George is a 74-year-old who suffers from Alzheimer's disease, chronic arthritis and diabetes. His wife, Mary, 72, is 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 couldn't find his way back. Police had to be called several times. He also had a habit of turning on the stove and forgetting about it.

Eventually, it became apparent that Mary could no longer care for George at home. But moving to assisted living and leaving his wife of 43 years behind was out of the question. The family was beside themselves at how to get dad the care he needed, without tearing their parents apart.

Then they heard about an assisted living and skilled nursing residence in the area where couples could live together in the same apartment. Although the family didn't realize it, the concept of couples living together in senior communities is quite common. Assisted living facilities, skilled nursing and memory care residences offer options for couple to live in the same residence, while each receives the care they need, and pays for only the services they need.

What Kinds of Homes are Available for Couples?

Couples can choose senior housing ranging from studios, one-bedroom, two-bedrooms and even suites in many retirement communities. They have the amenities of an upscale condo: lake and garden views, a choice of floor-plans, fully loaded kitchens, private bathrooms, walk-in closets, hand-held showers, and are fully wheelchair accessible. Couples can choose the size of home and level of care that's right for them.

Making the move to a senior 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 for Emeritus at Northridge, California.

Needs Assessment

To ensure both individuals receive the care they need, the senior community should conduct an assessment prior to every new resident's move-in. That determines the level of care each person requires. Kirby says another follow-up assessment should be conducted 30 days after move-in and every six months moving forward.

Costs for Couples

What happens when one person needs more care than the other -- for example, George with his Alzheimer's disease and mobility problems? He needs help with medication management, bathing and dressing and must be monitored for wandering, but his wife is independent and able to care for herself.

"The spouse who doesn't need extra care 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 level of care they need."

The couple is charged for only one room, with an additional fee for the second person. One spouse can receive the highest level of care, while the healthier spouse receives less, and each pays only for the care they need.

"In the case of couples, the key is to care for the frailest of the frail. The couple can live together, and only the spouse who needs more care pays for that higher level of care," Kirby explains.

The cost of room and board in assisted living can be as little as $1,500 per month; however, that price will be higher depending on the level of care that each resident needs. The median rate for a private one-bedroom apartment in an assisted living residence is $2,575 per month according to the Assisted Living Federation of America.

Some senior communities use a tiered pricing model with bundled services. For instance, a resident needing very little assistance would be at the lowest tier. Other pricing models include all-inclusive, a la carte, or fee-for-service basis.

Planning for the Future

If the time comes when the husband requires more care than the assisted living facility can provide, then the couple can move to another wing of the same community. For example, George and Mary would move to the skilled nursing, or memory care wing, on the same campus as his assisted living home.

Or if they choose, Mary could remain in assisted living, while George moves down the hall to memory care. Mary has the security code for the memory care unit and can visit as often as she wants. They still spend a significant portion of their days together.

A Balancing Act 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. "The best thing you can do is work with them and the rest of the family to develop a good compromise and then help them find a facility which best matches their criteria," says Plaksin.