Senior living options: Comprehensive guide to housing and care

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Looking to make a move to meet your changing needs? Read this guide to understand the different senior housing and care options available today.

Senior living community building

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When to consider senior living options

As people grow older, they may need more assistance in order to stay healthy and live safely.  Or perhaps their family and friends may be stressed and overworked with new responsibilities, and have less time to provide support going forward.  Some empty nesters may no longer need to maintain a family-sized home, and want to downsize for simplicity.  Others may be facing reduced income in retirement, and want to downsize to manage expenses.  Finally, some seniors may be living in large communities, but want to scale down to smaller home settings to reduce their risks during a pandemic.

To meet people’s different needs, a wide range of senior living options are available today.  Some options include housing only, some provide care only, while others combine both.  This article provides a comprehensive list of these options, along with guidance on which ones may be right for you.

Senior housing options

Here are twelve types of senior housing, generally ordered from the lowest level of support to the highest level of support.

Aging in place

Aging in place refers to staying in your own home, while making home modifications to accommodate your changing health needs.  Some people round out this solution with local transportation services, senior care services that come to their homes, and senior safety devices.

Aging in place works best for people who are mostly independent, do not need a significant amount of assistance, and have a supportive community around them.  The costs also can be lower than that of other options since you can select only the home modifications and services that you specifically need.  Drawbacks of aging in place are that you will have less social interaction and nearby emergency help.

Home sharing

Home sharing can include renting out rooms in your home to others who can help when needed, or the reverse, where you’re the one moving into someone else’s home.  Often, this involves sharing a home with your kids or relatives.  As with aging in place, you still may want to make home modifications for greater safety.

This approach can benefit both parties by reducing expenses, providing built-in companionship or baby-sitting, and giving peace of mind to family members who can see their loved ones at any time.  Potential challenges to keep in mind include family dynamics and the possibility for the live-in caregiver to become overworked.

Check the National Shared Housing Resource Center to find homesharing programs in your local area.

Active adult communities

Active adult communities provide housing, exterior maintenance, and resort-style shared amenities such as a clubhouse, pool, fitness center, tennis court, dog park, social activities, and more.  Typically limited to people age 55 and up, they also may be called age-restricted or age-qualified communities, senior apartments, retirement communities, or retirement villages.  Housing types can range from apartments all the way to single-family homes.

These communities are best suited for healthy, active, independent adults who can make good use of their amenities.  Otherwise, the additional costs and possible entrance fees may not be worthwhile.

Intentional communities

Intentional communities are cooperative, planned communities where individuals work together to design and create a complex that revolves around their own common values.  As a result, these communities can vary greatly from one to the next.  Examples include general senior cohousing as well as affinity-based senior communities, which may revolve around a shared religion, culture, identity, or interest.

In terms of support, intentional communities are more likely to be comparable to active adult or independent living communities, rather than assisted living, memory care, or skilled nursing facilities, which are regulated at state and federal levels.  Scheduled activities and dining services may be customized to reflect the community’s common values.

If you can find (or create) an intentional senior community whose goals, values, and approach align with yours, this can be a great solution that is promotes friendships and builds a strong support network. Check out senior cohousing by the Cohousing Association of the US and the Directory of Intentional Communities.

Independent living communities

Independent living communities provide private housing such as apartments, townhomes, or single-family homes, along with shared common areas such as a fitness room, pool, library, hair salon, computer room, and movie theater.  These communities also enable maintenance-free living by offering some level of housekeeping, dining, transportation, and social activities.  While they don’t offer personal or medical care, they often provide wearable pendants or bathroom pull cords so residents can call for help in case of emergency.  They also often partner with a third-party home care agencies that can provide additional services on a scheduled basis.

These communities are intended for seniors who are reasonably healthy, active, and independent, but would benefit from help with select IADLs and from the additional safety and support of having other people nearby.  A potential drawback is the extra monthly cost of these facilities and services, as well as an upfront entrance fee for some communities.

Assisted living facilities (ALFs)

Assisted living facilities or communities provide apartment-style housing, shared common areas, housekeeping, dining, transportation, and social activities.  Where they differ from independent living communities is that they add personal care services, 24×7 on-demand assistance and on-call nurses, and more home modifications to increase accessibility.  Accordingly, assisted living also provides more full-service housekeeping, laundry, dining, and emergency assistance, while streamlining housing, shared facilities, and social activities to accommodate a less active resident.

Assisted living communities are intended for seniors with mobility or health issues that require having someone help them perform ADLs.  Costs increase as the resident needs more personal care, so assisted living can become significantly more expensive than the other senior living options mentioned above.

Residential care homes

Residential care homes offer assisted living care in a smaller private home setting.  They also may be called group homes, personal care homes, board and care homes, adult family homes, or adult foster care homes.  Depending on the home’s floor plan, rooms and bathrooms may be private or shared.  The home also may lack amenities found in large assisted living facilities, such as a fitness center, library, pool, movie room, hair salon, transportation, and so on.  Because the staff-to-resident ratio tends to be higher than in an assisted living community, however, residents at care homes get more personalized care and attention.

These homes are ideal for people who want assisted living, but prefer a more intimate environment, smaller group size, and individualized care, and do not value the amenities found in a large facility.

Respite care facilities

Respite care facilities provide assisted living on a short-term basis.  They enable seniors to benefit from the services and amenities available at standard assisted living communities while recovering from a hospital stay, or while their regular caregivers at home are temporarily unavailable.  Because of the short-term nature of the stay, respite care costs will be higher than if someone were renting monthly at that same assisted living facility.

Memory care facilities

Memory care facilities provide assisted living for people with advanced memory impairment.  The facility may be a standalone community dedicated to memory care, or a designated memory care section within a larger assisted living community.  Each resident typically lives in their own small studio.  Compared to standard assisted living, memory care provides a higher staff-to-resident ratio and more supervision and assistance.  These facilities also have stronger security and safety measures, including controlled access to prevent wandering and walk-outs.  The community also may hold special activities that are designed to help with memory impairment.  Meanwhile, memory care facilities offer fewer of the amenities typically found in assisted living, as they would not be used enough.

These facilities are intended for seniors who have advanced Alzheimer’s or dementia, but do not need ongoing medical care.  Costs will be greater than those of comparable assisted living communities because of the high level of personal care involved.

Skilled nursing facilities (SNFs)

Skilled nursing facilities, also called nursing homes, combine assisted living with round-the-clock medical care and a wide range of therapy services.  Rooms may be private or shared.  Given their focus on medical care, skilled nursing facilities tend to provide fewer lifestyle amenities and activities than assisted living communities do.  Even so, SNFs are more costly than all of the other living options mentioned above.

These facilities are designed for short-term rehab care of people recovering from hospital stays, or for long-term care of people with permanent, complex medical conditions.

Continuing care retirement communities (CCRCs)

Continuing care retirement communities, also called life plan or life care communities, bring together independent living, assisted living, and skilled nursing facilities into a single community.  Usually, the three living options are located in separate buildings, wings, or floors, with separate amenities conveniently located for each one – though residents are free to make use of the entire community.  A few communities mix independent living and assisted living together, so that residents can stay put in their existing units and switch between the two living options without having to move.

CCRCs are ideal for seniors who want to stay in one senior community as they age.  As their care needs change, not only can they avoid dealing with disruptive moves and losing a familiar support network, but they also get priority over new incoming residents on choosing their desired units.  CCRCs also are helpful for couples who have different care needs but want to stay in the same community.  The main drawback of CCRCs is the cost; many – though not all – require a substantial buy-in fee on top of the monthly rent.

Inpatient hospice facilities

Inpatient hospice facilities provide medical care to people who are within their final six months of life.  At these licensed facilities, the medical care focuses on providing comfort, rather than longer life.  When considering these facilities, a key factor is whether the senior would prefer to move into an inpatient hospice facility or to stay in their current residence and bring in home hospice care.

This article, Senior Living Options: Housing, Services, And Care, has been written and published by Senior Wing.

Senior care options

To better meet your own senior living needs, another approach is to supplement your preferred senior housing option with some level of senior care.  This can enable you to stay longer in your current home environment, rather than moving to an unfamiliar community or facility.  Below are six types of senior care, generally ordered from the lowest level of support to the highest level of support.

Village Movement

The Village Movement is a nationwide network of locally managed nonprofit organizations that help seniors age in place.  These organizations coordinate and provide assistance with IADLs such as transportation, grocery shopping, light housekeeping, light home maintenance, and technology usage.  They also offer social and educational events.  Their volunteer model and reasonable annual membership fees make this one of the most affordable solutions.

Home care

Home care refers to the non-medical support and assistance with IADLs and ADLs that is provided at your home.  Also called in-home care, at-home care, or domiciliary care, it can be performed by home care agencies or independent caregivers or even family and friends.

Home care can help a senior to age in place in their own home or in a home sharing situation longer, rather than moving into an independent living or assisted living community.  Because home care providers often require a minimum number of hours per visit, they tend to be a practical solution only if you can group together multiple tasks on a scheduled basis.

Similarly, independent living communities often partner with third-party home care agencies so their residents who need care services can stay put instead of moving into assisted living.  A key advantage of having a dedicated home care agency onsite is that it can afford to provide assistance in 15-minute increments, rather than requiring 4-hour minimums.  If someone needs limited help with ADLs only on a scheduled basis, then getting home care while staying in an independent living community will be more economical.  Once someone needs extensive assistance or on-demand, unscheduled assistance, such as for toileting and transfers, then assisted living will be the more appropriate and economical choice.

Home health care

Home health care refers to medical care or therapy that is prescribed by health professionals and provided at your home.  It can enable a short-term patient to move out of a skilled nursing facility back into their own residence sooner, yet still receive the medical support and rehab services they need to continue their recovery.  This is also a more economical approach, as SNFs are much more costly than other senior living options.

Alternatively, home health care can allow a senior to stay in their current environment instead of moving into a skilled nursing facility or nursing home on a long-term basis.  For example, assisted living facilities cannot accept residents who need them to provide medical care, such as to manage feeding tubes and administer medications.  What an assisted living resident could do, however, is to bring in home health care to handle the medical tasks, as long as they can be planned and scheduled in advance.

Adult day care

Adult day care, also called adult day services or adult day programs, describes senior care that is provided during the day at a facility outside of their home.  The intent is to give caregivers time off to handle other needs.  The offerings can range from social and recreational activities (called adult social day care) to personal care to medical care and therapy (called adult day health care).

Adult day care is valuable when a senior wants to age in place at home with their own caregiver, yet would benefit from interacting with a community of people, while getting the level of care they need.  This can be particularly helpful for seniors who are starting to have some cognitive impairment.

Respite care

Respite care is temporary or short-term care that is provided so that someone’s regular caregiver can take a break.  Rather than a separate type of senior care, it’s a broader term that encompasses temporary home care, home health care, and adult day care, as well as short-term stays at assisted living facilities or skilled nursing facilities.

Home hospice care

Home hospice care is medical care provided at home to people who are estimated to have up to six more months to live.  The focus is on providing quality of life, rather than extending life.  As an alternative to inpatient hospice facilities, home hospice care can be brought in to wherever the patient may be, including independent living and assisted living communities.

How to choose a senior living option

Given all the different types of senior housing and care options, how can you identify the one that’s right for you?  Key factors to consider:

  • Care:  What level of care do you require?  Do you need help with IADLs, ADLs, and/or medical care?  Strike a balance between an environment that provides lots of support and can handle potential future care needs vs. an environment that provides less support but offers amenities that can enrich your life.  For seniors with dementia, moving multiple times can be disruptive, so choosing one place that provides continuity for the future is valuable.  For others, however, consider the adage of “you become your environment” and be mindful of choosing a place that provides excess support that you don’t genuinely need.
  • People: Whom do you want to be surrounded by?  Do you prefer smaller home settings or larger community environments?  How close do you want to be to your family, friends, and medical team?
  • Finances:  What is your budget?  If your desired senior housing option is beyond your budget, consider living in an environment that provides less support, while paying for senior care to help with select tasks.  This approach often can be more economical. 

Once you’ve decided what category of senior housing you want and are considering specific possible residences, go beyond the marketing brochures, photos, and videos.  Be sure to visit and experience what life would be like there. Start looking well before you want to move into a senior community not only because your preferred location may have a waitlist, but also because it becomes more challenging to tour the communities once someone needs personal care or medical care.

  • Housing:  How well do the layout, accessibility features, and amenities meet your needs?
  • Dining:  Don’t just read the weekly menu.  Actually eat a meal there and experience the process.
  • Activities:  Again, don’t just peruse the monthly activity schedule.  Participate in a scheduled activity, or at the very least, observe one.
  • People:  How do residents interact with you, the staff, and each other?  Talk with multiple residents and ask open-ended questions about their experiences there.
  • Trial:  For a place where you could possibly stay for a long time, it’s worth doing a trial stay, even for just one night.  You’ll learn things that aren’t apparent on your one-hour tour.

What if you just can’t decide on a single category of senior living, but keep debating between two types, like independent living supplemented with home care vs. assisted living? In that case:

  1. Evaluate both independent living AND assisted living communities
  2. Identify your preferred community within each category
  3. Then make a decision between your preferred independent living community vs. preferred assisted living community

While it will be more work to visit both types of communities, it may help you work through a sticking point in your decision process. Instead of having to make an abstract decision between two types of senior living, you can make a concrete decision between actual communities that you’ve seen and visited.

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