Housing & Transportation

Elder Housing Options

Even if an elder is able to remain in his or her home now, you should begin your exploration of other elder housing options as soon as possible. Many communities and facilities have waiting lists. You may want to gather brochures and visit locations ahead of time, so you'll know what the local options are.

Your local Area Agency on Aging (AAA) or public housing agency has information about the options best suited for the elder in your care. For a more in-depth discussion of each housing option, see the "National Care Planning Council's Guide to Retirement Care Communities."

Independent Living

These facilities are designed for elders who are able to live on their own, but want the security and conveniences of community living. Some facilities offer organized social and recreational programs as a part of everyday activities (Congregate Living or Retirement Communities), while others provide housing with only a minimal amount of amenities or services (Senior Apartments).

Independent living facilities may offer housekeeping services, laundry facilities, linen service, meals or access to meals, local transportation, and planned social activities. Some facilities offer recreational activities, exercise facilities, community lounges, and reading rooms. Health care is not provided, but many facilities allow a home health aide or nurse to come in to assist with medicines and personal care. Because these facilities are not licensed by local, state, or federal agencies, there are no formal regulations.

There are now housing options for seniors and others on the campuses of more than 60 colleges and universities. Although the residents may be largely age 65 and older, they have chosen to live there because of the proximity to an age-integrated neighborhood, rich with educational and cultural opportunities. Their focus is on lifelong learning, and residents have access to college classes, cultural programs, and recreational facilities while enjoying ongoing contact with students and faculty. Some of these communities are financed and facilitated by universities, while others have been launched by real estate developers and other commercial interests. For a partial list of communities, visit the AARP Web site.

Financial Considerations: Private funds are most often used to pay for independent living, although some senior apartments are subsidized and accept state and/or federal funding to cover a portion of the payment for low-income individuals. Medicare and Medicaid do not cover independent living since no health care is provided.

Assisted Living

Assisted living offers a combination of residential housing, meals, and personalized support services, but it does not provide skilled nursing care. Assisted living is designed for adults who may need help with activities of daily living such as housecleaning, bathing, dressing, and/or medication reminders, and want the security of having assistance available on a 24-hour basis in a residential environment. All meals are provided, and often there are transportation services and cultural programs. The underlying goal of assisted living is to support the autonomy, privacy, and individuality of the residents.

Assisted living residences are regulated at the state level, and the definition of assisted living varies by state. Assisted living can also be called by different names, such as residential care, supportive housing, or congregate care. Your local Area Agency on Aging (AAA) can provide information on assisted living options in your area.

Financial Considerations: The cost of assisted living varies according to location, size of the unit, services included, and whether the unit is owned or rented. In 2008, the monthly fee was typically $2,700 or more per month ($32,000 or more per year). Most assisted living residents pay privately, but there are a few ways for qualified low-income elders to access subsidies through either U.S. Department of Housing and Urban Development (HUD) vouchers and/or Medicaid waivers. (See Medicaid for information on Medicaid eligibility.

Alzheimer's or Specialized Care Facilities

An increasing number of assisted living facilities and nursing homes offer specialized care to people with Alzheimer's disease and related memory disorders or dementia. These facilities offer higher staffing levels and care that supports individual skills and interests, in an environment designed to minimize confusion and agitation.

Similar to assisted living communities, specialized care facilities provide assistance with dressing, grooming, bathing, and other daily activities. Meals, laundry, and housekeeping are usually provided within private and semiprivate rooms in a residential-type setting. Your local Area Agency on Aging (AAA) can help you identify facilities in your area that offer these types of services.

Financial Considerations: Compared to other assisted living facilities and nursing homes, these facilities have somewhat higher costs, but similar opportunities for third-party assistance (Medicare, private insurance, Medicaid).

Continuing Care Retirement Community (CCRC)

CCRCs provide the services necessary for residents who wish to remain in the same retirement community as their personal and health care needs change. CCRCs typically combine three housing options on one campus:

  1. Townhouses, apartments, or cottages for independent living
  2. Assisted living apartments for elders who need meals and some personal care assistance
  3. Nursing home accommodations for elders who require more comprehensive skilled nursing care

CCRC units follow the same licensing and regulation rules as freestanding facilities. Independent living units are not licensed, assisted living units are regulated by the state, and nursing facilities are licensed and regulated by both the state and the federal government.

Financial Considerations: Most CCRCs require a sizable entrance fee. In 2008 these ranged from less than $100,000 to more than $300,000, with monthly fees from $700 to more than $3,000. The composition of service packages, especially the health care component, varies greatly. It is important to be clear about which services are included in the monthly fee and which services are additional. Units in a CCRC may be rented or owned, but almost all are paid for privately.

Some CCRCs have had significant financial problems that have created hardship among their residents. Your state's attorney general's office or your local Better Business Bureau may be able to tell you if any complaints have been filed against a CCRC that you are considering. (See also Protecting Elders' Rights.

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