Finding the right care options for your loved one

Millions of families today are facing a difficult reality: “mom cannot live safely in her home anymore, and I am unable to care for her myself. She needs more medical attention that I can give, but I do not want to place her in a nursing home. What do I do now?” Many years ago, if you could not live alone in your home anymore, your only option was a nursing home. Today, there are so many different care options for the older adult, all with varying levels of medical care, privacy, cost, and assistance. Below is a chart that lists the type of care facility, what requirements the individual must meet in order to reside there, how much it costs, and the level of care received.

Housing Options in Later Life: One Size Does Not Fit All

Independent Living Congregate Housing Assisted Living Long-term Care Continuing Care Retirement Center
Description Individual residing in their own home, alone or with another individual(s), functionally and socially independent most of the time.  In home assistance may be provided by third party service agencies, church, friends or family. Person residing in their own apartment. Functionally and socially independent most of the time, chronically ill, socially isolated, frail are provided with 24-hour on-call assistance. Institutional setting or apartment style building.  Independent apartment or private / semi-private room. Institutional setting Services designed to provide whatever level of support needed regardless of the individual’s needs.
Examples House, duplex, condominium, or apartment Mid-rise or High-rise facility, or cottages.  HUD 202; HUD 236, independent housing project, or group home. Wing of Long-term care facility or congregate housing facility, or separate apartment building or house. Intermediate care or Skilled Nursing Facility.  Free standing institutional design. Combination of independent cottages / apartments, congregate, assisted living, and long-term care on a campus.
Primary Services None 24-hour monitoring for assistance, ore or more meals daily in common dining room, various planned activities and recreation areas,   Laundry room for use by residents. Federal rent subsidy a likely option 24-hour monitoring and low-level medical interventions on behalf of the individual.  Monitor medications, assist with ADL’s as needed, all meals provided, laundry and housing keeping provided.  Could include separate wing or accommodations specifically designed for dementia care

24-hour total care.

Accommodations for dementia care.

Range from minimal or no service through 24-hour total care.  Single campus setting, Resident can move from one aspect of the campus to another depending on level of care desired / needed.  Exceptionally nice amenities common throughout.
Special Regulations None Federal and or State regulations, especially if HUD property.  Additional state regulations may apply. Varies greatly from state to state.  General overview by a state agency (agency by state).  Some legislation, standards, guidelines. State and Federal regulations apply.  Medicare and Medicaid may be relevant to individual; additional regulations if so. State and Federal according to level of care.
Pros and Cons Independence. Upkeep of home and property, property taxes, utilities, potential isolation. Rent, utilities, taxes, some meals provided, sliding scale cost, activities; socializing with fellow residents.  Loss of some privacy and independence Level of care provided at a cost less than LTC, but generally expensive.  Meals, medication monitoring, assistance adds to monthly cost.  Loss of some privacy and independence.  Limitations to the extent of care available. Highest level of care provided 24 hours daily by professional staff.  High cost.  Loss of some privacy and independence, some potential social stigma Potentially the best living situations regardless of level of care needed.  Loss of some privacy and independence.  High initial and monthly cost based on level of care and type of residence.  Can have financial complications.

J. Steven Fulks, Ph.D Barton College