Choosing Senior Housing and Residential Care

What are the main types of senior housing and residential care?

Senior housing is a group-living situation where senior citizens can live in proximity to their peers and partake of a wide range of activities and special services. Senior housing ranges from single-family homes in a senior community to large group living facilities. Seniors who want to remain in their own homes can find resources and direction in Helpguide's Services to Help Seniors Stay at Home.

People who explore senior housing as an alternative for themselves or a loved one find a complex and often confusing array of options and descriptions but senior housing really consists of just 3 basic types:

Independent living
Assisted living
Nursing home care

Assisted living is sometimes called “board & care” and “congregate housing.” Residential care that combines all 3 housing types is called Continuing Care Retirement Communities (CCRC’s). This gives us 6 major senior housing options:

Independent Living – For healthy seniors who are self-sufficient and want the freedom and privacy of their own separate, easy-to-maintain apartment or house, along with the security, comfort and social activities of a senior community.
Assisted Living – Numerous kinds of housing-with-services for people who do not have severe medical problems but who need help with personal care such as bathing, dressing, grooming or meal preparation.
Board and Care – State-licensed assisted living for people who need minimal assistance with personal care such as bathing, dressing, grooming or toileting, but who need or want communal meals and easy access to social contact with peers.
Nursing Homes (Skilled Nursing Facilities) – Facilities with 24-hour medical care available, including short-term rehabilitation (physical therapy) as well as long-term care for people with chronic ailments or disabilities that require daily attention of RN’s in addition to help with personal care such as bathing or dressing or getting around.
Congregate Housing – Used to be considered a unique combination of private living quarters combined with shared activities including communal meals and other social activities, but is now considered a type of assisted living.
Continuing-Care Retirement Communities (CCRCs) – A complex of residences that include independent living, assisted living and nursing home care, so seniors can stay in the same general location as their housing needs change over time, beginning when they are still healthy and active.
Payment Options for Senior Housing and Residential Care – Discusses average costs, payment options, and financial assistance programs for senior housing in the U.S.

Why is the topic of senior housing sometimes hard to understand?

It used to be pretty simple. So long as you were independent, you lived in your own home, or moved to a retirement community. If you needed a little help with personal care, and your meals provided, you went into board and care. If you needed quite a bit of help with personal care, or skilled nursing care, you went into a nursing home.

In the last 2 or 3 decades, the world of senior housing has developed many more options for elder care from specialized nursing homes to types of assisted living that prevent being placed in a nursing home. It’s good for consumers, and a sign of hope to the aging, that we have more good choices for care, but it has also led to these complications:

Different names are used for the same type of housing. A nursing home was once known as an old folks’ home or retirement facility and today may be called a convalescent hospital, skilled nursing facility, or rest home. Among the 26 different names for board and care in the U.S. are “boarding care,” “board & lodging” and “adult foster care.”
The same names are used for different types of housing. Sometimes “assisted living” is applied to any senior housing where assistance is provided, from just meals (as in some retirement homes), to board and care homes, to nursing homes. The phrase, “long-term care” used to apply to nursing home care for people who were never expected to recover from a disabling illness; but sometimes all forms of senior housing offering assistance that will be needed for many years, are now called “long-term care.”
The rapid growth of assisted living facilities makes for ever-changing combinations of services in a widening variety of settings. This has led to a variation on the old adage, “If you’ve seen one you’ve seen ‘em all.” When it comes to residential care, “If you have seen one assisted living facility, you have seen one assisted living facility.”

How do I determine what type of senior housing arrangement is best?

After familiarizing yourself with the types of residential care, it’s time to conduct a thorough inventory of the senior’s wants, needs and goals. Some key issues to consider:

Temporary versus long term care: An older person may go to a nursing home for rehab following a surgery or stroke, then return home. In other circumstances, a senior’s needs are better served by planning a move into a situation that is likely to remain the same for the many years to come.
Independence: Can the senior live alone, and more importantly, does he/she want to? Or would living in a more service-oriented environment be more nurturing?
Privacy: Independence and assistance generally form a continuum: privacy decreases as the need for assistance increases. If the senior's desire for privacy is paramount, independent living, assisted living, or a Continuing Care Retirement Community would all be preferable to a board & care home or a nursing home.
Needs for personal care: How much and what kinds of personal or “custodial care” are needed or desired? There are online needs assessment questionnaires to help determine this and then match the care needs with the right type of housing.
Needs for medical care: If the senior has a chronic illness that necessitates special medical care, or ongoing services of medical professionals, independent living and even assisted living may not be suitable.
Costs: Learn about the financial aspects of senior housing to determine what options are affordable for you.
Walk through and evaluate several care facilities or senior communities that seem suitable. Reviewing facility comparison checklists can help you determine which type of environment fits the senior resident’s requirements and preferences.
Seek guidance from professionals who are experts in senior housing issues such as medical social workers, case managers or geriatric care managers. They can help with all phases of this process: identifying goals and values, assessing needs, determining what is affordable, and suggesting appropriate facilities.

Types of personal care provided by senior living facilities

Personal care (also known as custodial care) encompasses what are known as "ADL”--activities of daily living. These commonly include:

Cooking and cleaning
eating
bathing
dressing
using the toilet
getting around the house (mobility)

Additional personal care support may provide assistance with:

transportation around the community
medication reminders
finding companionship
participating in social and recreational activities

While an independent living senior community does not provide personal care in the home, the various types of assisted living facilities do.

Types of community services and activities provided by senior living facilities

Depending on the type of senior housing one chooses, optional community services may include:

Communal Meals
Housekeeping
Laundry
Local transportation
Exercise facilities, such as pools, saunas and exercise machines
Arranging for personal or medical care
Libraries
Beauty shops
Gardens

Activities can include:

Recreational, educational, and social events
Activity rooms or clubhouses
Golf courses
Tennis and shuffleboard courts
Health and exercise programs or classes
Chapels and religious services

Independent living facilities are most likely to offer some or all of the above community services, health and recreational/spiritual activities. Assisted living and Continuing Care Retirement Communities may adapt the services offered to meet the specific needs of the seniors living in their facilities. Nursing homes also have a range of services and social activities adjusted to suit the limitations of the residents.

Types of health services provided. When is a Nursing Home necessary?

If a senior cannot live alone due to forgetfulness, frailty, or a chronic medical condition, assisted living facilities can be explored, but a Nursing Home (Skilled Nursing Facility) might be the only option. Only nursing homes have the medical professionals on staff to address ongoing medical needs, with a care plan supervised by physicians and Registered Nurses on site 24 hours per day. In addition to assisting with custodial care, a nursing home may provide:

Interim medical care (after a hospital stay for an illness or procedure)
Rehabilitation services: occupational, physical, respiratory and speech therapy
Pharmacy, laboratory and radiology services
Therapeutic recreational and educational activities
Transportation on a limited basis
Laundry service (often for an extra cost)
End of life care (hospice)
Respite care (relief for caregivers)

Not all nursing homes provide all these services, so it’s important to find the facility that provides the type of care needed. Also, some nursing homes specialize in certain kinds of care for special needs such as:

Kidney dialysis treatment
Alzheimer's and dementia care
Respiratory care
Parkinson's care

Finding professional help for locating suitable senior housing or elder care

The complexities of senior housing and elder care are such that most people are well advised to seek professional services to assist them. Sometimes moving to a care facility on a temporary or long-term basis is dictated by medical necessity. In these cases, the choice of a facility is often made while the senior is in the hospital where you can get the guidance you need from a medical social worker, case manager or discharge planner. If not hospitalized, you can seek the advice of your physician and you can seek community-based geriatric care managers--based in private practice for a fee or based in community agencies for no fee or on a sliding fee scale. See Related Articles on Helpguide below.

Independent Living for Seniors
Retirement Communities and Homes