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Living and Housing Options

Last Updated 5/13/2010 9:52:12 AM

Senior services: Living/housing optionsMoving out of one's home is probably one of the most difficult decisions faced by older adults and their family members. If you are an older family member, you may have lived in your home for many years and have numerous memories of your time there raising your children, hosting family get-togethers or just enjoying the company of your spouse and friends.

Leaving familiar surroundings and people can be overwhelming and scary. Even if you realize that the house is becoming difficult or tiring to maintain or that many of your friends may have moved away, it is still "home." However, sometimes people are quite surprised to learn of the many appealing options available in their own community or in other areas, which may be closer to family members.

If you are a family member, you may be concerned about your parent(s) living alone, becoming isolated or trying to maintain a house that requires constant upkeep. The idea of suggesting that they can't take care of themselves or the house any longer is distasteful, to say the least.

However, when it comes to the overall safety and well-being of an older family member, most families have to have this difficult discussion someday, unless your older family members have made the decision themselves. Discussing possible living options with older family members requires strength, calmness, compassion and understanding. It also requires educating oneself about the options available, financial resources, and the preferences of the older adult(s).

The first step in planning for a move is to assess your or your family member' s needs and preferences. What type of care is needed?

  • Do you/they need assistance with daily activities such as bathing, eating or toileting?
  • Do you/they need assistance with meal preparation, housekeeping, medications, finances or transportation?
  • Do you/they need socialization?
  • Where would you/they like to be located near family members, or near a hospital?

The assessment process can be accomplished through your observation of your older family member's needs and your discussion of what they would like. It is also possible to have a geriatric care manager do an assessment that will include an evaluation of the person's medical and health needs, mental and emotional status, physical functioning, and social needs and preferences. The care manager can then make recommendations about what level of care would be advisable.

Living Options

Older adults with functional limitations can stay in their own home, or move to a smaller one. These are some of the options.

  • In-Home Assistance: Staying in the home is usually possible for those who may need some additional assistance with non-medical care, such as help with cooking, housekeeping or transportation. Some families use homecare agencies or private caregivers to assist family members on a regular basis. There are many licensed and bonded agencies in the community.
  • Home Modification: Making some modifications to an existing home can increase the safety and convenience for older adults. These may include stairway chairlifts, lever style door knobs, or improved lighting. There are also Certified Aging Specialists (CAS) who are contractors trained in evaluating older adult or disabled individual's needs and making home modifications to accommodate them. Universal Design (UD) is another approach to home modification that strives for both aesthetic and functional changes to the existing home. Modifications meeting Universal Design standards, such as wider doorways or walk-in, curbless showers, may be costly, but add value to your home. (See Resources)
  • Naturally Occurring Retirement Communities (NORCs): These communities are the result of the residents' decision to stay in their own homes as they age and are usually neighborhoods where the majority of residents are older. Concierge-type services are offered, along with social activities and events, for an annual membership fee. Avenidas Village in Palo Alto is an example of such a community. El Camino Hospital's eldercare consultants provide consultation services to members when hospitalized.

If the above options do not prove viable, then seniors may consider other alternatives, including moving into an assisted-living facility or a retirement community.

  • Community Care Retirement Communities provide a range of housing options on one campus, from independent units to assisted-living apartments to skilled nursing facilities. Generally, CCRCs require an initial entrance fee and require you to be independent when you first enter.
  • Assisted-Living Facilities have individual apartments that can accomodate a couple or an individual. Services such as dining-room meals, 24-hour security, transportation and social programs are provided. Payment is on a monthly basis and is based on the level of care needed by the resident. Most A-L facilities provide three or more levels of care, with costs increasing accordingly. Some of these facilities have special accommodations for memory-impaired residents.
  • Residential Care Facilities are generally for those who need 24-hour care with non-medical needs, such as personal hygiene, eating, or medication management. These facilities are often in residential settings and provide rooms, often shared, as accommodations. RCFs are licensed and charge for services on a monthly basis.

The next step, for those who need a higher level of care, is to move to a skilled nursing facility (SNF).

  • Skilled nursing facilities or nursing homes or convalescent centers provide 24-hour care under a registered or licensed vocational nurse. Residents may need medical care, such as intravenous feedings or medication injections. Some residents have dementia, and some facilities have a special wing for patients with memory impairments. SNFs also have recreational and social programs for residents. Custodial care, i.e. non-medical care, is not covered by Medicare or other health insurance. Care in a nursing home may be covered by Medi-Cal (Medicaid programs), provided the resident is medically and financially eligible.

Many older adults will consider moving in with a family member. That may be a good option for some, but experts advise families to think carefully before moving an aging adult into an adult child's home. The Family Caregiver Alliance suggests considering several issues, such as future changes in the parent's cognitive or medical status, before deciding whether or not to move the parent to one's home (see Resources).

If an older family member does move in, there are many community resources, such as senior centers, adult day programs, transportation and care management services, that can assist both the older adult and family members to adjust to new roles and expectations. It is important for all family members to be realistic about the expectations and demands of living in one house, including issues related to finances, privacy, and children in the home.

In this day and age, there are many living options for older adults. Often times, the decision is, necessarily, based on what financial resources are available for long term care. Medicare does not cover the costs of long term care so most options are on a private pay basis. If you have long-term care insurance, some of these expenses may be covered. Or, if you are medically and financially eligible, Medi-Cal (Medicaid) may cover long term care in a nursing home. Often, it is worthwhile discussing long term care planning with an elder law attorney. Our eldercare consultants can provide you with legal referrals, both locally and out-of-area.

Our eldercare consultants can help you plan for future housing or care needs. They can provide you with information, resources and referrals for living options, homecare services, facilities, and moving services, both locally and out-of-state. They can also help you evaluate these options in terms of your or your family member' s needs and resources.

To learn more about this service, to speak to an eldercare consultant or to schedule an appointment, call 650-940-7210 or e-mail caregiver.assistance@elcaminohospital.org.

You may visit our eldercare consultants, located in El Camino Hospital, Health Library and Resource Center, First Floor, 2500 Grant Road, Mountain View, CA.


Information on Nursing Homes and Residential Care Facilities in California: California Advocates for Nursing Home Reform (CANHR)

Nursing Homes: Making the Right Choice, National Institute on Aging

Information on Assisted Living Facilities and Programs, Consumer Consortium on Assisted Living

Long-term Care Resources and Information, Medicare