Making the move to a senior living community is always a major life change. When a couple can move together, this decision and the transition itself become a little easier.
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 by herself, but moving him to an assisted living community and continuing to live in their home alone was out of the question. Both George and Mary would likely experience some depression if they were separated, and George’s confusion and dementia-related behaviors 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 living 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 where they could live together in the same apartment.
Senior Living Options for Couples
Many independent living communities, assisted living communities, skilled nursing facilities and memory care centers can accommodate senior couples who wish to live together, even if each spouse has different care needs.
“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, NHA, CHC, CHPC, compliance director at SnF Management Company.
Fortunately, couples can choose from various apartment layouts in different types of senior living communities, including studios, one-bedrooms, two-bedrooms and even suites. Most have the amenities of an upscale condo, such as 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 Geriatric Functional Assessment Is the First Step
To ensure both spouses receive the care they require in their new home, their individual needs and abilities must be evaluated. Typically, an assessment for prospective residents will inventory and rank a person’s behaviors, chronic illnesses, communication abilities, dietary requirements, ability to perform activities of daily living (ADLs), ability to manage medications, need for assistive devices and much more.
This assessment can be conducted by a physician, a social worker, a geriatric care manager (also known as an Aging Life Care Professional), or a nurse at 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 unless they also hire in-home care services. 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 spouse 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 then every six months moving forward.
The Cost of Senior Living for Couples
Senior living costs for couples differ greatly depending on the type of care setting they need and the level 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 greater due to Alzheimer’s disease and limited mobility. He requires help with medication management, bathing and dressing, and careful supervision to prevent him from wandering. On the other hand, Mary is entirely independent and still able to care for herself.
“The spouse who doesn’t need extra care usually only pays for room and board,” explains Maria Plaksin, admissions liaison for Consulate Health Care in Fort Myers, Florida. “The other spouse pays for the additional services they need.”
If the couple lives together, then they are only charged rent 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 clarifies.
The base cost of room and board in an assisted living community can be as low as $1,500 per month, however, the total price will increase depending on the location, the amenities selected and 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 $4,051 according to the Genworth 2019 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. As their needs increase, their tier level (and costs) would, too. Other common pricing models include all-inclusive and à la carte, which is also known as fee-for-service.
Planning for a Couple’s Future Care Needs
If the time comes when one spouse requires more care than a senior living facility can provide, then the couple has a few different options. 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—independent living through skilled nursing care—in one location.
George and Mary didn’t choose to buy into 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 secure 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 in this second scenario, Mary would still be able to visit her husband as often as she wants. They can participate in activities in the memory care unit together and dine together, but Mary could enjoy respite in her own apartment while George gets the high level of dementia care he needs.
Balancing Care Needs for Elderly 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 continue living 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,” Plaksin notes.
It can be challenging to find the right senior living facility for even one person let alone a couple. The goal is to minimize moves between care settings since these transitions can be costly and very hard on elders. For many senior couples, consulting a geriatric care manager is helpful. These professionals are skilled in assessing seniors’ current and future needs, coordinating care, and navigating local long-term care options. Visit the Aging Life Care Association website to find a professional near you who can assist with long-term care planning for couples.
Source: Genworth Cost of Care Survey 2019 (https://www.genworth.com/aging-and-you/finances/cost-of-care.html)