Unfortunately, wisdom isn’t the only thing that aging brings. It also brings changes that can make staying in a cherished home difficult, if not impossible. As an elder’s care needs change over time, so will their housing options. When deciding a senior's future housing plan, understanding the differences between independent living, assisted living and nursing homes is a crucial part of the long-term plan.

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, a person must move to a setting that is better equipped to meet their needs. On many occasions it is not the senior, but rather a concerned family member, who recommends this move from the home where they have created so many memories. This is certainly not an easy decision for the caregiver either—especially if they have made the promise to never put them in a nursing home.

The move into senior living will always be an emotional one, but steps can be taken to make this transition a little less difficult.

Long-Term Care Planning

As with many things in life, this is a transition that is usually much smoother when carefully planned and researched. Plan ahead—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 an approaching 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 and even surprises that may spring up.

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Understanding Senior Care Levels

One of the greatest fears expressed by the elderly is placement in a skilled nursing facility. It is common to hear aging parents say, “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 care 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 the surrounding community. Common elder care terminology typically includes in-home care, assisted living facilities, family group homes, board and care homes, independent senior living communities, skilled nursing facilities, memory care units, 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. Undergoing a comprehensive care assessment is usually the best way to obtain personalized elder care recommendations.

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 for as long as possible. It is tragic when a person is placed in an environment that is too restrictive too soon, causing them to lose years of independence unnecessarily. It is equally tragic when a person is placed in a setting that is very unrestrictive yet incapable of meeting their increasing needs. Ultimately, both these scenarios result in multiple moves to different facilities, which can be very disruptive and disorienting for seniors.

Types of Senior Living

While there are many different senior housing options available today, the three main types are independent senior living communities, assisted living facilities and skilled nursing facilities.

Independent Living Communities

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 communities 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 their peers. They usually have on-site staff members who 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 no care whatsoever or a tiered approach of increased levels of care as needs change. Continuing care retirement communities (CCRCs) fall into the latter category. CCRCs are unique in that they offer a full range of residential elder care options (independent living, assisted living and skilled nursing) on one campus.
  3. Activities are often arranged for residents to remain social and stay engaged.
  4. Independent living is paid for privately, but 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 without assistance. These facilities are staffed 24 hours a day with employees who are trained to assist and/or supervise residents with completing activities of daily living (ADLs) in their private apartments. A typical person living in an ALF may need help managing medications, bathing, toileting 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 2019 Cost of Care Survey, the national median cost for an ALF is $4,051 per month. Most care costs are paid for out of pocket. Some costs associated with eligible services may be covered by benefit programs.

Skilled Nursing Facilities (aka Nursing Homes)

Skilled nursing facilities (SNFs), 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 and care that SNFs provide, they are typically considered the most 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 median monthly rate for a semi-private nursing home room in the U.S. is $7,513, according to the Genworth survey. A private room costs $8,517 per month on average. Medicare only covers medically necessary short-term care in a SNF if certain conditions are met, but Medicaid covers long-term skilled nursing care for seniors with limited income and assets. Some veterans may qualify for nursing home benefits through the VA as well.

Choosing Senior Housing

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- the general categories to guide your search for the appropriate long-term care setting. As you look to make the best choice for your loved one, talk to people you trust about their experiences with long-term care in your community. Understanding the long-term care options, services, locations and amenities available near you will ensure your loved one's care needs are met in a comfortable, new home setting.

Read: Paying for Long-Term Care

Sources: Genworth Cost of Care Survey 2019 (https://www.genworth.com/aging-and-you/finances/cost-of-care.html); Skilled nursing facility (SNF) care (https://www.medicare.gov/coverage/skilled-nursing-facility-snf-care)