If you have a senior loved one, such as a parent, who is no longer able to safely care for themself, you may be looking for assisted living accommodation for them. There are several types of senior living facilities that provide a safe and friendly living environment.
Many facilities offer a range of services from full housekeeping, restaurant-style dining, social activities, and outings, to help with daily routines such as bathing and dressing, as well as medical assistance. If your loved one also has an existing health condition, you will also need a facility that offers licensed nursing services.
This article will help you understand the differences between certain types of assisted living facilities, factors to consider when choosing a facility, costs involved, questions to ask, and even help with planning the move.
If you are already knowledgable on the subject, or have just read the article and are ready to begin your search, we recommend downloading our Assisted Living Comparison Checklist to help guide you through the process. There is a Google doc or an Excel version of the checklist below.
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Types of Assisted Living Facilities
These days there are so many different options for senior living that you can be forgiven for not knowing the difference between assisted living and nursing homes. There are several options to choose from, both for single seniors and those who want to move with their partners.
When it comes to making a choice for a family member it can seem overwhelming, but don’t panic. To help you, here’s an explanation of the different housing options for seniors.
Independent Living
This is the general term describing any type of housing facility that is designed specifically and exclusively for seniors. This includes retirement homes, senior housing, retirement communities, and senior apartments. Whether the living facilities are condos, apartments, or houses, in general, they are easier for seniors to navigate and maintain. They are ideal for seniors who need a place that requires little upkeep and who need only minor assistance with daily living.
Assisted Living
Also known as congregate care, adult group home, or residential care, assisted living is for seniors who need help with the activities of daily living. Staff is available 24 hours each day. Depending on the level of care needed, some assisted living facilities provide apartments with a shared dining room, while others just provide rooms. There are also other common areas for socializing with other residents.
Continuing Care Retirement Communities
Continuing Care Retirement Communities (CCRCs) are facilities that provide a combination of independent living, assisted living, and nursing home care all in one location. This means that seniors can stay within the same community even if their housing needs or level of care changes over time. It also allows spouses to stay close to each other even if they have different requirements.
Nursing Homes
This is the highest level of senior care outside of a hospital. As well as providing help with daily living activities, they also provide a high level of medical care. Each resident’s care is supervised by a licensed physician and nursing staff are always present along with other medical professionals such as physical therapists. This is a good choice for seniors who can no longer handle their personal care and medical needs at home or in another facility.
Factors for Considering Senior Living
Choosing living accommodation for your elderly loved one is a big decision and one that you can’t afford to take lightly. The last thing you want is for your family member to be unhappy in their new home.
There’s certainly a lot to think about. When you’re assessing senior housing needs for a loved one, you need to evaluate the following issues:
- Level of care: You can’t see into the future, but if your family member has a health condition that’s going to worsen over time, it is important to consider the best way to handle this down the road. Consider how much you are going to be able to help.
- Location: Even though your loved one may currently be fully independent, this situation could quickly change. Consider how far she is from basic amenities such as shops and medical services. Think about how easy it is for your loved one to navigate around her home. Also, assess how much maintenance her home and garden need.
- Social support network: Interaction with friends is very important for your loved one. Consider how easy it is for her to visit neighbors and friends and engage in social activities. If she becomes isolated in her home, she will quickly succumb to depression.
- Caregiving support: Consider her needs now and her future needs. If, as a family member, you cannot commit to caregiving, she may need a housing facility that includes a certain level of daily assistance.
- Finances: It may now be time to start working with your loved one to make a budget for senior care later on. Senior care can be expensive, and costs can increase rapidly in high levels of care.
The Cost of Senior Living
Independent Living
The monthly cost of independent living facilities varies considerably from state to state. For example, the average monthly cost in Oklahoma is $1,865, while in Pennsylvania, it is $3,555.
Assisted Living
The monthly cost of assisted living will vary from state to state. The level of care, room size, and amenities are other factors that can drive the cost up. Currently, the average monthly cost of assisted living in the U.S. is $4,000, which is around $48,000 per year.
Continuing Care Retirement Communities
CCRCs come with a two-fold cost. You will need to pay the initial entrance fee and ongoing monthly fees. The entrance fee must be paid before your loved one moves in. The cost will vary depending on the location and the facility itself. The entrance fee usually starts at around $330,000 and can, in some communities exceed $1 million. Once your loved one has moved in, you will need to pay a monthly maintenance fee with an average cost of $2,000 to $4,000.
In some locations, CCRCs are available that operate on a rental basis. In this case, you will not have to pay an entrance fee. The average cost for an independent living facility in this type of CCRC is between $3,000 to $6,000 a month.
Nursing Homes
Nursing home costs can vary greatly depending on the location, length of stay, and level of care. The average cost of a private room in a nursing home is $290 per day or $8,821 per month. Whereas the average cost of a semi-private room is $255 per day or $7,756 per month.
When you decide on a senior living facility, you will need a contractual agreement that details all the healthcare and supportive services that are being provided and the fees associated with each one. You will also need to ask about the facility’s billing and payment policies and what additional services are not included in the monthly fee.
Getting Help with the Cost of Senior Living
Many families use personal funds to pay for senior living expenses. For example, the sale of a loved one’s home, or a combination of retirement funds and personal pensions. Although your senior loved one may have saved for retirement over the years, you and your family members may still wish to contribute to their senior living costs.
Senior Living and Insurance
More mature adults are typically used to relying on their health insurance plan to cover such things as hospital stays and medical procedures. But many people wonder if their insurance will help them pay for senior living accommodation. Whether your loved one’s insurance plan will contribute depends on the plan they have:
Medicare
The extent of Medicare’s coverage is short-term, non-custodial care, such as a hospital stay. Your loved one will not be able to use it for assisted living. However, Medicare will usually cover at least some of the healthcare-related expenses while they are in a senior living facility.
Private Health Insurance
Private healthcare providers such as Humana, Aetna, and Blue Cross may cover the expense of some healthcare and nursing costs, you will have to contact your loved one’s provider to find out the details. However, they do not contribute to personal care within an assisted living facility.
Long Term Care Insurance (LTCI)
Long Term Care Insurance provides coverage for home health care, nursing home care, and personal daycare for seniors over the age of 65 years. It covers care in both assisted living accommodations and nursing homes.
It also covers more healthcare costs than Medicare. For example, Medicare will cover the expense of medical care in a nursing home for up to 100 days if your loved one is recovering from a hospital stay. But once your loved one’s health stabilizes, even if she needs personal care, Medicare will not cover the cost. LTCI, on the other hand, will.
There are several types of LTCI policies to choose from. A typical LTCI policy will cover a set amount for each particular service. For example, $100 per day for standard nursing home care. There will also be a limit to the benefits you receive. This could be in terms of the number of years the benefit is paid out or the total amount of expense covered.
The cost of an LTCI can vary considerably. If purchased at the age of 55 in 2021, the average cost of an annual premium is $1,750 for a single man, $2,150 for a single woman, and $3,000 for a couple. You can’t wait until you need long-term care to purchase a plan. Your decision to invest in LTCI should be made as part of your long-term financial planning.
Paying for Senior Living with Life Insurance
You may not realize this, but your loved one may be able to pay for their assisted living accommodation with their life insurance policy or that of a family member. It is possible to sell a life insurance policy for market value and use the funds to pay for long-term care while still retaining some death benefits. Alternatively, you could surrender the life insurance policy to the insurer for its cash value. In this case, you will forego and death benefits.
Paying for Senior Living with Home Equity
If your loved one owns property such as a home or business, they may be able to use home equity to cover the cost of their senior living accommodation. There are several ways to leverage home equity to cover assisted living expenses. These include:
- A bridge loan: This is a form of short-term loan that is ideal for covering an urgent situation when you need cash quickly. You can use a bridge loan to cover the cost of senior living while you are working on liquidating your assets.
- Reverse mortgage: A reverse mortgage is a good option if your loved one wishes to retain her home for a spouse or other family members, particularly if they’re living there. This type of loan allows you to draw on home equity to provide the borrower with some money to pay for the costs of assisted living.
- Renting or selling a home: Which one you choose will depend on your loved one’s situation and needs. Selling your home may free up the assets relatively quickly, but if your loved one wants to keep the property in the family, then renting may be the best option.
Paying for Senior Living with Other Benefits
If your loved one is a retired veteran, or previously worked as a railroad or government employee. They may be entitled to come benefits to help cover the expense of senior living. Wartime veterans and their spouses should contact the Department of Veterans Affairs (VA) to see if they qualify for a pension program and if so, what’s included.
Making Healthcare Decisions
Even if you are playing a key role in the decision to place a loved one in a senior care facility, patient confidentiality can prevent your loved one’s physician from discussing her medical conditions with you. To ensure that you can participate in all conversations with health care providers regarding tests, medications, treatments, and life-or-death decisions, you will need to have certain legal documents.
What documents you need will depend on the state you and your loved one live in. Typically assisted living facilities require the following documents:
- Medical of health care power of attorney
- Advance medical or health care directive
What Can Happen if you Do Not Have These Documents
If you do not have the necessary legal documentation, you may be prohibited from accessing your loved one’s medical information or directing their health care if they are unable to make decisions for themselves. If your loved one’s medical team is not prepared to work with you, you may have to apply to the court for a petition for guardianship. You can avoid this if you and your loved one and your family members work together to prepare these legal documents ahead of time.
Questions to Ask About Senior Living Facilities
Finding the right facility for your loved one can be tricky, especially if you have several options. Here some questions to ask the staff when you visit a facility. Take them along with you and hopefully, they will help you make a more informed decision.
Questions to Ask about the Facility’s Staff
- What qualifications/training do your members of staff have?
- What is your staff/resident ratio during the day and at night?
- Are staff members permitted to administer medications?
- Do you have a licensed nurse on staff?
- Is there a nearby doctor or hospital nearby in case of emergency?
- Does your staff provide assistance with general daily living?
Questions to Ask About Residential Spaces
- What types of rooms or apartments are available and what is their cost?
- Can residents have a private room?
- Are residents permitted to decorate their living space?
- Do residents have private or shared bathrooms?
- Are kitchens fitted with appliances?
- Are pets allowed?
- Do living spaces have a 24-hour emergency response system?
- Is housekeeping included in the monthly fee?
Questions to Ask About Meals
- How many meals are provided for residents each day and at what times?
- How often does the menu change?
- Can you cater meals to suit a resident’s special dietary needs to requests?
- Is the food prepared on-site, daily?
- Can residents eat/keep food in their apartments?
- Can special meals be prepared for holidays and birthdays?
Questions to Ask About Healthcare
- Does a resident need a health assessment or physical exam prior to admission, or do you perform it?
- Do you work up a written care plan for each resident, if so, how often is it reviewed?
- How do you assess which services a resident will need?
- What is your policy on medication management? Are residents allowed, in some cases, to administer their own medication?
- Do you have physical therapy and hospice services on site, if so, is there an extra charge for these services?
- What is your protocol for responding to a resident’s emergency?
Questions to Ask About Community Spaces
- What spaces do residents share within the facility?
- Do residents have access to any outdoor areas?
- Are there any smoking areas available?
- Do you have any shared community services such as a fitness room, salon/barber’s shop, or concierge?
- Is there an area where residents can participate in their hobbies?
- Is there a TV room?
Questions to ask about activities
- What type of activities do you provide for residents?
- Can I see a schedule of events?
- Do residents go on any regular outings within the community?
- Do you provide any entertainment, if so, how often?
- Can residents arrange for transportation if they wish to go anywhere, if so, is there an extra fee?
Questions to ask about the facility?
- Do you have a waiting list for admittance to the facility, if so, how long is the wait?
- What is your discharge or eviction policy?
- Do you have a list of resident’s rights?
- How often is the facility audited and what does the auditor check for?
Moving Day Tips: Simple Ways to Make Things Easier for Everyone
Once you and your family have decided on a place that’s just right, the next step is to prepare for the move-in. It can be hard to get ready to move into an assisted living or skilled nursing facility. The transition period can sometimes be a long one. Whether your loved one is living close or far away, you remain a primary caregiver and will be able to offer a lot of support during the transitionary period.
Getting Ready to Downsize
Downsizing is an unavoidable part of preparing to move to an assisted living facility. Whether it’s taking clothes to the Salvation Army or letting go of an old armchair, getting rid of things your family has accumulated over the years can be heart-wrenching even if they’re no longer needed. To an elderly family member, it can feel like they’re letting go of treasured memories of their former life. But this is a necessary transition because assisted living accommodation is compact and there will be limited storage room.
Family caregivers are usually responsible for helping parents deal with conflicting feelings about downsizing, and this can be difficult. Fortunately, there are things you can do to help make it easier for your loved one to deal with these changes.
Donate to a Good Cause
One thing that can make it easier for your parent to downsize is by helping them to donate their items to a good cause. Although your loved one may want to cling onto some possessions, once she recognizes that she no longer needs them and that someone else could really use them, it can be easier to let them go. If you have large items, like furniture, to let go, charities like Goodwill, Habitat for Humanity, and the Salvation Army will be only too happy to arrange to collect them from the home.
Enlist Some Help
Get family and friends to help with downsizing and packing up things for the move. This can be invaluable for a loved one who is struggling with the transition because you can share memories and laughter while you work. Try not to let your parent get too sentimental about her possessions as this will make her reluctant to part with them.
Have a Farewell Celebration
Throwing a special dinner party with family and friends can help your parent say goodbye to her old home and get ready to welcome the new one. Each guest could share a story of a past event in the old house as part of the celebration. Doing this can help prevent your parent from grieving about moving out of her home.
Hold on To the Familiar
Downsizing doesn’t have to mean letting everything go. It’s important for your loved one to keep personal possessions so she will have familiar things around her in her new home. Things like books, photographs, ornaments that have been long-time companions should be kept even if space is a little cramped at first. Some things may be easier to let go of later when your loved one has settled in. Familiarity is particularly important for someone who is moving into a memory care facility.
What to Take to Assisted Living
It’s a difficult decision, whichever way you look at it but the important thing is to try and retain the look and feel of your parent’s original home. Don’t worry about buying new items, recreate the same homely feel in the new living space with the furniture she already has. Keep it simple and don’t overcrowd the space. Here’s a list of essentials to take along to the new home:
- Bed, bedding nightstand, and lamp.
- Sofa and chairs.
- Dresser.
- Shower curtain and rings, set of towels.
- Laundry basket.
- Clothes hangers.
- Garbage cans.
- Clock.
- Personal items like books, photos, and ornaments.
- TV/radio, CD player.
- Telephone.
- Toiletries.
- Clothes.
Some assisted living facilities may have built-in shelves, or a small desk or writing table. Others may have a kitchenette so snacks and drinks can be made in the room.
Making decisions about senior care for a family member or loved one is not easy and making the transition can sometimes be difficult for the ones you love. That’s why it’s important to think ahead and make plans for senior care when it is needed.
