When Home Care Isn’t Enough: Evaluating Senior Living Options


Unfortunately, wisdom isn't the only thing that aging brings. It also brings challenges that can sometimes make staying in a cherished home difficult, if not impossible. When a person faces these challenges, knowing where they need to live is not easy to decipher.

As a director for an agency whose mission it is to help seniors stay in their homes for as long as possible, I know that sometimes, despite valiant efforts, the decision to move a person into a setting that is better equipped to meet their needs has to be made.

On many occasions it is not the senior, but rather a family member, who is making the decision to move a senior from the home where they have created so many memories. This is certainly not an easy decision for the caregiver, particularly when they have made a promise to “never put them in a home.”

The decision for a person to move out of their home and into another setting will never be an easy one, but it can be made less difficult.

Planning Is Crucial

As with many things in life, things usually go much smoother when you plan and do your research. Plan, plan, plan—it can't be said enough. Although we may joke about getting older, very few of us actually plan on it happening.

Advancing age is similar to a hurricane. I live in Florida, where we experience these devastating storms. It is remarkable how many people fail to prepare for these events. The main distinction between hurricanes and aging, though, is that the latter affects everyone. Planning ahead ensures you’ll be better prepared to face some inevitable decisions.

Understand Your Options

One of the greatest fears expressed by the elderly is placement in a nursing home facility. It is not uncommon to hear, “I don't want to end up in a nursing home” or “promise me you won't put me in a nursing home.” People tend to believe that nursing homes are the only option for seniors when they can no longer safely remain in their own residences. The reality could not be further from the truth.

Senior living options grow and evolve every year. The first part of planning for an alternate living situation is to become aware of the various possibilities available in your community. Terminology may commonly include assisted living facilities, family group homes, independent senior living communities, skilled nursing facilities, in-home care, intentional communities, and continuing care retirement communities.

The second key component is understanding that individuals have different needs, and eligibility for certain living options is dependent upon those needs. Senior living options are not “one size fits all.” Take an honest look at your loved one's medical conditions and care requirements so that you will have a clearer idea of which levels of care would be the best fit for them.

The third part of planning is researching each type of facility. There are several things to bear in mind when conducting this research. Caregivers must understand the concept of “least restrictive setting.” The least restrictive setting is the one where a person maintains as much of their independence as possible. A person's own home would be the least restrictive setting possible, whereas a skilled nursing facility would be considered the most restrictive setting.

When thinking about the least restrictive settings, it is vitally important to consider future needs. Make sure that the living arrangement you choose is one that will be able to accommodate a senior's current and future needs. It is tragic when a person is placed in an environment that is too restrictive, causing them to unnecessarily and prematurely lose years of independence. It is equally tragic when a person is placed in a setting that is very unrestrictive yet incapable of meeting their increasing needs. Ultimately, in both of these scenarios they often end up having to move again.

Types of Senior Living

There are three main senior living options: independent senior living, assisted living facilities and skilled nursing facilities.

Independent Living Facilities

Independent living facilities are exactly what they sound like. They are usually set up with a mix of residential settings and house large numbers of seniors. They may also be known as retirement, or continuing care communities. These unrestrictive settings allow a person to maintain complete autonomy and are very good options for individuals who can still do most things for themselves, but prefer contact with other people of their age. They usually have on-site staff members that provide minimal supervision for safety and security purposes. Many offer a wide variety of recreational activities, amenities and social events for their residents.

Key points about independent living facilities:

  1. Residents maintain their independence;
  2. Facilities may provide a tiered approach of increased levels of care as needs change;
  3. Activities are often arranged for residents to remain social and stay engaged;
  4. Primarily funded by private pay. Federal housing authorities provide financial assistance for some facilities.

Assisted Living Facilities

Assisted living facilities (ALFs) are designed to help those who have difficulty caring for themselves to the extent that they can no longer safely live in their own home. These facilities are staffed 24 hours a day with employees who are trained to assist and/or supervise residents in their private apartments with completing activities of daily living (ADLs). A typical person living in an ALF may need help managing medications, bathing, or getting dressed. ALFs are more regulated, therefore this type of facility is more restrictive than independent living. While many seniors are resistant at first, they often wind up loving the environment after acclimating to the change. Touring these communities with your loved one is the easiest way to demonstrate that living in an ALF is the right choice.

An important point concerning ALFs is that the different levels of care offered are dependent on individual state regulations. The type of license a facility has determines the types of assistance staff members can provide. ALFs are typically not intended for residents who require around-the-clock skilled nursing care.

Key points about ALFs:

  1. Direct assistance is available to those who need support to perform activities of daily living;
  2. Trained staff members are available 24 hours a day;
  3. This setting is more restrictive than independent living but is still an environment that promotes independence;
  4. Dependent upon licensing, tiered levels of care may be available to address increasing needs on site;
  5. The cost of living in an ALF can be expensive. According to Genworth's 2016 Cost of Care Survey, the national average cost for an ALF is $3,628 per month. The majority of care costs are paid for out of pocket. Some costs associated with eligible services may be covered by benefit programs.

Skilled Nursing Facilities

Skilled nursing facilities, or nursing homes, are designed to house and assist individuals who have health conditions that require constant monitoring and the 24/7 availability of trained medical personnel. Because of the high level of monitoring that skilled nursing facilities provide, they are typically considered to be a very restrictive senior living option.

Important points about skilled nursing facilities:

  1. Nursing care is available 24/7 to provide medical monitoring and full assistance with activities of daily living for individuals with serious health conditions.
  2. This care is expensive to pay for privately. The average monthly rate for a semi-private nursing home room in the U.S. is $6,844, according to the Genworth survey. A private room costs $7,698 per month on average. Eligible costs are covered on a limited basis through benefit programs and any remaining care costs are funded through private pay.

Few of us want to find ourselves living somewhere unexpectedly, or as a last resort. These senior living options are just the tip of the iceberg. As you look to find the best care setting for your loved one, understanding the basic long-term care offerings will assist you in finding a comfortable, new home setting that addresses all of their needs.

Eric Flusche is the Director of Supportive Aging Services at Senior Friendship Centers in Lee County, FL.

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Most of the families choose AL which is a wonderful option until fall happens and the care gets more challenging. The the family member needs to be moved/transfer to another level of care if the AL has that option, or hire a caregiver or just go straight to NH. Nobody or a lot of people don't even know about Adult Family Homes, or Group Homes, Residential Care Homes. The are homelike environment with less Residents, maximum 6 in my state Wa, offering all level of care, from no assistance to the end of lives including hospice care. We are licensed by the state and inspected, specialized in Mental Health and Dementia, we have in home MD visits, dentist, x-rays, laboratory, nurse on-call, hair stylist, etc. Everything the senior needs we can offer in our homes so, there is option pretty much in all state. Some of the house do not accept Medicaid as a payment option because the state pays very little but, some they do accept.
esto en realidad hay que analizarle muy bien pues en los casa en florida en los ultimos anos se an encontrado casos muy ororosas con los ancianos y estos han sido publicados en este estado por la prernsa casa de cuidados de ancianos y otros centros la tercera edad en este paois devia ser mas fructifera para quien lo ha entregado todo y al llegar a vejes solo se le ve con el objeto de mejor negacio . en realidad analizar si es esto lo que queremos para nosotros al llegar a la vejes .
quisiera tener mas informacion sobre esto simplemente para saver que escoger y por que decidir mejor
I'm a retired, independent professional business woman in my mid 70's, working artist - outdoor nature photographer, and independent senior currently living in FL, in a HUD Independent Living Apartment, Aging In Place community, but want to relocate back to the No. CAL area, preferably to the Sacramento area for convenience in traveling to Reno, San Francisco, and Napa - Sonoma areas. Access to public transportation is a must as I use the services frequently. I spent 30 plus years in So. and No. CA so am not new to the areas. I prefer the weather there to the FL summers. I have family members in So. CA, however I plan on maintaining my separate and independent lifestyle in a similar independent senior community. I want to relocate to a property with minimal amenities where I manage my own utilities, and that gives me the freedom to pursue my art, photography, and day trip travels on my schedules. Not schedules that someone else has set up for me.