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Housing Options for Seniors

Where will your parents live if their physical and/or mental health seriously deteriorates? You might be aware of most of the options but look at this list to see if it helps you develop a strategy and planning process.

Who decides where Mom or Dad will live? This is one of the biggest decisions for caregivers as it involves who will do the "caring" and who will pay for it. If you have a harmonious family, in which good communication prevails, the process can go smoothly, and fully consider the preferences of all family members, including your parent. If you have a family prone to conflict and poor communication, the process could drag on and cause discomfort all around, obviously. If necessary, you might consider getting support and guidance from a geriatric care manager or other professional who is objective and has the best interests of your parent as primary motivation.

A. Staying Home. Supporting the parent in his/her own home for as long as this is a safe, effective affordable solution is usually the first choice for the aging individual and the caregivers. Many elderly will fight hard to stay at home, living as independently as possible, for as long as possible. The most common stumbling block to this approach is the senior's resistance to having "strangers" like home health aides and paid companions in their home, especially if they need personal care. However, visiting nurses, aides, companions, combined with family caregivers, can often prolong the time a senior can stay in their own home as their health deteriorates. Adult medical day programs can also serve this purpose, providing supervision, support, medical care, meals, activities during the day, while the senior can return to his/her own home in the evening. This gives the caregiver(s) a much needed break as well.
B. Intergenerational Living is the formal name for bringing your parent home with you. Financially, this can be one of the least costly solutions, unless you have to renovate to add a new bedroom or bathroom. You might also need a ramp which could cost a few hundred or a few thousand dollars. However, having your elderly parent live with you and your family can be very costly, emotionally. Sometimes brothers and sisters will take turns, on a rotating schedule, caring for their parent in their respective homes. The success and duration of this "intergenerational living" will vary based on personalities; historical relationships; physical and mental health; presence of grandchildren, noisy pets, or other elderly relatives; finances, etc. A variation of this plan is to have your parent move in with another elderly relative, preferably a sibling with whom they have had a harmonious relationship. Providing in home health and social services for these elderly relatives, in addition to what you can provide, might become necessary sooner rather than later.

Independent Living Apartments/Condos/Homes
Seniors who need minimal support might enjoy an independent environment but one located in a community in which support, medical care, meals, activities, transportation are readily available nearby as part of the community services, should they choose to use them.

Residential Care Homes
This is a more current term for what used to be called a "licensed boarding home." Usually a small facility in a residential community, housing 5-25 residents, it serves those with fewer needs than other facilities. Typically, they provide meals, activities, housekeeping, supervision and some level of assistance with activities of daily living.

Specialized Alzhieimer's Care Centers
Similar to a residential care home, these centers also serve a small number of seniors, who have varying levels of memory impairment and other symptoms of dementia/Alzheimer's. They are secure facilities so that the seniors can't wander. They offer assistance with all activities of daily living, medication management, as well as a range of activities and supportive services. These facilities could cost as much as or substantially less than those specialized units for Alzheimer's patients within larger assisted living or nursing homes. (THE COUNTRY HOME FOR SENIORS FITS IN THIS CATEGORY.)

Assisted Living,br/> This model, an alternative to skilled nursing homes with their medical model, started proliferating in the 1980s and 90's. They often look more like a plush hotel than a medical facility, and yet offer a range of services that closely mimic those of nursing homes. Assisted Living centers do not meet the needs of those requiring 24 hour skilled nursing care and typically do not serve those who are bed bound or have serious medical conditions, need intravenous treatments, inhalation therapy and other advanced procedures.

The primary impediment for many families is the cost, which can range from $4,500 to $7,000 or more a month, depending on level of care needed. Most have a base fee for the room, which is usually private, and "add on" fees for specific services, such as medication management, personal care needs, mobility assistance, etc. Most also have entrance fees, security fees, community fees but in return offer a wide range of attractive services in a hotel-like environment. Many are corporately owned and part of a large network of homes, which can have advantages and disadvantages. Quality of care can vary widely among facilities with the same ownership. Also, the specialized, secure unit serving those with Alzheimer's might have disadvantages not present in the assisted living section of the facility.

Skilled Nursing Facilities
Are required for those who need 24 hour nursing care, are bed-bound, or have specific medical conditions not adequately managed in less medically oriented facilities. Like assisted living communities, the costs, ranging from $5,000 to $10,000 a month or more, can be prohibitive for many families. (The topic of Medicare and Medicaid coverage belongs in another article.)

Continuing Care Retirement Communities (CCRC)
Involve a large campus with a range of housing options, usually including independent living, assisted living, skilled nursing, sub-acute rehabilitation and Alzheimer's care. These can present the most costly option with an initial "buy in fee" of several hundred thousand dollars very common. The primary advantage of selecting a CCRC is that the resident can move along the "continuum of care" at the same facility, if his/her needs increase over time. CCRCs are less numerous than assisted living and skilled nursing facilities, which means their location might present travel/visitation challenges for family and friends. Many CCRCs are affiliated with religious groups, as are some assisted living and skilled nursing facilities.

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