Understanding Senior Housing Options

Planning for your future

Aging is a time of adaptation and change, and planning for the future will make sure your needs, or the needs of a loved one, are fully met. Continuing to thrive as you age means learning how to maintain your independence for as long as possible. This may mean modifying your own home, or it could mean moving to a housing facility with more support options on site. When planning ahead, consider the needs you might have in the future:

• Physical and medical needs. As you age, you may need some help with physical needs, including activities of daily living. This could range from shopping, cleaning, and cooking to intensive help with bathing, toileting, moving around, and eating. You or a loved one may also need increasing help with medical needs. These could arise from a sudden condition, such as a heart attack or stroke, or a more gradual condition that slowly needs more and more care. About 70 percent of individuals over the age of 65 will require some type of long-term care services during their lifetime.
• Social and emotional needs. As you age, your social networks may change. Friends or family may not be as close by, or neighbors may move or pass on. You want to make sure that you have continuing opportunities for maintaining and building new social networks. If you become isolated and housebound, it can have an adverse effect on your mental health.
• Financial needs. Long-term care can be expensive, and balancing the care you need with where you want to live requires careful evaluation of your budget. You may consider moving to a facility with more onsite care or easier maintenance, or modifying your home and using in-home help if necessary.

Understanding senior housing options

There is a broad array of housing options available to seniors, from staying in your own home to specialized facilities that provide round-the-clock nursing care. The names of the different types of housing options can sometimes be confusing, as the terminology can vary from region to region. The main difference will be in the amount of care provided for activities of daily living and for medical care. When researching a housing option, make sure it covers your required level of care and that you understand exactly the facilities offered and the costs involved.

Aging in place

Many older adults prefer to stay at home as they age. It has the advantage of being a familiar place and you know your neighbors and the community. There is a wide range of home care services that can help you maintain your independence within the comfort of your own home, from in-home help to day care.  Staying at home may be a good option if:

• You have a close network of nearby family, friends, and neighbors.
• Transportation is easily accessible, including alternate transportation to driving.
• Your neighborhood is safe.
• Your home can be modified to reflect your changing needs.
• Home and yard maintenance is not overwhelming.
• Your physical and medical needs do not require a high level of care.
• You have a gregarious personality and are willing and able to reach out for social support.
• You fall within the geographical confines of an integrated community, such as a “village” or NORC (Naturally Occurring Retirement Community).

Aging in place is a less effective senior housing option once your mobility is limited. Being unable to leave your home frequently and socialize with others can lead to isolation, loneliness, and depression in seniors. So, even if you select to age in place today, it’s important to have a plan for the future when your needs may change and staying at home may no longer be the best option.

The Village concept

The Village solution to aging in place is a relatively new concept, enabling active seniors to remain in their own homes without having to rely on family and friends. Members of a “village” can access specialized programs and services, such as transportation to the grocery store, home health care, or help with household chores, as well as a network of social activities with other village members. As of 2009, there were 50 village organizations across the United States and one in Australia, with many more communities planned worldwide. Each offers different services depending on the local needs of the individual communities. The cost of membership varies according to area and the level of services required, but is often in excess of $500 a year.

Naturally Occurring Retirement Communities (NORC)

Like the village concept, Naturally Occurring Retirement Communities enable seniors to stay in their own homes and access local services, volunteer programs, and social activities, but tend to exist in lower income areas. A NORC may be as small as a single urban high rise or spread out over a larger suburban area. See Related Links for help finding a NORC program in the U.S.

Independent living

Independent living is a general name for any housing arrangement designed exclusively for seniors. Other terms include retirement communities, retirement homes, senior housing, and senior apartments. These may be apartment complexes, condominiums, or even free-standing homes. In general, the housing is friendlier to older adults — it’s more compact, easier to navigate, and includes help with outside maintenance. Sometimes recreational centers or clubhouses are also available on site.

You may want to consider independent living if:

• You see needing minor assistance with activities of daily living.
• You’d like a place that does not require a lot of maintenance and upkeep.
• You like the idea of socializing with peers and having activity options nearby.

If you don’t want to live exclusively with others your own age, there are alternatives to an independent living community. You can consider moving in with a family member, or simply moving to a more accessible apartment or condo. The key is being in an area with good access to transportation, services, and social networks.

Assisted Living

In general, assisted living is a housing option for those who need help with some activities of daily living, including minor help with medications. Costs tend to vary according to the level of daily help required, although staff is available twenty-four hours a day.

Some assisted living facilities provide apartment-style living with scaled-down kitchens, while others provide rooms. In some, you may need to share a room unless you’re willing to pay a higher cost. Most facilities have a group dining area and common areas for social and recreational activities.

An assisted living facility may be a good choice if:

• You need more personal care services than are feasible at home or in an independent living retirement community.
• You don’t need the round-the-clock medical care and supervision of a nursing home.

Nursing homes

A nursing home is normally the highest level of care for older adults outside of a hospital. While they do provide assistance in activities of daily living, they differ from other senior housing in that they also provide a high level of medical care. A licensed physician supervises each resident’s care and a nurse or other medical professional is almost always on the premises. Skilled nursing care and medical professionals such as occupational or physical therapists are also available.

A nursing home may be a good choice if:

• Both medical and personal care needs have become too great to handle at home or in another facility. This may be due to a recent hospitalization, or a chronic illness which has gradually been worsening.
• You need a higher level of care temporarily after a hospitalization, but it’s anticipated you will be able to return to home or another facility after a period of time.

How to assess your senior housing needs

There are a range of choices for senior housing, and no simple answer as to which one is right for you. Here are some of the issues in evaluating your options:

Level of Care

No one can predict the future. However, if you or a loved one has a chronic medical condition that is expected to worsen over time, it’s especially important to think about how you will handle health and mobility problems. What are common complications of your condition, and how will you handle them? Are you already at the point where you need daily help?

Location and accessibility

Even if you are completely independent at this time, circumstances can change. It pays to think a little about your current location and accessibility of your current home. For example, how far is your home from shopping, medical facilities, or other services? If you can no longer drive, what kind of transportation access will you have? Can your home be easily modified? Does it have a lot of steps, stairs, or a steep hill to navigate? Do you have a large yard that needs to be maintained?

Social support

How easy is it for you to visit friends, neighbors, or engage in hobbies that you enjoy? If it becomes difficult or impossible for you to leave your home, you’ll become isolated and depression can rapidly set in.

Caregiving Support

You will want to consider housing where both your current and future needs can be met. Do you have family or other support available nearby? Traditionally, family has provided the backbone of caregiving support for older adults. In today’s times, though, family may not be as readily available due to distance, work, children, or other commitments. Even if family members can commit to caregiving, they might not be able to fill in all the gaps if physical and medical needs become extreme. The more thought you put into your future, the better chance your needs will be met.

Finances

Making a budget with anticipated expenses can help you weigh the pros and cons of your situation. Alternate arrangements like assisted living can be expensive, but extensive in-home help can also rapidly mount in cost, especially at higher levels of care and live-in or 24-hour coverage.

Consider a professional assessment

Depending on your current level of care, you may already have had an assessment through your medical team. This can cover your medical issues and concerns as well as issues related to activities of daily living. If not, you may want to ask for a referral. You may also want to consider an assessment by a geriatric care manager. Geriatric care managers can provide an initial assessment as well as assistance with managing your case, including crisis management, interviewing in-home help, or assisting with placement in an assisted living facility or nursing home. More about geriatric case managers can be found in the Related Links section.

Overcoming emotional roadblocks

Considering senior housing, especially options with higher levels of care, may cause a lot of anxiety. It can be difficult to think deeply about losing your independence, or future medical concerns, or the costs involved. Throw family involvement in the mix and things can get complicated. Here are some potential emotional roadblocks, along with tips on how to overcome them:

Senior concerns

“There’s no point in thinking about this today. I’d rather live life in the moment and take things as they come.” While it’s not healthy to obsess over the future, almost everyone will have to consider senior housing options at some point, either for themselves or for a loved one. It’s scary to think about losing independence, especially if you are used to being self-reliant. The more you plan ahead, though, the more control you have if an emergency strikes you or your spouse.

“I don’t want to get my family involved. I want to plan my own care” or on the other side:

“I’m not worried. My family will step up when I need them.” It’s not an easy conversation, but it’s important to both communicate with family members your wishes and plans, and listen to their concerns. For example, long distance family members might be thinking its better you move close by or move in with them so that they can better coordinate your care. However, you might not want to uproot yourself from your community, friends, and current medical care. On the other hand, just because you have family close by does not automatically mean they will be able to help with all your needs. They may also be balancing work, their own children, or other commitments. Clear communication from the outset can help avoid misunderstandings or unrealistic assumptions.

Family concerns

“My loved one is having a harder and harder time keeping up. I’m worried about safety, but he won’t listen to me.” It’s painful to see a loved one having trouble. Maybe clothes are not as clean as they used to be, the refrigerator is looking sparse, or the house is getting increasingly messy. Or things may have progressed to frequent falls, or memory lapses such as leaving the stove on. While you can’t force a loved one to accept help or move home, unless he or she is a danger to self or others, you can provide them with information and reassurance. Don’t take it on alone. Talk with your loved one’s medical team. Brainstorm with other family and friends. Sometimes a senior will listen more to a doctor, care manager, or other impartial party.

“My loved one wants me to provide all of the help for them. I’m worried I won’t be able to keep up, and I feel guilty.” Caregiving may start with small assistance, and rapidly grow to an all-encompassing task. You may be juggling the needs of other family, your own health, or be worried about keeping your job. There are only 24 hours in a day, and you need to be able to balance your own health, family, and finances. Getting help is not a sign of weakness. It means you care enough about your loved one’s health and safety to realize when the responsibility is too great. Educate yourself about the resources that can help your loved one, and see if other family members can help.

 “My parents were abusive. I’m scared about what will happen as they age.” In a perfect world, all children would have loving parents who cared for them. However, some children experience physical, emotional, or even sexual abuse at the hands of their parents. As the tables turn and parents become frailer, it may be frightening to think about taking on caregiving. What should you do? Remember that you should not commit to something that makes you physically or emotionally unsafe. That may mean minimizing hands-on involvement, working with a care manager, or having no contact if that is the best choice for you.

Understanding costs

There are a whole range of costs for senior housing, ranging from subsidized senior apartments to nursing homes which can average $70,000 per year. When considering senior housing, the following considerations can factor into cost:

• Location: High cost of living or metropolitan areas will normally be more expensive for all levels of housing.
• Level of care: In general, the higher the level of care, the more you can expect to pay. Nursing homes are the most expensive, but assisted living facilities can also easily run $3,000 to $4,000 a month or more.
• Insurance coverage: Medicare, health insurance coverage for seniors, generally does not cover senior housing options other than nursing homes. Medicare also only covers limited stays in nursing homes when skilled nursing care is required. Medicaid, health insurance for limited incomes, may cover some assisted living costs and does provide nursing home coverage. However, facilities are not required to take Medicaid.
• Long-term care insurance: You can purchase insurance to offset some of the costs of long-term care. Coverage and provisions can vary, but frequently some in-home help and assisted living facility costs are covered, as well as nursing homes.
• Home modification cost and in-home help: A home modification may initially seem expensive, but it can result in savings over time if it allows you to stay at home longer. You can also estimate how much in-home help may cost.

Related articles

Need More Help?

Resources and references for senior housing and residential care

Helpguide’s Yellow Pages
Resources for public assistance, social services, and other health and human services.

Choosing senior housing

Key to Choice (PDF) – A guide to help you assess your lifestyle needs and evaluate the many housing and service options available to seniors. Includes samples of budgets and evaluations. (The Metropolitan Area Agency on Aging)

Steps to Choosing Long-Term Care – Guidance for choosing from many types of senior care, starting with in-home services. Includes help determining the right kind of care, how your needs may change over time, your long-term care choices, paying for care, and assessing different facilities. (Medicare.gov)

Senior Citizens: Homes and Communities – A comprehensive look at senior housing from the U.S. government’s Department of Housing and Urban Development. Includes links to HUD-approved housing counselors and related government sites. (HUD)

Types of senior housing

The Village: A Growing Option for Aging in Place (PDF) – Fact sheet about the benefits and challenges of the village model for aging in place. (AARP)

NORCs, an Aging in Place Initiative – Information on Naturally Occurring Retirement Communities with a directory of programs in the U.S. (JFNA)

Eldercare Locator – Offers database of local housing options and community services for older adults and their families. Help is also available by calling 1-800-677-1116. (U.S. Administration on Aging)

National Association of Professional Geriatric Care Managers – Provides information about the geriatric care manager field and a searchable database of care managers. (NAPGCM)

Understanding costs of senior housing

Medicare Coverage of Skilled Nursing Facility Care – Detailed information about Medicare coverage of skilled nursing care, as well as ways to get help paying for skilled care. (Centers for Medicare and Medicaid services)

Paying for Assisted Living – Discusses what to look for when evaluating costs as well as some of the Medicaid and Supplemental Security Income (SSI) options available. (National Senior Citizens Law Center)

Guide to Long-Term Care Insurance – Information about policies, how to evaluate them, and questions to ask. (America’s Health Insurance Plans)

Authors: Joanna Saisan, M.S.W., and Monika White, Ph.D. Last updated: April 2011.