are much higher due to his Alzheimer’s disease and limited mobility. He needs help with medication management, bathing and dressing, and careful supervision to prevent him from wandering. On the other hand, Mary is entirely independent and able to care for herself.
“The spouse who doesn’t need extra care usually only pays for room and board,” explains Maria Plaksin, Director of Community Relations for Calusa Harbor Senior Living in Fort Myers, Florida. “The other spouse pays for the additional services they need.”
If the couple lives together, then they are only charged for one unit, often with an additional fee for the second occupant. Each spouse can receive the care they require, so long as the facility is able to meet their needs. In some cases, spouses may wish to have their own separate rooms or even adjoining units. The possibilities vary at each community.
“In the case of couples, the key is to care for the frailest of the two. The couple can live together, and only the spouse who needs more care pays for that higher level of service,” Kirby explains.
The base cost of room and board in an assisted living community can be as low as $1,500 per month, however, that price will increase depending on the additional services each spouse needs. The median monthly cost in the U.S. for a private one-bedroom apartment in an assisted living residence is $3,750 according to the Genworth 2017 Cost of Care Survey.
Some senior communities use a tiered pricing model with bundled services. For instance, a resident needing very little assistance would be classified in the lowest tier and as their needs increase, their tier level would, too. Other common pricing models include all-inclusive and à la carte, also known as fee-for-services.
Planning for Future Care Needs
If the time comes when one spouse requires more care than a senior housing facility can provide, then there are a few different options, depending on the facility’s capabilities. Some residential communities offer multiple levels of care in the same large building or on the same campus. Continuing care retirement communities (CCRCs) are popular for this reason because they offer the full spectrum of elder care in one location.
George and Mary didn’t choose a CCRC, but they did opt to move into a combined assisted living and memory care facility. Once George’s needs exceed what the assisted living staff can accommodate, he and Mary can both move to an apartment in the memory care wing on the same property. Or, if they choose, Mary could remain in the assisted living area, while George moves to the memory care unit. This distance usually amounts to a quick walk down a hallway, an elevator ride to a different floor or a short stroll to a neighboring building. Although they would technically be living separately, Mary would still be able to visit her husband as often as she wants. They would be able to participate in activities in the memory care unit together and dine together, but Mary would still be able to enjoy respite in her own apartment while George gets the high level of care he needs.
Balancing Care Needs for Couples
Finding appropriate care for a couple with differing needs is largely a balancing act. It often comes down to a prioritization of wants and needs between the two individuals. Concessions are inevitable when dealing with two people at very different places in their lives who want to stay together. Unfortunately, negotiation can be especially difficult when one spouse is experiencing cognitive decline. “The best thing you can do is work together as a family to reach a good compromise and find a facility that best matches their criteria,” says Plaksin.